If you have grown up under the realities of western medicine, you likely have general grievances about the financial cost of care, the inconvenience of scheduling and attending appointments, and the long wait times at the emergency room or to see a specialist. As a medical student and an occasional patient, the majority of my experiences have been in this philosophy of health care where everyone is entitled to quality care regardless of financial means. Even the underserved populations, like the unhoused, can still go to the emergency room and get the same standard of care as the next, more financially comfortable patient.

I was not prepared for the realities faced by the patients and health care providers in undeveloped nations upon visiting Tanzania. What started as a mission to provide vital supplies and observe care in a rural town in the Katavi region of Tanzania has since fueled me to share the experiences of the people who live there with my medical student peers and others who may have an interest in global medicine.

The hospital consisted of long, rugged outdoor hallways interspersed with a placard above the door indicating the name of the ward. The intake area was an outdoor desk with benches arranged near it as well as a cashier. Small adjunct buildings such as a pharmacy, a lab, an eye clinic, a cafeteria and an administrative building were scattered about the property. The wards were a continuous room with metal frame, twin-sized beds arranged in a row along the opposite sides of the room, with a blue mesh mosquito net hanging above them. There were no bedside monitors, air conditioning units, televisions, buttons on the wall, or curtains. Beside each bed a small bedside table with a single drawer, or a small crib in the maternity ward. At the back of each ward there was a bathroom usually consisting of a stall with a toilet, a stall with a squat toilet, a sink without soap, and a shower. A small room at the front of the ward typically contained a desk, a cabinet, a tin of gauze, a stack of white sheets, and a bin with the patient files belonging to those on the ward. Patients sit in the ward and do not read or watch TV; they talk to each other or lay there observing. Patients do not cuss out the nurses or doctors, they rarely scream or cry, they fight and they endure. The treatment of patients on the wards was similar but differed depending on fullness, age of the patients, and resources available.

While rounding on the male surgical ward, we came to find a patient on a bed lying underneath a metal cage with a sheet draped over him. We asked the nurse who the patient was and what had happened to him, and she told us that he was burned and left at the hospital. We found it curious that she seemed unbothered with his condition and he was not on any IV medications or fluids. We lifted back the sheet to reveal a thin, lanky man lying on his stomach with his head turned to the side and with his eyes and mouth nearly swollen shut with contusions. His lack of shirt revealed his extensive back, arm, and abdominal burns. He was wearing faded black skinny jeans and a belt, so his legs were not exposed but he had burns on the soles of his feet. Tears slowly leaked out of his eyes as he winced in pain. We spoke to him in a mix of broken Swahili and English and tried to get a patient history and background. The nurse told us that he was not hooked up to IV fluids or receiving any medication because he had no money and no family had come to provide the supplies to him. We took over his care, ensuring he had antibiotics, IV fluids, pain medication, and dressing changes daily. He had his wounds debrided by a nurse with no pain management and we found him crying in his bed in the ward. We did an escharotomy under ketamine and continued to manage his pain with tramadol and NSAIDs.

There is no central stock room where nurses or physicians can go to get any supplies they may need off the shelves. This includes but is not limited to IV lines, needles, gauze, tape, scissors, band aids, wipes, gloves, ointments, or medications. We quickly learned that any supplies we may need to assist with patient care had to be purchased by us at the pharmacy and carried in backpacks to be used as needed. If we were mid-dressing change on our burn patient and ran out of silver sulfadiazine, gauze, or gloves, one of us would have to walk to the pharmacy to purchase it with our own money. We bought bottled water and food and brought it to this patient since no family had come. As he was healing and able to speak more, he revealed to us that he and his wife had just moved to the town, and he had gone to the market and was accused of stealing and some men in the market had beat him and burned him with an iron. His wife had an emergency C-section to deliver their first son just prior and could not come to bring him anything and they had no family in the area. Two weeks into treating him, his wife returned to the hospital maternity ward with a post-op infection, she came with their son, but he was not allowed into this ward. His sister had come to help care for them, but the majority of her time was spent with the baby, and she had no financial means to help him other than bringing bits of food and water for him. He had yet to meet his son and when we got to see him hold him in his arms for the first time, tears glistened our entire team’s eyes. This man suffered unimaginable pain both physically and psychologically, he saw the ugliest sides of people and said he had lost all hope of meeting his son and was sure he was going to die, but we restored that hope in him and he was so grateful that we would go out of our way like that for him. His story had a happy ending and his wife, his baby, and he were discharged together and put on a bus to be reunited with their families. He was not an isolated incident where he had no family or money and thus received no care and was left to die. A bizarre and foreign concept to us that people are just left until they can provide the financial means for their care as we generally have a pay after approach in western medicine.

The female maternity ward was a large ward in which the beds were almost always full. The cribs always sat unoccupied by babies and instead by a bag, blankets, or other personal effects. The nurses’ station was in the center of this ward, and the most recently post-operative patient was placed in the bed across from the desk. A round plastic container was under each bed to be used as a bed pan or for soiled blankets which each family was responsible for. Off to the side of this ward there was a small dimly lit hallway with a desk at the end, a baby warmer against the wall, and three small doors. Behind each door was a primitive exam table pushed up against the wall with a step stool, a metal IV pole, a trash bin, and a small metal table. These rooms were for the women actively in labor and pushing. On the wall next to a sink were hooks with white rubber aprons and rubber boots. A woman would deliver her baby and then provide a blanket to wrap it in, and it would be whisked away to be weighed and set in the baby warmer. The baby was not tagged with any identifying bracelet, there was no newborn screening done, no baby hat given. The mother would just lay on the bed for one hour to ensure there were no complications. Only female visitors were permitted to enter and come sit with her. No pain relief was provided, only a shot of Pitocin to prevent hemorrhage and a single 250 mL IV bag.

Undergoing a C-section was much the same except you were taken to the operating theatre in a rickety wheelchair and sat by the door, often in obstructed labor until the surgeon was ready. In the operating theatre, there was a surgical table, an overhead lamp, a monitor for vitals, a broken looking anesthesia machine, two large fans, a newborn bassinet and a table for surgical instruments and gowns. No outdoor shoes were permitted in the OR and instead the rubber boots or Crocs littered around the doors were worn. Patients undergoing surgery received IV antibiotics and usually spinal anesthesia but were never intubated and generally came to as the surgeon was suturing the wound from the outside. They were given a shot of tramadol to help with pain and then taken back to the respective surgical ward. The baby that had been delivered was taken by a nurse shortly after delivery and would be waiting for the arrival of their mom in the baby warmer. If patients did not purchase all necessary supplies, including a cord clamp, things were improvised. The surgeon would snap off the cuff of his glove and tie the cord with that prior to cutting it. Blood pressure checks for the mom only happened every few hours and she generally did not receive IV fluids or extensive enough monitoring, and thus postpartum shock is a common occurrence. Mothers who had miscarriages or stillbirths were placed in the same ward as those cradling their healthy newborns’ heartbreak side by side with joy, separated by nothing more than the space of a bed.

The pediatric ward was the one we spent the most time in, and compared to the others, had more things in it such as an oxygen machine to supply the two most proximal beds. A parent generally sat in bed with their child next to them, or in their arms if they were infants. The majority of patients were there for severe malaria-induced anemia, burns, upper respiratory infections, diarrheal diseases, malnutrition, and sickle cell crisis. The physicians do not have stethoscopes, they do not do vitals other than pulse oximetry and temperature, they only order basic labs, they rarely order a chest X-ray or ultrasound because patients cannot afford it (under three USD), and they pretty much only treat the patients they know they can save. They seem to have this general knowledge of a lost cause when they see one and often families have lost children previously. There is a nutritionist who visits the ward, but she does not have baby formula other supplemental things to give out, she advises parents on making a porridge with sugar and oil in it. There are no spare diapers, no spare blankets, no spare dressing supplies, no water or food, no medications, no ventilators. I found myself often using my own water with the hydroxyurea we purchased in a borrowed cup to be able to dose our sickle cell patients. There were no pre-filled saline syringes for IV-line flushes, and we were responsible for buying our own syringes, filling them, and carrying them around with us.

As with every hospital, patients die. Physicians make peace with this fact of life knowing they did everything in their power to help their patients or make them comfortable. It is easy to judge the doctors in developing countries and say they do not care about their patients, or they are uneducated but it is truly comparing apples to oranges. It is unfair for us to make these assumptions based off of three weeks of observation. It is important to remember global medicine trips should be about helping, educating, and friendship. The systemic injustices were not solved by us nor is it our place.

Before going on the trip, my objective was to learn and practice medicine but ultimately it was to connect with people. I held babies, I held hands, I wiped tears, I hugged people, I blew bubbles, I made kids smile, and old men happy with Vaseline for their chapped lips and dry skin. I welcomed new babies with a “”Happy Birthday” and laughed and cried with patients. Healing physically and emotionally for patients truly begins by simple acts of showing care to each other as humans and making people feel less alone. All these things are what make global medicine a truly unique and privileged experience for health care providers.

Giana Nicole Davlantes is a medical student.