progress at work.....

The last few days have been fantastically productive and my head aches a little from all the brainstorming Grace and I have been doing! (We even have an ‘action plan’ wall in the house – it’s very blue peter - I know- we are sad!!)

We have now met all the palliative care team members at both the Kolandoto and Shinyanga sites – a mix of doctors, clinical officers, nurses, pastors, pharmacist and home based care volunteers. How it works here is so different. In fact the void between the UK and here is vast – in terms of structure of service, resources, time management …… everything.

I am slowly getting used to ‘African Time’ – nothing moves quickly here and there are a million formalities that need to be observed to complete even the simplest of task! Saying hello to someone can take 5 minute due to the number of greetings you must share! (longer if your Swahili is as stilted as mine!) Setting a meeting time appears to be a pointless exercise as guaranteed only us mzungus will stick to the observed pre agreed time!!

That said our big meeting on Friday went exceedingly well and we were welcomed once again with open arms and anticipation. From this we have some clearer ideas of the objectives for our time here which will focus predominantly on formal teaching sessions and mentoring via joint visits in the community and work on the ward at Kolandoto. Ensuring morphine is accessible and used with confidence is paramount before we leave. We have also identified that referral pathways into the palliative care team and record keeping needs to be developed and strengthened.

Excitingly we met the chief medical officer at the regional government hospital in Shinyanga and managed to secure his agreement for a regular weekly teaching programme. This is amazing as currently there are no links between the palliative care programme and the government hospital. The provision of palliative care there is poor and they currently do not use oral morphine.  A real opportunity for us here.

So

Whilst there is evidence of some really good work being done there are some gaping holes – some of which Grace and I can try and fill and some that Grace and I dare not even peer over the edge i.e. poverty and peoples need for food supersedes their need for medicines and palliative care in many instances. Clearly this is an issue for the Tanzanian Government to consider but it is a huge problem. I figure we can only do what we can do – and as a wise person often reminds me ‘how do you eat and elephant?’

In bite sized chunks obviously….