Health Improvement Project Zanzibar (HIPZ) is a UK-registered charity managing two hospitals in Zanzibar and providing healthcare to 250,000 people. Here a recent volunteer pediatrician describes her typical day.
We drive to the hospital in trepidation of the day ahead. It doesn’t matter whether you’ve been here one day or one year, you never know what to expect. We pass through rural villages, cassava farms, schools and an overwhelming predominance of children … it’s no wonder given the high birth rate and an average life expectancy here of only 47 years. Harrowingly, 1 in 7 children under 7 years old die here.
We arrive at 7:30 a.m. to join the daily morning meeting which sees all medical staff coming together to discuss current patients and organisational issues at the hospital.
From 8 a.m. I can be found either in the sweltering postnatal ward supervising neonatal checks or reviewing sick neonates with the local midwives, or conducting a new paediatric outpatient clinic which I have recently set up with the local staff. Emergencies are prioritized, and it is not uncommon to be resuscitating a critically acute unwell child at any time of the day with limited resources—fluids, a few antibiotics, basic lab tests, and oxygen (although sadly not consistently available). Local medical officers who have had little training and inadequate supervision are often afraid of treating children, and my role has been to encourage and supervise them.
By 9 a.m. our ward round begins. Turnover is usually rapid, with pneumonia and acute diarrhoea being the most common presentations. However mothers are often keen to leave and it’s difficult justifying keeping children when there are eight dependent children at home and a farm to run. This is especially challenging in acute malnutrition, where admission is typically two weeks. I hope that our new clinic will help by managing cases closely in an outpatient setting and also providing a great opportunity for health and nutritional education.
For serious cases, at times there is no way to get the child the care they need. That’s because there is no intensive care or ventilation on the whole island; but also because families cannot afford investigations or treatment. Heartbreakingly demise is almost inevitable. Other times small miracles really do happen, when an acutely wasted child barely conscious on admission goes home on the shoulders of a proud mother.
Many things taken for granted back home like good nursing care and a reliable drug supply directly affect a child’s prognosis. Staff motivation is low at times leading to patients directly suffering. I find myself involved in the intricacies of hospital management, including workforce planning, drug and equipment procurement, and infrastructure development.
Afternoons are spent reviewing seriously unwell patients, troubleshooting any managerial issues, or providing casebased scenario teaching for staff such as neonatal resuscitation with ‘Natalie’, my trusty simulation doll. Our drive home varies from jubilation to silent reflection, as we celebrate or commiserate on events of the day. Tackling the health challenges of Zanzibar is clearly beyond the scope of any individual, but it is clear that global health programmes like HIPZ have already paved the way for sustainable improvements in healthcare.
Pemma and Nick Spencer Chapman’s son Michael and his partner Caitlin (HIPZ trustees and former volunteers) are currently fundraising for HIPZ by cycling around the whole island. You can sponsor them at: https://www.justgiving.com/fundraising/Caitlin-Farrow
http://www.hipz.org.uk/donate or SEND HIPZ A CHEQUE
You don’t have to donate online – we are also happy to receive cheques. If you send a cheque, please make it payable to HIPZ UK (this stands for Health Improvement Project Zanzibar and is the registered name of the charity) and send it to the address below.
If you are a UK taxpayer, please download a gift aid form (or ask Pemma or Nick for a copy) and send this to us with your cheque. For every £1 you donate we can reclaim tax to increase your donation by 25p.
54 Westward Road
Gloucestershire GL5 4JA, UK