Maternity unit at Mnazi Moja Referral Hospital (MMH), Zanzibar, Tanzania
Ragnhild Skagseth, Norway
Where and when have you been working abroad?
Where: Maternity unit at Mnazi Moja Referral Hospital (MMH), Zanzibar, Tanzania.
When: From September -16 until May -17.
Maternity at MMH is a big unit with as many as 12.000 – 14.000 deliveries annually. The number of staff is low. There where 4 consultants, 17 registrars and 16 nurses in gynaecology and maternity department in May 2017. The numbers of interns are shifting from time to time, but in general between 4-5.
How much experience did you have before going? Was that enough?
A bit more than 3 years of obstetrics and gynaecology (most obstetrics), and almost 2 years of internal medicine. Feels like I had enough obstetric training from home, more experience than all the registrars I worked with had. But I wish I had more surgical skills, due to the amount of post partum hysterectomies done during my time at Mnazi Moja.
What kind of work have you been doing?
The primary task is to be a part of the daily duties in the ward, cooperate with local doctors and midwifes, and to share knowledge. I have been trying to improve and train the staff on obstetric skills at both delivery ward and in the theatre. The goal has been to improve the level of care for the patients.
Because of the low number of midwifes at the ward, work has been including a lot of midwife tasks like checking blood pressure, monitoring fetal heart rate, administrate medications, collect blood for analysis, monitoring progress of labour, giving care and support, and deliver babies of healthy mothers. Furthermore, I have often been conducting twin- and breech deliveries all alone because there is no staff available. Also, there is daily life saving resuscitation and surgery to patients with poor progress of labour, antepartum- and postpartum haemorrhage. There are daily several patients with severe preeclampsia and eclampsia that needs lifesaving stabilisation and help to be delivered.
I have been trying to teach the local doctors ultrasound skills, but because of a busy ward that work have not been prioritized. I have done most of the teaching at the ward, where I have reminded the staff numerous times to take proper history and examination, and to act on that information regarding the treatment to the patient. The staff also had to be constantly reminded on the importance of proper documentation and patient hand over. I also feel it has been important to be a role model when it comes to showing commitment to patients, to give them comfort and care, as this is something that is easily neglected in a busy ward.
How did you find out about this possibility? Did you have a contact person who will be willing to organize a stay for another trainee (or at least give some information) and whose name you can pass on?
I heard about the possibility to work at MMH trough my work at Haukeland University Hospital (HUS), where a consultant doctor from my department planned on working at MMH for 4 months. The department for international collaborations had some extra money on their budget and wanted a registrar to come along for 6 months. I also got the possibility to prolong my stay for 3 more months. Also a consultant in obstetrics and gynaecology from Lillehammer hospital came to work at MMH from January to April.
Alexander Vietheer, consultant in obstetrics and gynaecology, that worked together with me during the first 4 months at Mnazi Moja is now in charge of the collaboration between maternity at MMH and maternity at HUS. He is to be contacted at e-mail: dr.alexander.vietheer@mailbox.org
AIS (senter for internasjonalt samarbeid/ department of international collaborations at HUS) can also assist with help concerning practical issues for those who are interested to work for a period at maternity MMH.
How did you finance your stay?
I got my normal ground salary since I work at HUS (without on call salary). AIS also covered rental cost for my apartment at Zanzibar, insurance, vaccinations, and flight tickets.
Your e-mail-address in order to answer questions from interested trainees:
ragnhild.skagseth@gmail.com
