Nancy Hagood Reflection – Rounding in the NICU at a Tanzanian Hospital 

Nancy Hagood is an internal medicine/pediatrics resident at MUSC. Nancy was awarded a Center for Global Health Student & Trainee Travel Grant in the summer of 2022 to pursue a project with the Selian Lutheran Hospital in Arusha, Tanzania. To view more pictures of Nancy’s time in Tanzania, please visit this Flickr gallery.

Thanks to the support of the MUSC Center for Global Health, and a long-standing partnership between with the Arusha Lutheran Medical Centre, I had the opportunity to spend a month working alongside physicians at Selian Lutheran Hospital in Arusha, Tanzania, in the fall of 2022.

As a Med-Peds resident at MUSC, I have been able to participate in the global health track, a longitudinal track throughout residency that begins in intern year and involves several global health experiences, including an opportunity to travel internationally for a month as an upper-level resident. MUSC has several international partnerships, and I chose to travel to Selian, a rural hospital located 10 kilometers north of Arusha that serves a catchment area of more than one million people, including many members of the Maasai and Waarusha tribes.

Each day at the hospital began with an early morning chapel service for all hospital staff. The service was entirely in Swahili, which meant I understood very little, but the spirit of the hospital staff was palpable. At the front of the chapel was a simple painting of a loaf of bread and a fish, a reference to the miracle of the multiplication of the loaves and fish to feed the five thousand. During my time at Selian, I observed that this was a very appropriate symbol for their work. Selian is a place that is low-tech and high impact. It is a place where resources are few and work is difficult, but the hope and healing provided there is known all over town.

Once chapel ended, we quickly transitioned to morning report, where interns presented patient cases, and had their overnight decision making publicly critiqued. Then we headed to the patient wards. Each day, I rounded with the interns and consultants (term for attending physician in Tanzania) in the NICU and the pediatric wards. I occasionally had the opportunity to teach them, and more frequently, they had the opportunity to teach me. Many of the common diagnoses were similar as in the U.S.: bronchiolitis, gastroenteritis, asthma, neonatal sepsis, birth asphyxia, prematurity, and sickle cell. But, each of these diseases was complicated by severe malnutrition, co-infection with worms, inability to draw blood cultures or frequent labs, lack of access to standard medications or diagnostic imaging, or perhaps most importantly, tribal cultural norms that influenced decision making and care every step of the way.

There were many similarities between medicine in Tanzania and the U.S. – the hospital structure, the education system, rounds, disciplined clinical reasoning, the camaraderie of the hospital, and the relationship with patients. There were also many differences – more uncertainty, more reliance on history and physical exam alone, more losses, and more wins. In Tanzania, the infant mortality rate is 34 per 1,000 live births, compared to 5 per 1,000 live births in the U.S. Selian is working to change that statistic. At Selian, 90% of preterm infants survive, including a recent 25-week preterm infant. There are high-highs and low-lows in Tanzania, and I cannot imagine a better team to learn from than the physicians and nurses at Selian. Their example will forever inspire me to do more and believe more for patients and communities.