About

Mnazi Mmoja is a 440 bed, government run hospital servicing the main island of Zanzibar. It is located in Stone Town, the island's capital.

It is staffed by both local and international doctors - including a team of specialists from China - and is reasonably well equipped for a developing world hospital.

Departments include internal medicine, surgery, paediatrics, obstetrics, ophthalmology, ENT, occupational therapy and physiotherapy.

Not surprisingly, given its location, Mnazi Mmoja is a popular choice for medical students completing their elective placements.

Is it for me?

Mnazi Mmoja is probably a good elective destination if you:
- want to get a taste of medicine in Africa, but somewhere not too remote / unsupported
- are interested in tropical medicine / infectious diseases (Malaria, TB, HIV)
- would like to spend some time in a different and friendly culture
- are interested in having a holiday, not working very hard and spending some time at the beach

Applying

The easiest way to apply for an elective at Mnazi Mmoja is to contact Dr Omar who is the medical superintendent for the hospital [anwasul@yahoo.com].

Don’t be surprised if you hear nothing further after your initial acceptance. Dr Omar is notoriously bad at replying to email enquiries.

When you arrive in Tanzania you can reach him on
+255 777 422119/ 715 422119
Try to call a day or two ahead to arrange a pick up from the airport or ferry.

You will be required to pay a $75 USD / week donation to the hospital at the start of your elective. Dr Omar can also arrange a place for you to stay (see the accommodation section) at a cost of $70-105 USD / week.

Some students arrange their placements through a third party organisation such as Work the World, although it is considerably more expensive to do so.

Staying well

You will need malaria prophylaxis and strong mosquito repellent. It is also not a bad idea to treat your clothes with permethrin, which is available from most camping stores. A mosquito net is probably optional as almost all accommodation in Zanzibar will provide one.

If you go to the infectious diseases clinic at your home hospital they can also give you the most up to date advice on what other vaccinations (ie Hep B, yellow fever, cholera) and drugs (ie HIV post exposure kit) you need.

When in Zanzibar you will need to boil tap water if you wish to drink it. Alternatively, bottled water can be purchased just about anywhere and is not too expensive.

What to bring

Essentials
Malaria prophylaxis
Mosquito repellent
Sunscreen
Hat
Sunglasses

Clothing
See ‘what to wear’ section

Hospital
White coat
Scrubs
Stethoscope
Penlight
Gloves
Antimicrobial hand wash
Oxford handbook or similar

Electrical
British power adapter (3 pin, 220V)
Torch (the power does cut out)
+/- Mobile phone (local sim cards are available widely)
+/- Laptop

Donations
Anything will be appreciated including books for the library and decent stethoscopes for the ward. There aren’t even tourniquets.

Money

The official currency is Tanzanian shillings but US dollars are widely used too. The conversion is around 1350 shillings to the US dollar.

Most ATMs will accept VISA and some also work with MasterCard + Cirrus. The ATMs around town are very unreliable so try to keep some cash reserves.

I didn't come across any ATMs outside of Stone Town, so take cash with you if you plan to travel around the island.

Stone town

Stone town is an interesting, friendly and generally safe place. You can see a map here.

Accomodation

Dr Omar can arrange a room for you on the second floor of a large house near the hospital. The house is owned by a man named Mr Habib who lives on the upper floors with his family. It is well placed, close to the hospital, local markets, internet cafes and a only a five minute walk to the waterfront once you learn the shortcuts. (It is just around the corner from Lukmann’s, one of the best budget restaurants in Stone Town).

The accommodation is reasonably priced by local standards, costing 10 USD per night for a shared room and 15 USD for an individual. The rooms vary a bit in quality but all have mosquito nets on the beds and fans. Some also have TVs, minibars, and airconditioning (although at the time of writing the house was running on a generator and these were not to be used).

The set up is comfortable and has pretty much everything you need to be self sufficient. There is a communal living room and kitchen, several bathrooms, a washing machine etc. There is also a young guy who acts as a sort of doorman downstairs. Mr Habib and his son are generally quite helpful but they do occasionally wander in unannounced which has made some guests a bit uncomfortable.

Some students decide to organise their own accommodation which seems to be fairly easy as there are plenty of guesthouses in town.

Mr Habib's

Language

The official language Zanzibar is Swahili.

Stone town is a popular tourist destination and as such many people here will speak at least some English. You can easily get by around town without any Swahili at all, although your attempts to use the native tongue are generally appreciated. At the very least, you will get a laugh out of the locals.

At the hospital, language can be more of an issue. Mnazi Mmoja services a large catchment area and many patients will come from more rural parts of Zanzibar. Most patients you will encounter on the wards and in the outpatient clinics will not speak English.

Although the doctors all speak and keep medical records in English, if you can’t speak Swahili you will be limited in your ability to interact with patients independently. At the very least you should try to learn some basic greetings and phrases that will allow you to examine patients (‘sit up’, ‘roll over’, ‘where is the pain?’ etc).

Ideally you should take some lessons before you come to Tanzania but tuition can be arranged through the local university. It costs around ten dollars an hour per student.

The more Swahili you learn the more rewarding your time will be, both in and outside the hospital.

Some useful phrases
How are things? (lit. news?) Habari
Good Nzuri
Fine Safi
My name is… Jina langu….
I am a student doctor Mimi ni daktari wanafunzi

Lie down Lala

Do you have… Una...
Diarrhoea kuharishe
Vomiting katapika
Coughing kukohoa
Fever homa
Pain maumivu

Where? Iku wapi?
Here Hapa

Yes Ndyo
No Hapana
Thankyou Asante (sana)

Remember, in Swahili the stress is placed on the second last syllable.
Ha-pa-na A-san-te

What to wear

Around town
Zanzibar has a predominantly Muslim population and you will find the dress standards, in Stone Town particularly, quite conservative.

Women are expected to cover up more than seems fair given the climate. You won’t need to wear a head scarf (as most local women do) but bare shoulders, midriffs and knees are frowned upon, even when swimming.

If you want to swim in town, bring a something (ie board shorts and a t-shirt) to wear over your bathers. Things are a little more relaxed at some of the tourist beaches in the North and East where swimming in bikinis seems to be accepted.

For guys, wearing shorts is fine as long as they are at least knee length.

(You will see plenty of tourists around who flaunt the rules. How much you try to fit in is really up to you).

Khangas, the colourful scarves worn by locals, can be worn as a sarong and make a great alternative to a beach towel as they are light and dry very quickly. You can buy them cheaply (2000-5000 TSH) from many of the small shops around town.

At work
At the hospital you will need to wear a white coat to identify you as a student. Apart from this, the dress requirements are quite relaxed. Long sleeve shirts and ties are definitely not required. Some of the doctors will even wear jeans and sandals.

It does get quite hot in the hospital, especially with a large number of patients crammed into a single consulting room. Try to strike a balance between looking professional and coping with the heat.

Although it is tempting to wear sandals, personally I wouldn’t go into any hospital wearing open shoes. You do see sharps lying on the floor from time to time too.

On the wards

On the whole, staff at Mnazi Mmoja are very welcoming. You will generally have free reign to go to any department and no one will make you feel in the way. There are ward rounds, theatre lists and outpatient clinics you can attend. In general, most days you will finish by midday and have the afternoons free.

There is plenty of opportunity to perform procedures and get up close / scrub in for surgery. You will encounter tropical diseases or very advanced / late presentations that you would never see at home. Its also a great chance to familiarise yourself with the myriad of presentations of Malaria.

Naturally the quality of teaching can vary a lot depending on the particular doctor you shadow, and of course, there are things that are just done differently in Zanzibar. Some days are a bit slow, and because investigations are very limited, there are plenty of cases you will never get a definitive diagnosis for. Most students who come here have some experiences they find frustrating, confusing or harrowing. You will see substandard patient care, and it is not always due to a lack of resources.

There are some areas of the hospitals, particularly the theatres, that are very well equipped. In other areas it can be more apparent that you are in a developing country. Don’t expect have any local anaesthetic on hand when you volunteer to drain an abscess. Don’t be surprised if you go a whole day without seeing a single staff member wash their hands.

Other facilities

The hospital has a library so fortunately you don’t have to bring your own copy of Harrison's. Most books are a little out of date, but then again, how much study are you planning on doing?

Wireless internet is available in the library which you can access if you have a laptop.

Food

Lukmaan's, just around the corner from Mr Habib's place, has the best budget food in Stone town.

Down by the waterfront there are plenty of more upmarket options. Moonsoon Restaurant, opposite Livingstone's, has great live Taraab music on Saturday nights.

In front of the old fort, right on the water, you'll find Forodhani Gardens. At night this place comes alive with street vendors selling all kinds of food inc. satay, seafood, sugar cane juice, Zanzibar pizzas. The food can be a bit overpriced but its usually fun.

There are a few nice coffee shops around where you can get a proper expresso. If you are on a budget I'd recommend going to one of the small street vendors you can find around in the alleyways (such as at Jaw's corner) with a pot of filter coffee and a wooden bench for you to sit on. Its about twenty times cheaper than going to a proper cafe.

At night there is also a great chai tea vendor who normally operates in a street just behind the old fort.

The Darajani markets on Creek Rd are a good place to pick up fresh fruit + veg (if you can put up with the stench of fish). There are plenty of little shops behind it for other essentials.

Things to do

TBA