27 years in the ER
"It was an INCREDIBLE honour to meet you guys in person and participate in your project of bringing the personal 'coal face' of disease and health care to people. You have forged a growing community of listeners who will be far more informed than previous generations and can hold people like me and health system managers accountable for delivering caring, fair, high quality medical services while recognizing its limitations and the influences of many other determinants of real health.
You guys R-O-C-K!!! Thank you."
- John Ross MD FRCPC
NO John Ross, you Rock. The work you do is invaluable and we can't thank you enough for being game for taking an evening out of your busy schedule to sit down and have a curious, silly, enlightening and intelligent conversation with a few goofy boobs like us. This is by far one of our favourite episodes and it's all thanks to you.
HUGE shout out to Shobac Cottages and the MacKay-Lyons family for inviting us out to perform this intimate live house performance and for treating us to an incredible night of food and epic party time afterwards!
Hope ya'll enjoy the episode and be sure to read John's wonderfully written blog post below.
A Christmas in Dar es Salaam Tanzania
Waleed smiles broadly when he sees me. We met for the first time two weeks ago. As I push my bicycle in his direction, he knows I am bringing more business his way. He arrived at his usual spot a few hours earlier, a dusty corner at a busy intersection not far from the hospital compound where I am staying. He says “pole rafiki (sorry friend)” and “karibu (welcome) as he notes the flat front tire. In a few minutes he has the inner tube out, has found the hole using a dirty bucket of water, sanded the area, applied glue, cut a patch from an old inner tube, checked the rest of the rubber, tested the valve, reinserted the tube and pumped up the wheel while I ‘chat’ in very limited Swahili to his friends and other customers needing tire repairs. He is skilled, efficient, and pleasant. He does this every day, all day. All for 1000 Tanzanina Shillings, or CAN$0.65 per repair. I offer him TSH2000 and he is grateful. With a thumbs up and “asante sana (thank you very much)” I check for a break in the traffic of speeding grossly overloaded mini-buses, cars, trucks, motorcycles, people, and launch my ‘Liberator’, keeping as tightly to the side of the road as I dare, while avoiding grateless sewer openings, missing pavement, and quicksand-like dust. This is the first year, since I started coming here in 2011, that I have had a bicycle while here for a month or two of teaching at the Emergency Department of the National Hospital in Dar es Salaam, Tanzania, East Africa – this time for two months. It has greatly increased by range, while the riding breeze manages my body’s response to the 35C temperature and near 100% humidity.
This is not a pretty city. It is in fact a chaos of garbage, traffic, derelict structures, broken concrete, new construction, people, commerce, and transportation. Some roads are quite good, many look like no mans land between the trenches in WW1. As I ride along, wearing I think the only bicycle helmet in the country, trying to avoid hazards, looking frequently in the mirror I duct taped to the right handle bar, I try to take it all in. On the median of one of the main roads, numerous young men, a few older ones, usually with no legs from I assume past motorbike crashes, which we see numerous times each day in the Emergency Department, are trying to sell DVD copies, ultra-cheap clothing, or simply begging. There are no government social support systems here – you take care of yourself, or you hope your family can help. These people literally drag themselves, sometimes using hand-powered tricycles, to the roadside every day, despite the brutal sun, heat, dust, and exhaust. Other young men walk through crowds of people, trying to sell single cigarettes or spoonfuls of peanuts for a few hundred Shillings each. On average, with some luck, they make $1-3 a day. As a white foreigner, I am regarded by those who live in poverty as unimaginably rich. I guess I am. And yet it is rare to be asked for money. When eye contact is made, there is always a big smile, a “karibu” and if close enough, a handshake. Most will test me with a series of standard Swahili greetings – all in rapid fire. If I pass, using the right responses and greetings, there will be more smiles and handshakes. Otherwise, a short lesson is offered so I won’t screw up the next time. They are welcoming, friendly, and generous despite living with severely limited resources. I feel surprisingly safe.
The Emergency Department, in this city of over three million people, and serving the national hospital for the country of 45M, did not exist until late 2010. Emergency care, provided by trained personnel, is still largely unknown in all of Africa except for a few countries. This is the first in East Africa – a program training doctors and nurses to manage the huge number of emergencies that occur every day. When I walk through Triage some days it is choked with people – mothers holding babies, people with dripping wounds or blood soaked bandages, many sent from clinics or other hospitals. People line the hallways for many hours, or are rushed into one of the four resuscitation rooms. Each room, with only one monitor, may have five or more patients crammed into them. Ambulances arrive constantly, but they are really old four-wheel drive trucks. When transferring patients from outlying district hospitals, they will only leave when the truck is full. That may mean two people from a car crash, lying on the floor, 1 with a stroke, 2 pregnant women in labour, three mothers with fevered children, two of whom are unconscious. The driver, with no medical knowledge, and a nurse, with limited skills, sit in the front while the patients fend for themselves in the back. There are no paramedics, no ‘pre-hospital’ or out-of-hospital care. But, if they survive long enough to get to the Emergency Department, they have a chance now whereas three and a half years ago they did not.
I am sitting under the sterile florescent lighting in the house near the hospital, ceiling fan trying to move the hot, humid air around while sweat trickles down my neck and back. Outside, the plaintiff prayer call of the Muslim Imam, from the mosque 200m away sounds strangely complementary to the melodious harmonies of the Christian choir, practicing I assume, for the upcoming Christmas service in the church next to the mosque. I cannot conjure up the Christmas spirit that gradually builds each year from the short days, cold air, cards, greetings, and parties back home. But there is a spirit nonetheless. I struggle each time I come here, leaving the protective bubble wrap of life in Canada, working with people who other than birth location, are the same as us. And yet we have so much, and they make due with so little. Life in Halifax, Nova Scotia, or Canada, is far from perfect. But slow down sometime this holiday season and consider the incredible gifts that make up our version of normal, and think about other members of our species who live outside our protective bubble who make the most of the limited resources they have. Have a Merry Christmas and New Year.