Recording Moshi, Tanzania

22 05 2010

Hello everyone! My name is Austin Mattox and I am working alongside Wendy Lin and Tammy Chin at Mwika Uuwo Medical Clinic outside of Moshi, Tanzania this summer. I am a rising Senior at Duke pursuing a double major in Chemistry and Biology and the Global Health Certificate.

Wendy, Tammy, and I will be spending two months working, shadowing, and doing some basic research as Mwika Uuwo Medical Clinic located about an hour outside of Moshi, Tanzania. Tanzania is a thriving country (it’s the site of Mt. Kilimanjaro, Serengeti National Park, and mny other treasures) that is making huge strides in the practice of medicine. Tanzania is located in East Africa, bordering a great number of countries including Kenya and Uganda and the Indian Ocean on its Easternmost part. Duke has been very fortunate to work with Kilimanjaro Christian Medical Centre, located in Moshi, for many years on global health related topics including HIV/AIDS and malaria. As such, Duke has had the opportunity to meet many wonderful people and build strong friendships in the Kilimanjaro region. Wendy, Tammy, and I feel very blessed to become part of the Duke/KCMC/Mwika Uuwo community and are incredibly excited about working with everyone this summer.

This summer, we are planning to work with the staff at Mwika to understand and research their approach to medical record keeping. In the United States and other more wealthy nations, medical recording is highly standardized, regimented, and streamlines. Less wealthy nations (please allow me to go off into a bit of a tangent here: I am strongly opposed to most terms used to characterize countries, such as the distinction between “developed” and “developing” countries. I am of the belief that no country is ever “developed.” Being “developed” would imply no further change is occurring or necessary. Certainly that is not the case for the United States or any other country I can think of. I am also opposed to the “world” distinctions such as first, second, and third world countries. Honestly, I don’t know how you classify a country as “first, second, or third world.” These terms also have a stigmatizing air attached to them and thus I avoid using the “developed/developing” and the “first, second, third world” distinctions. I am choosing the more wealthy nation/less wealthy nation distinction when necessary because I feel this distinction is a descriptor for a measurable item) may not have the necessary finances to fund and run large-scale medical recording systems seen in the electronic records of the VA medical center or the regimented, standardized files at Duke. Continuity of medical care at some medical places in less wealthy nations may be reduced due to lack of standardization in the medical records even within the same clinic. If new recording systems can be implemented that increase continuity of care, patient treatment outcomes will hopefully improve as a result. Thus, the health of a population in the region could be improved with small changes in the recording of medical information.

We are working with Mwika Uuwo this summer to understand their system to medical recording and draft a new version of the patient medical chart based on questionnaires and interviews with staff members. We also plan to provide questionnaires to patients to understand their concerns about how their information is being recorded and saved. Most “non-Western” countries also integrate a holistic approach to medicine that is not often seen in the United States. These approaches could include religious, cultural, and spiritual practices that are used in conjunction with traditional medicine in the healing process. While a bit more informal than the research with the medical recording system, I am interested to understand how medicine is generally practiced in other parts of the world. Other topics we are focusing on include the stigmatization of obstetric fistula within the local community and general prevalence of malaria and HIV/AIDS. Our goal is to make a sustainable impact working WITH the community (another tangent, if you will: there is a huge difference between working with and working for the community. Working for the community usually takes the approach that you, as the outsider, know exactly what the community needs and by golly (a touch of my North Carolina roots) you are going to do your project that way. In contract, the much better approach of working with the community involves the same mindset that you would use with people you truly respected. You enter the community as invited guests with ideas and plans for what you would like to do. The community then helps you develop your ideas and works with you to implement them. The working with model brings everyone to the same table and allows everyone to have a say in how the project is designed and implemented). We have spent the past six months preparing information, our project, and our group for our summer’s work in Tanzania. We have had the most wonderful contacts in Tanzania and had full support and many many many helpful hints from our mentors at Duke.

I am really looking forward to gaining knowledge of global health in the field in Tanzania. Medical practices surely differ between Tanzania and the United States; as such, I am looking forward to everything than the staff at Mwika Uuwo can teach me about general medical care and medical recording. I am also looking forward to living with my homestay family nearby the clinic and seeing a bit of the Tanzanian life.

Stay tuned to the blog for more updates. In the meantime, if you have a spare moment, check out a new initiative called OpenMRS – a community-driven, open source medical records system. It’s been implemented in quite a few countries including Tanzania, the United States, Kenya, and Lesotho. The URL is http://openmrs.org/wiki/OpenMRS. I’ll probably blog a bit more about this in the future once I get a better grasp on how everything works. It’s a really cool idea though – check it out!

Until next time – asante sana (Kiswahili for many thanks)

-Austin Mattox

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One response

27 05 2010
Kristen

Hey guys,

I’m the other DGHI-funded student in Tanzania this summer–but i’ll be out in Dar. Two years ago I was in Mailisita (6 miles out of moshi, on the road towards Arusha) working at Light in Africa (www.lightinafrica.org). They have a nursury and volunteer home at Mailisita- the white building right at the “Mailisita” Dala Dala stop. They also have a girls home, boys home, and are transitioning to a unique “village” set-up (real “homes” with 10 children and a caretaker, keeping related children together, and teaching the children to fill normal family roles..) in Boma Ngombe (about 10 miles from Moshi). They also have a small home in the mining town Mierani, further away. Many of their children are orphans due to HIV/AIDs or other diseases that afflicted their parents, or suffer from physical disabilities, mental disabilities, or backgrounds of emotional and physical abuse.

One thing they do related to your project is run medical outreaches in the local maasai communities. They try to keep some form of medical records for these communities, but when I was there, that meant writing down peoples names, ages, and what ailment they had on a piece of paper that was then put in a filing cabinet back at our home. We had no way of knowing if they had seen doctors for the same issue before, if they had seen OUR doctors for the same issue or related issues before. But it was the best we could do. If you three have the chance, I’d suggest trying to get in touch with LIA (email africa@lightinafrica.org and tell them what you are doing and how long you are there, OR just try finding the place stopping by in the early morning.) Perhaps you could use some of your grant money to help organize a medical dispensary day (it only takes about $300 I believe) or just talk to Mama Lynn and her staff about their opinions as “field workers” outside the hospital. Or, at the very least, there will be some European and American volunteers there all summer that might be a nice relaxing comfort to meet.

If you need any help around Moshi, let me know and i’ll try my best to remember. I also will be trying to go out to LIA for at least a weekend. And, if you want to come out towards Dar for a weekend later this summer, let me know!

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