Tuesday, 27 March 2012

On economics and education

I think we are all feeling the need for a break and I am glad to say that tomorrow we are driving to the coast to Fish Eagle Point, which I hope is a beautiful beach lodge, for Aaron's birthday and some much needed R&R!

We have been ill again with weird Tanzanian bugs and i had horrible pus on my tonsils so am on antibiotics.  I am also feeling a bit jaded at work so am including my latest BMJ posting for you to read.

I promise I will post some cheerier fare whilst we are away...


On education and economics

There are many differences between health care and medical education in Tanzania and in the UK, but the concept I find hardest to understand is “attendance or sitting allowance”.  This allowance is paid to all staff that attends courses for their health care education and it seems that staff will not attend educational events unless they are paid their attendance allowance.   The allowance can be a significant sum and the educational facility providing the training event is expected to cover the cost.
Apparently this practice originated many years ago when the WHO began running educational events and courses about HIV/AIDS and now seems to be ingrained.   I am used to a society where we seek and pay for medical education and now with the reduction of study budgets it is common practice to self-fund attendance at courses and meetings.

Now I understand that western salaries are much greater than salaries paid in Tanzania but mixing economics with education seems to be detrimental to the will to learn.  Perhaps a different form of attendance bonus allowance based on an 80% attendance in the workplace per year would be more successful, although I am not sure how it would be policed or funded.

The Tanzanian government is struggling to meet the doctors and nurses strike agreed 100% pay increases and this is due in part to the fact that within a population of 45 million there are only an estimated 800,000 tax payers.  There was another mini-strike of 2 days recently and we are awaiting a re-shuffling of the cabinet.  I don’t think there will be many willing volunteers stepping forward for the job of Health Minister!

Currently we have 4 Spanish surgeons who come each year to the RDTC, at their expense, for a 10 day period, to operate on our patients and train the dermatology residents in surgery and dermatopathology.  Last Monday was amazing as there were over 100 Albino and Xeroderma Pigmentosa patients in the department being screened for surgery.  All the patient expenses are paid for by a Spanish organization, as well as attendance allowance for the local staff, and some patients had traveled for 2 days across Tanzania thinking they had skin cancer to be told they had tinea capitis (a fungal infection of the scalp)! 

Xeroderma pigmentosa is a dreadful autosomal recessive disease where there is a defect in the gene responsible for repairing DNA following photodamage. Photo-damage begins in early childhood and is characterised by cutaneous and ocular changes such as freckles, photophobia, corneal keratitis and ulceration.  In Africa if strict photo-protection is not adhered to then malignant tumours such as squamous cell carcinomas, basal cell carcinomas, keratoacanthomas and malignant melanomas develop in children as young as 3 and 4; death from metastatic disease occurs from the teenage years.  

Peter and Mafalda trying to sort out paying out the expenses to the patients

queing up for the expenses with Peter trying to keep order!

It is very difficult to arrange for children to be operated on under general anaesthetic due to no dedicated paediatric theatre space.  It is the first place I have worked where adults are prioritized over children but perhaps this is due to economics as well.  As in many places there seems to be a two tiered system with those who can pay being fast-tracked to theatre and those who can’t waiting weeks and sometimes months.  We have watched a 4 year old girl’s scalp tumours multiply five fold whilst she has been an inpatient for 6 weeks.  I have found this the hardest part of my job watching but not being able to get her to theatre as inevitably there is an adult emergency and she is bumped off the list.  This week however she has been operated on thank goodness.  Dermatology are currently building their own wards and theatres so if dedicated anaesthetic time can be arranged, and this is a big if, we will be at last be able to operate on our patients.


  1. What an incredible couple of weeks! what has been the most taxing part of work recently?

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