Barking up the wrong tree?

A new contender for outrageous bodaboda load award.

The Hospital Superintendent was very cross!

Today I went to Tanga to meet with the Regional Medical Officer. This meeting had been arranged at my request by the Hospital Superintendent. The RMO is the most senior doctor in charge of a Region and is quite high up in the hierarchy of Healthcare politics. I was keen to see if there might be any avenues to make the organisation of future trips easier and was also wondering if this meeting might be a bridge to meeting other more senior Tanzanian Healthcare policy makers (the Minister for Health?!).

I was asked to explain what I have been up to since being here and also why I wanted to meet with the RMO. I dutifully gave an account of our work, focussing mainly on the Mesh Hernia series as I feel this seems a tangible project to base future requests around. I then went on to explain the barriers we had faced in coming out and how I felt that these are a significant issue for future collaboration (it makes it very hard).

My hope was that the RMO would be enthusiastic about our work, see the potential for expansion of the mesh project (as well as others) and would be highly supportive of future collaboration. Naïve perhaps. All cards were kept very close to the chest.

Quite reasonably perhaps, the RMO wanted to know more details about our work and of course has suggested that this be shared in the form of a written report. A googly that I had not expected was that there would be an expectation that the work should be ‘validated’ by Tanzanian Surgeons. Unfortunately (although predictably if the thought had ever occurred to me), the two ‘surgeons’ I am working with are AMOs (not medical doctors and not trained specialists). On the one hand this could be viewed as a big gold star for the viability of future expansion of our approach, on the other it turns out they do not hold the necessary kudos to endorse such things. Furthermore, the concerns that I raised regarding the procedures and costs associated with our presence here were met with knowing smiles and described as the necessary procedures to arrange such visits.

I perhaps slipped with etiquette and may have proffered a ‘faux pas’ when I allowed some of my irritation to bubble to the surface. When discussing the costs, the suggestion was that initially these should all be met by the hospital who makes the invitation for overseas assistance. Until such a time as there was a strong enough argument, backed by evidence, to justify starting the processes required to acquire exemption from such fees (a lengthy process). When I challenged this notion with the statement that the hospitals cannot afford such costs (as well as the fact that the costs were high for people to work for free), the response was that if the hospital required such arrangements to care for the patients then the patients should pay for such a privilege. That is after all the model that the Tanzanian healthcare system is based upon. I was perhaps a little too blunt in asking what the point was of taking money from those with little and putting it into the generic government’s accounts for such a purpose. I also highlighted the World Health Organisations agenda in Global Surgery to reduce the burden on those requiring costly intervention (too many people in low- and middle-income countries are crippled by the costs of surgery – they often have to sell animals, farms and possessions to pay for what they need, leaving them destitute). In retrospect, this may not have been the best time to raise such a point.

I am told by the Hospital Superintendent that the meeting went well. There were certainly times when the finer points we were both making did not translate brilliantly into the others ‘language’ leading to some miscommunication perhaps, but at the end of the conversation the RMO was happy to learn more and support the work if the reports were suitable. We certainly left with smiles and friendly farewells. I must confess that my take on things was less enthusiastic. I left feeling significantly deflated. It was certainly not the pat on the back and ‘let us know what we can do to help’ response that it perhaps could have been.

This experience completely validates all the concerns and frustrations I have heard vocalised by many of the volunteers / NGOs / charities we have met working here. The procedural climate in Tanzania has become significantly more challenging in recent years, and in some experiences prohibitive, leading to the collapse of organisations and exit of individuals. From my perspective specifically regarding healthcare workers, it is such a shame that it seems so hard for people to come. People who will willingly work for ‘free’, are happy to share their experience (currently absent within the country) and gladly support the development of expertise within the country for the future. But perhaps that statement is being overly simple. Or perhaps the simplicity is what makes it so powerful. Hmm.

So it seems any quick wins for the future that I was hoping might emerge from these tactical meetings whilst I am still here, may not be so easy to come by. They also seem to create more work for me. However, I am sure that there is certainly merit in making these contacts. A faceless name on a piece of paper is far less compelling than a name of someone you have physically met in the past….. I hope.