Last summer, ASH leadership and staff traveled to Muhimbili National Hospital in Dar es Salaam, Tanzania, to consider adding this site to the current list of ASH-HVO sites, which includes Uganda, Peru, and Cambodia. Read more about how and why the Tanzania site was chosen, the needs of this important program, and how you can volunteer your time and expertise.
The national referral hospital in Dar es Salaam is faced with a tall order: provide care for hematology patients throughout Tanzania. In a country that is similar in size to Egypt and that has one of the highest incidences of sickle cell disease in the world, this charge is formidable. At Muhimbili National Hospital (MNH), eight dedicated clinicians – six hematologists and two internists – lead the effort to address the hematology needs of the entire country. Can ASH do anything to help?
"The appeal of Muhimbili is that the challenges it faces are significant but, given the dedication of onsite personnel, not insurmountable. ASH members have the opportunity to elevate patient care at MNH and build a foundation for both program sustainability and growth."
It was late July when the ASH contingent visited. Despite the 90oF heat, it was winter in Tanzania (the country lies between 1o and 12o south latitude). The MNH campus, a collection of blue and white buildings, sprawls across dozens of acres just outside of downtown Dar es Salaam, a city of 3 to 4 million located on the Indian Ocean (and 468 kilometers southeast of Mt. Kilimanjaro National Park). Droves of Tanzanians could be seen making their way toward one of the many wards of the facility, most of them with food in hand. It was visiting hours at Muhimbili, and local patients depend on relatives for their daily meals. Trooping conspicuously through this crowd was the team of ASH representatives, led by members Dr. Theresa Coetzer, vice chair of the International Members Committee, and Dr. Enrico Novelli, a member of ASH and an expert in sickle cell disease. The group was there to conduct a site evaluation, assessing the hospital as a potential host of ASH member volunteers sponsored by the Society in conjunction with Health Volunteers Overseas (HVO). This partnership recruits ASH members to conduct clinical and laboratory training and classroom education at sites in the developing world. As is the custom with this program, the impetus to assess the site in Tanzania was a request from the potential host country’s hematologists.
Tanzanian hematologist Dr. Julie Makani with ASH members Dr. Enrico Novelli and Dr. Theresa Coetzer at Muhimbili Hospital in Dar es Salaam, Tanzania.
Over the course of a week, the ASH-HVO assessment team got to know the hematologists and other clinicians at Muhimbili, heard of their needs, listened to their concerns, and reviewed the long-term goals they have for hematology care in Tanzania. The group visited inpatient facilities and outpatient clinics, the pediatric unit of the hospital that features a separate sickle cell disease ward, the laboratories that perform diagnostics for hematology, the on-site blood bank, and the Muhimbili University of Health and Allied Sciences (MUHAS) that educates specialists in hematology. Uniformly, personnel affiliated with each of these units, including high-level administrators, articulated a shared dedication to advancement of hematology care at Muhimbili.
The conclusion of the site assessment can be easily summarized: Yes, the need for assistance is great; yes, ASH hematologists can have an immediate impact on patient care. The appeal of Muhimbili is that the challenges it faces are significant but, given the dedication of on-site personnel, not insurmountable. ASH members have the opportunity to elevate patient care at MNH and build a foundation for both program sustainability and growth. One of the most pressing needs at the hospital is clinical teaching in diagnostics and patient care. Although trained hematologists are present, the magnitude of the need for specialty care limits the amount of time they are able to spend on each case. Hematology patients, therefore, are often cared for day to day by general medicine practitioners and interns. These clinicians would greatly benefit from on-site interaction with ASH visiting hematologists. In particular, training by ASH-HVO personnel in the implementation and application of both newer diagnostic techniques and the delivery of standard-of- care treatment would help local hematologists better serve their many patients.
The laboratories at MNH have their own set of needs. The performance and interpretation of basic diagnostic studies, such as bone marrow analysis, need to be improved, but the rapid impact that the ASH-HVO program can have on the host site is exemplified by an observation made by a member of the site-visit team. While reviewing the PCR capabilities of the hospital, Dr. Coetzer showed that by using available technology, a prohibitively expensive diagnostic test that had been outsourced to South Africa could be performed rapidly and inexpensively on site. Other technical and diagnostic laboratory issues that can be resolved through the interaction of volunteer hematologists with the physicians and technicians at MNH appear numerous.
The ASH-HVO team visited the National Blood Transfusion Service (NBTS) in Dar es Salaam, the state-run institution charged with the safe collection, allocation, and distribution of blood and blood components to Tanzania’s health-care providers. AABB, formerly the American Association of Blood Banks, has established a training and support program at NBTS to help meet this national mandate. However, the AABB initiative is limited to support of NBTS centers, such as that in Dar es Salaam. The site assessment team brought together, for the first time, personnel from the on-site blood bank at MNH with the NBTS staff and established the foundation for a program whereby AABB and the ASHHVO program will work with the other stakeholders to ensure that the transfusion service at MNH has the capacity and technical expertise necessary to support advanced patient care.
ASH understands the need for building hematology capacity in the developing world. In Tanzania, where the burden of hematologic disorders is especially high, ASH’s members stand ready to support our dedicated local colleagues.
If you are interested in volunteering at Muhimbili National Hospital in Dar es Salaam, Tanzania, please contact Chase Willett, ASH International Programs Specialist, at firstname.lastname@example.org or sign up using the volunteer form.
More About Health Volunteers Overseas
To improve the quality of medical care in developing countries, ASH, in 2007, partnered with Health Volunteers Overseas (HVO), a nonprofit organization dedicated to improving global health through education. ASH member-volunteers travel to countries in need of education and training for health-care providers who care for patients with blood disorders. This program covers the management of a wide range of blood diseases, from the many forms of anemia (including those associated with malaria, pregnancy, iron deficiency, thalassemia, and sickle cell disease), to disorders that lead to abnormal bleeding and thrombosis, to malignant disorders such as leukemia and lymphoma.
HVO training programs focus on diseases and health conditions that are endemic to a particular region, and the procedures and skills taught are relevant and realistic. Accordingly, an overarching goal of ASH-HVO is sustainability, with stewardship of the programs being passed into the hands of local personnel so that patients in the home country continue to benefit after the volunteers have departed. In addition to teaching, ASH-HVO participants shape curricula, influence national health policy, and promote realistic health interventions in real time.
Volunteers are provided with a clean, safe place to live. Travel costs to and from the site are the responsibility of the volunteer. (These expenses are tax-deductible.) All volunteers also receive detailed orientation materials from both HVO and the program director in advance of their departure. Get more information.
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