by TERI REYNOLDS
Traffic congestion in Dar es Salaam or “The abode of peace”, Tanzania’s largest city. PHOTO/Wikipedia
I’d left the hospital and was running late for the airport. [*] But I wasn’t running. I was sitting in traffic in Dar es Salaam—the wide, deep, unmoving kind of traffic where you go through predictable stages of rage, despair and acceptance, only to have the acceptance disrupted by hope when there’s a few metres of progress, wiping the slate clean for the return of rage.
It had been a difficult period in the hospital where I had come to work. The population of Dar has almost doubled in the last decade, to nearly 5 million. Most live in self-built neighbourhoods without access to public water supplies and rely on pit latrines for sanitation. Tanzania has a per capita annual income of around $600, an average life expectancy of 51, and an overstressed pyramidal health system that feeds patients up to a small number of referral hospitals. There is no pre-hospital system and almost no access to emergency care. Ours was the first Emergency Department in the country, a new addition to a huge national public hospital that was oversubscribed, under-resourced, and simply overrun by needs it couldn’t meet. The new ed had radically raised the bar for early resuscitation and stabilization, replacing a barely staffed room where patients waited in metal chairs until they died, or someone from an in-patient service came down and tried to take care of them. We were now seeing a hundred patients a day, triaging within minutes, stabilizing trauma and resuscitating sepsis, and training, training, training. Lives were saved in our little world, probably every day, but the interface with the rest of the system was far from smooth.
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