Surgery in Mwanza, Tanzania - Clinical Departments

Surgery in Mwanza, Tanzania:
From Arrival to Departure
Center for Global Health
Division of Infectious Diseases
Weill Medical College of Cornell College
440 E. 69 th Street, New York, NY 10021 Tel: 212‐746‐6880; Fax: 212‐746‐9744

INTRODUCTION
Welcome to Bugando! This guide is intended for surgeons and surgery residents travelling
to and staying at the Bugando Medical Center (BMC) and Weill‐Bugando University College
of Health Sciences (Weill‐BUCHS) in Mwanza, Tanzania. It should provide a timeline of what
to do prior to departure from the United States, what to expect in Tanzania, and how to
structure your time at Bugando so that it will be most productive for you, the local health
care providers, and the students.
This guide has been arranged in chronological order, in an attempt to provide absolute
deadlines for vaccinations, travel arrangements, and other schedule considerations. More
general information about Bugando surgery, life in Mwanza, and post‐trip considerations
(e.g. reimbursement) is organized at the end of the guide for “pleasure reading” once you’re
settled in on your flight from the United States.
Many thanks to Cornell surgery R5 Glen Shapiro for his initial report on surgery in Tanzania;
Cornell R4 Ben Golas for his suggestions on updates; the Cornell Department of Global
Health, particularly Dr. Warren Johnson; the Cornell Department of Internal Medicine; and
Drs. Jen Downs, Beatrice Im, and Robert Peck in Tanzania.
2

INDEX
INTRODUCTION TO TANZANIA, MWANZA, and BUGANDO…………………………………………………………………………………….…..4
PRIOR TO DEPARTURE……………………………………………………………………………………………………………………….………….……………7
Checklist
Travel from NYC to Dar and Dar to Mwanza
Hotel Reservation in Dar
Vaccines and Travel Insurance
Visa Information
What to bring
Introduction to Swahili
ARRIVAL IN TANZANIA…………………………………………………………………………………………………………………………………….………..16
Arrival in Dar es Salaam and Mwazna
Arrival at Bugando Guest House
BUGANDO…………………………………………………………………………………………………………………………………………………..………….…17
Adventures of the Bugando Guest House
Arrival at Bugando Hospital
Orientation and Rotation Plan
Major Ward Rounds
ICU Rounds
Call
Emergencies
Operating Theatre
Patient Care
Conferences and Teaching
Miscellaneous
Medical Training in Tanzania/BMC
A Day in the Life…
Salary and Cost of Living
Patients’ Medical Bills
APPENDIX………………………………………………………………………………………………………………………………………………………..……….25
Supermarkets
Restaurants
Recreation
Internet
Phones
Banking
Mail
Health and Safety Advisories
Hotels in Mwanza
Reimbursement
Mwanza and Embassy Phone Directory
FIGURES……………………………………………………………………………………………………………………………………………………………………34
Visa Form
Reimbursement Form
Bugando Map
Official Mwanza Map
Key points (hand‐drawn) Mwanza Map
3

INTRODUCTION TO TANZANIA, MWANZA, and BUGANDO
Tanzania
� “Tanganyika” was initially a German colony in the 19th century, then became a
British mandate in 1921
� Under the leadership of Julius Nyerere, gained its independence from Britain in 1961
and shortly thereafter merged with the archipelago Zanzibar to form nation of
Tanzania
� Adopted democratic political party system in 1995
� Main city is Dar es Salaam, located on the Indian Ocean; capitol is Dodoma
� Population 40 million (Dar es Salaam 4 million)
� Average life expectancy 46
� Death from infectious diseases and trauma
o HIV (prevalence 9%), bacterial diarrhea, hepatitis, typhoid, malaria, and
schistosomiasis
o Trauma is the leading cause of death in ages 5‐18
� Thirty percent of mainlanders are Christian, 35% Muslim, and 35% traditional beliefs
� Zanzibar is nearly entirely Muslim
� Swahili is official language
� English is official language of higher education and government
� Additionally, Arabic and countless local languages are spoken
� Economy based on agriculture
o Main products and exports include coffee, gold, cashews, and cotton
� Tourist industry is supported by safari trips to the Serengeti, expeditions to Mount
Kilimanjaro (at 19, 340 feet, is the highest point in Africa), and exotic resorts on
Zanzibar
4

Mwanza
� Nearly 4000 feet above sea level on the shores of southern Lake Victoria, Africa’s
largest lake
� Because of its elevation, generally temperate climates year round
o Average 80 degrees Fahrenheit during the day and 70s at night
� Light rainy season lasts from November to January, and the heavier rains occur from
March to May.
o Downpours can be torrential, though it tends to rain at night rather than
during the day
o Day downpours typically last a few hours at longest
� Second largest city in Tanzania and economic center of Lake Region
� Population approximately 500,000
� Close proximity to western Serengeti, Rwanda, Uganda, and Kenya
� Despite being recognized as a “city,” it is more akin to a large town with the
population extending throughout its surrounding hills
� Local people value family life, church, and the occasional outing to a boisterous
roadside bar
� Ample wildlife (both farm and exotic)
� Ninety percent of population are members of Sukuma tribe, Tanzania’s largest ethnic
group
� Small but prominent Indian population runs retail and tourist industries
� Other locals depend on agriculture (corn, cotton, beans/peas) and fishing for their
livelihoods
� A very small Maasai population sells crafts, jewelry, and herbs
5

Bugando
� The Bugando Medical Center, a 900‐bed tertiary referral hospital, serves as the
medical epicenter of the region (total population served approximately 13 million)
� Employs 950 local people
� Founded by the Catholic Church in 1971, run by the Tanzanian government from
1971‐1985, and subsequently returned to control of the Tanzania Episcopal
Conference of the Catholic Bishops
� Dr. Charles Majinge is the Hospital Director and oversees 18 clinical departments
� Bugando University College for Health Sciences (BUCHS) opened at the site of BMC in
2003
� In 2007, renamed Weill‐BUCHS, in honor of benefactors Sandy and Joan Weill
� U.S.‐based Touch Foundation also has supported further development of Weill‐
BUCHS and BMC
o Touch is dedicated to addressing the global health care crisis by educating
and training health care workers
o Bugando is the Foundation’s pilot program
o Touch works with Weill Cornell to provide financial assistance for travel and
teaching activities of residents and attendings
� These collaborative relationships have allowed Bugando to undergo a significant
period of growth
o Currently, 800 students are enrolled in programs that include doctorate of
medicine, masters of medicine, and diplomas in the allied health sciences
(nursing, laboratory technicians, radiology)
� Growth of BMC and Weill Bugando critically important
o Tanzania has fewer than 1000 physicians
o 34 of the 40 million people living in Tanzania will never see a physician in their
lifetime
o One physician per 30,000 patients, the lowest ratio of physicians to patients in
any country in the world
� Overall, only two percent of the world health care force is present in Sub‐Saharan
Africa, despite carrying 25 percent of the global health burden
6

PRIOR TO DEPARTURE
PTD Check List
Three Months � Get your orientation material and travel information from Erin Byrt in
the Cornell Center for Global Health (emb2009@med.cornell.edu). For
your letter of sponsorship for your visa, you will need to bring your
passport number, expiration date of passport, citizenship and place
where passport was issued.
� Contact Professional Events, re: travel from NYC to Dar Es Salaam
� Contact Ajay Das, re: travel from Dar to Mwanza
Two Months � Make hotel reservations in Dar Es Salaam (for both arrival and departure
dates)
� Make appointment for needed vaccinations (Office of Travel Medicine)
� Complete international elective form for GME office
� Ask for letter of sponsorship from Erin Byrt (needed to obtain travel
visa)
One Month � Get travel visa (good for 3 months from date of purchase)
Two Weeks � Get Malarone prescription filled (may need to call Empire health
insurance for travel override request to obtain >30 day supply of
medicine to be dispensed)
� Get $500 CASH ($100 bills printed in 2004 or later); ATM widely
available throughout Tanzania, but no credit cards used
� Email Hilkka Abicht (most helpful staff contact at Bugando) at
bugandohospital@gmail.com and Dr. Rob Peck (IM/Peds rotation
director and also very helpful) at rnp2002@gmail.com
• If you intend to use your ATM card, debit card, or credit card call your
bank before you leave so that they will monitor for fraud and/or not
On Arrival to
Dar Airport
On Arrival to
Mwanza
cancel your card without you knowing
� Buy ticket to Mwanza at Precision Air or Air Tanzania office
� Exchange money: at least $200 USD to Tsh (Will need up to 200K Tsh for
very overweight baggage fee on local airlines)
� Buy cell phone (40K Tsh Nokia phone from Vodacom acceptable)
� Taxi ride to hotel should be in range of 20K to 25K Tsh. Can make
arrangements with this same taxi driver for return trip in a.m.
� Ask taxi driver to take you to Bugando Hospital, and ask guards at gate
to direct driver to Bugando/Serengeti Guest House. Taxi ride should be
in range of 15‐20K Tsh. Helpful to call one of taxi drivers on list (see
appendix), but most of the ones waiting at airport are also acceptable.
7

TRAVEL FROM NYC to DAR ES SALAAM
� Contact Kelly Salinger at Professional Events with your travel dates. If you have
specific route requests, she will compare these to the lowest available rate and
accommodate you if prices are comparable. She will bill Weill‐Cornell directly for
your travel. No travel insurance is included.
o E‐mail: professionaleventsoutions@comcast.net
o Phone: 303‐814‐9604; Fax: 303‐663‐5757
TRAVEL FROM DAR TO MWANZA
� Kelly Salinger cannot reserve this ticket for you on Air Tanzania or Precision Air. You
either can book on Precision Air Website (requires a bank transfer), or contact Ajay
Das (travel agent in Mwanza). You will pay Ajay in cash when you arrive in Mwanza.
Recent travelers have had good success with Ajay, and he also can help you plan a
weekend safari.
o E‐mail: cameltravel04@yahoo.com, or dass@cameltravelltd.com
o Phone: +255‐28‐254‐0354; Fax +255‐28‐250‐0700
� Alternatively, you may book the flight when you arrive in the Dar airport (agents are
just outside baggage claim), but it must be paid for in cash (~US$300‐350 for a round
trip ticket). Remember this is reimbursable, so save your receipt and boarding
passes.
o If you are traveling with someone who will not be reimbursed by Cornell,
note that Ajay’s ticket price (~US$260) is less expensive than the airport
price.
Sample Flight Schedules
Dar es Salaam‐> Mwanza Mwanza ‐> Dar es Salaam
Air Tanzania Precision Air Air Tanzania Precision Air
(via Kilimanjaro) (via Shinyanga) (direct)
(direct)
6:30am 7:30am 9:00am 10:45am
5:00pm 3:15pm 7:00pm 5:15pm
� Keep in mind that you will arrive in Dar es Salaam at least a day after your departure
from NYC. All flights arrive in Mwanza ~3 hrs after scheduled departure. These
flights are subject to change, but can be found on the Air Tanzania & Precision Air
websites.
� Therefore, depending on your arrival time, it is recommended that you spend a night
in Dar es Salaam and proceed to Mwanza in the morning. You do not want to arrive
at the guest house in Mwanza after 6pm, as there might be no one home at that
time and could be locked.
8

HOTEL RESERVATION IN DAR ES SALAAM
� The Kilimanjaro Hotel Kempinski is the best hotel in Dar es Salaam, but there no
longer is a negotiated rate of $150/night with the Touch Foundation. It now is
approximately $300/night.
� The new Holiday Inn is also very nice, in the range of $150‐200/night.
� The Swiss Garden Hotel is small, charming, and clean (eco‐hotel feel), and in the
range of $70‐90/night.
Kilimanjaro Hotel
Kempinski
Kivukoni Street/PO Box
9574
Dar es Salaam, Tanzania
Holiday Inn
Garden Ave
PO BOX 80022
Dar Es Salaam, Tanzania
Swiss Garden Hotel Ltd.
Mindu Street Plot No.
512
PO BOX 76086
Dar Es Salaam, Tanzania
Q‐Bar
Off Haile Selassie Rd
behind Shrijees
Supermarket
Dar Es Salaam, Tanzania
The Meditterraneo Hotel
and Restaurant
PO Box 36110
Dar Es Salaam, Tanzania
Purity Munge – Sales Coordinator
Tel: +255‐22‐213‐1111
Fax: +255‐22‐212‐0777
E‐mail: reservations.kilimanjaro@kempinski.com
Website: http://www.kempinski‐
daressalaam.com/en/home/index.htm
Coordinator: None
Tel: +255.22‐213‐7575
USA: 888‐465‐4329
Fax: +255‐22‐213‐9070
Website: www.holiday‐inn.com
Coordinator: None
Tel: +255‐22‐215‐32‐19 or +255‐22‐215‐27‐59
Email: info@swissgardenhotel.net
Fax: +255‐22‐215‐32‐19
Website: http://www.swissgardenhotel.net
Coordinator: None
Tel: +255‐754‐282‐474 or +255‐22‐21‐12‐667
Cell phone: +255‐754‐282‐474
Email/Fax: None
Website: None
Coordinator: None
Tel: +255.22.261.8359
Cell: +255.75.481.2567
E‐mail: None
Website: http://www.mediterraneotanzania.com/tanzania‐
hotels‐dar‐es‐salaam‐mediterraneo‐contact.html
9

VACCINES AND TRAVEL INSURANCE
� Call the Travel Medicine at 212‐746‐1601 for an appointment for the recommended
prescriptions and immunizations.
o Travel Medicine will bill Weill Cornell directly for the immunizations.
o Be sure to mention that you are a resident going to Tanzania. This goes a
long way in getting you seen sooner or if special arrangements needed due to
call schedules.
o Save the receipt when you fill your prescriptions.
� As a reference, these are the likely immunizations the office will offer you:
o Yellow fever (good for 10 years)
o Tetanus‐diphtheria‐pertussis (DTaP) (good for 10 years)
o Polio (if not immunized as adult, will need booster)
o Typhoid (oral good for 5 years, IM for 2 years)
o Hep A and B (if not previously immunized)
o Meningococcal (good for 5 years)
o Measles/mumps/rubella (if born after 1956 and have not received 2 previous
doses of vaccine)
o Varicella (if born after 1980 and neither have had disease nor previously
received 2 doses of vaccine)
� Anti‐malarial prophylaxis will be recommended. There are three choices. Malarone
is recommended, due to its low side effect profile and excellent protection (90%). It
is the most expensive, but fully reimbursable by Cornell. If you are traveling with
someone not reimbursable by Cornell, Lariam and doxycycline are the other two CDC
recommended anti‐malarials.
o Malarone (atovoquine 250mg/proguanil 100mg) QD
� Start one day before travel and continue one week after travel
o Larium (mefloquine 250mg) Q WEEKLY
� Start one week before arrival and continue four weeks after travel
o Doxycycline 100mg QD
� Start one day before travel and continue four weeks after travel
� Confirm your International Travel Insurance. Cornell provides SOS insurance for all
residents through Weill Cornell Medical College. It is important to print out the
insurance ID number and emergency phone number before you leave. Use he
following website:
www.internationalsos.com/private/WeillCornellMedicalCollege/SOSCard.cfm
� If you have any trouble with the website, Erin Byrt also has the SOS card information.
Also note that additional insurance is available:
� Cornell Blue Cross Blue Shield does have some coverage in Tanzania. There is a list
of preferred providers (800‐810‐2583). No out of network coverage and no known
evacuation services. Call 804‐673‐1177 for further inquiries.
10

� SOS International Global Emergency Assistance & Evacuation Insurance: $1 million
medivac services. Optional extra medical/dental coverage. For more information
see: www.internationalsos.com/buymembership
� WORLDNOMADS insurance covers medical and dental; $500,000 for helicopter
evacuation. See http://www.worldnomads.com for further information
11

TANZANIAN VISA INSTRUCTIONS
The Tanzanian embassy is located at
201 East 42 nd street, Suite 1700 (42 nd and 3 rd )
New York, NY 10017
TEL. 212‐972‐9160
FAX 212‐682‐5232
� It processes requests for visas Monday–Friday from 9:30AM–1PM (closed on BOTH
Tanzanian and American holidays).
� You should plan on submitting your visa application at least 2 weeks prior to
departure (but no sooner than 6 weeks before departure) as the duration of
processing varies (at least 5 days). Visas are valid for 3 months.
� Indicate that this trip is for “other business,” or you will encounter a logistical
nightmare
� Make a copy of the paperwork and keep a copy of your payment for reimbursement
later.
� Nationals of the following countries do not require visas for stays three months or
less: Namibia, Romania, Rwanda, Hong Kong, United Kingdom, Canada, Bangladesh,
New Zealand, Nigeria, India and South Africa.
� Nationals of the following countries must have their request for visa referred to Dar
Es Salaam, Tanzania: Somalia, Lebanon, Bangladesh, Sudan, Eritrea, Ethiopia, Iran,
Iraq, Turkey, Pakistan, Sri Lanka, Syria, Egypt, Jordan, Yemen, Morocco, Tunisia,
U.A.E., Saudi Arabia, Afghanistan, Nigeria, and West African Countries.
� Please check the Tanzanian Embassy website for any updates/revisions.
� Although a visa may be obtained upon arrival in Tanzania at any point of entry, it is
advisable to secure a visa prior to travel.
Documents you will need for visa application:
� Completed visa form (see appendix or download from Tanzania Embassay website:
http://www.tanzaniaembassy‐us.org/visa/visa.html)
� Valid passport – at least six (6) months before expiration
� $100 cash or money order made payable to the Tanzanian embassy; rush service:
extra $20.00 (available for pickup next day)
� Letter of support from the Center for Global Health
� 2 passport‐size photos
� A self‐stamped envelope for passport return if you plan on having the embassy mail
your visa & passport back to you (recommend using priority or express mail)
� Proof of purchase of flight ticket to Tanzania (electronic ticket receipt/itinerary is
sufficient)
� License or certification for pets is required if traveling with pets
12

WHAT TO BRING
IN GENERAL
TO BUY
� Convertors. May purchase a universal adaptor and converter from Samsonite,
Travelpro, or REI/EMS. Electronic equipment in Africa is two‐ pronged (square) and
the same as the UK. Voltage is 220 (US is 120V). If you don’t get one before you go,
you usually can purchase at JFK or Dubai airport as well.
� Anti‐malarial and anti‐diarrheal prescriptions. Many antibiotics, antifungals,
antimalarials, and other miscellaneous pharmaceuticals can be bought over the
counter at the Bugando pharmacy or in town at the New Mwanza Hotel pharmacy
(better selection). However, it is wise to fill the empiric prescriptions you’re given by
the Cornell Travel Clinic in the event you need something in an emergency.
� Bug repellant. By far the best is Ultrathon, though other preparations containing the
range of 30‐40% DEET are alternatives (30‐40% better than 100%). Ultrathon is $12
for a small 2oz tube at EMS (same‐day delivery in NYC), but one tube lasts for at least
2‐3 weeks. You do not need to wash your clothes with Permethrin. It is very
expensive and unnecessary. If you are vigilant about Ultrathon and wearing long
sleeves/pants at dusk, that is enough protection. Tse Fly bites reportedly can hurt
quite a bit. Fortunately, there are few in Mwanza – but present on safaris.
TO PACK
� Fleece or sweatshirt for safari or for nights (can be cool) on Bugando Hill
� Flashlights. Lights can go out at least once/day. Batteries can be purchased at U‐
turn supermarket if needed, but easier to bring your own.
� Pack enough for 10‐14 days of clothes wear, as laundry turn‐around time is 5‐10
days.
� Extra towel, since the turn around time on your laundry is so long. You also may
want one for the beach.
� Flip flops for showers
� Earplugs (roosters, nearby houses, etc can be noisier than expected)
� Sunblock
� Waterproof boots, rain jacket, umbrella (for rainy season)
� If you have access to an unlocked international phone, you can bring that and install
a SIM card for one of the local networks (Zain or Vodacom). You can buy this in Dar
es Salaam airport. You also can buy a cell phone on arrival in Mwanza; there are
many phone stores in town (see map).
FOR WORK
� Flash drive
� White coat (two probably best, if you have room in your luggage)
� Laptop computer for accessing internet
� Hand sanitizer (very few sinks and scarce soap)
� Toilet paper if you don’t want to use large rolls of construction paper (or nothing at
all)
� Attendings and students dress anywhere from casual khakis (usually the older
attendings) to more dressy (usually the students). Khakis and a collared shirt are fine
13

for visitors. Laundry detergent used has the potential to damage clothing, so keep
that in mind when packing.
� Scrubs are NEVER worn outside the operating theatre, so it is better to bring more
ward clothes than scrubs.
� Thank you notes for the end of the rotation. Letters of appreciation and gifts are
culturally very important in Tanzania.
o You should be prepared to write a thank you note to Hospital Director Dr.
Majinge (as well as pay a goodbye visit), Dean of Medical School and former
Chair of Surgery Dr. Mahalu (the biggest advocate for having Cornell surgery
residents at Bugando), and anyone with whom you worked closely.
o It also would be good if you could bring a small official gift that you think
would be useful to the department. This could be a used book, if in
acceptable condition. It is better to give a departmental gift than individual
gifts.
FOR THE OPERATING THEATRE
� If you have very small or very large hands, bring your own gloves. Size 7, 7.5, and 8
generally are available.
� Masks, OR hats, and scrubs. Any extras you leave would be much appreciated by the
operating theatre staff and students.
• Scrub packs or hand sanitizer if you don’t want to use bar soap in the operating
theatre
� Chest tubes/suture kits for teaching
� Incentive spirometers
� The students LOVE books – any pocket‐size review books are most helpful (e.g. old
ABSITE reviews, pocket surgical guides, USMLE), but otherwise any old surgical
textbooks also would be eagerly welcomed.
� Extra needle drivers/pickups and sutures (suture in very short supply, and you will
note that most knots are tied with instruments) for working on suturing and knot
tying with medical students.
� An extra pair of shoes for the operating theatre. The vast majority of people in the
theatre wear the white theatre rainboots, but are these are not necessarily
desirable. However, you might be asked if your shoes are “sterile” (I.e. not worn
outside the operating theatre). It’s best not to push this “sterile” rule, because they
are VERY serious about it and you’ll be a high‐profile visitor in general.
ALSO NOTE
� HIV prophylaxis is in the guest house. The “standard" post‐exposure prophylaxis is
Atripla PO QD starting as soon as possible (and definitely within 72 hours) for four
weeks after a needle stick/exposure from an HIV patient. Alternatively, per HIV at
UCSF, post‐exposure prophylaxis can also be kaletra/truvada for 1 month.
� Many travel books in the house, but helpful to bring your own.
� Mosquito nets, sheets, and blankets are provided for you in the house.
14

SWAHILI
� Tanzanians take greetings, introductions, and personal relationships VERY seriously.
Introducing yourself properly and knowing a few key Swahili phrases is perhaps the
most important thing you can do to show Tanzanians you are interested in and
respectful of their culture. Learn these before you get off the plane in Dar, and it will
take you a long way. Also note that extended hand holding during greetings is often
customary.
� These are the most important Swahili phrases:
o Hujambo? (How are you?)
o Sijambo (I’m fine)
o Na wewe? (And you?)
o Habari? (How are you?)
o Nzuri (fine)
o Poa (ok – a bit more slang)
o Salama (peace, ok)
o Safi (safe, ok)
o Sawa (ok)
o Ndiyo (yes)
o Hapana (no)
o Shikamoo (How are you? ‐ for persons of respect)
o Marahaba (I’m fine ‐ the person of respect’s reply to you)
o Habari za asubuhi (Good morning)
� On the street and in town, you will hear the word “mzungu” (singular) or wazungu
(plural) shouted at you numerous times each day. It means “white person.” If
you’re Indian, you might hear “ mhindi” or if you’re Asian (of any descent), “china.”
It’s usually just best to ignore this, as the locals oftentimes are merely announcing
the presence of an unusual sight, or hoping to sell you something or ask for money.
Children frequent the area around the New Mwanza Hotel and can be quite
persistent until you offer them a firm, “Hapana!”
� Additional Swahili information is available at kamusiproject.org
� The Lonely Planet series has a Swahili pocket phrase book that also can be helpful
15

ARRIVAL AT THE DAR and MWANZA AIRPORTS
� After claiming your baggage, do the following things:
o Buy your ticket to Mwanza at Precision Air or Air Tanzania (if haven’t already
arranged for e‐ticket via Ajay Das)
o Buy a cell phone from Vodacom
� The basic Nokia for Tsh 40K is acceptable
o Exchange money at the bank
o Get taxi to hotel
� Should be in range of Tsh 20‐25K
� The next morning, leave at least 1‐2 hours of travel time (traffic is VERY congested in
Dar) to get from the hotel to airport. Also allow 1‐2 hours check‐in time.
� On arrival in Mwanza, ask to be taken to the Bugando Hospital. At the gate, ask the
guards to direct the taxi driver to the Bugando/Serengeti Guest House. It is a 5‐
minute walk from the hospital. The housekeepers should be at home during the day
to let you into your room.
16

ADVENTURES OF THE BUGANDO GUEST HOUSE
� Meals are provided as part of the 20 USD/day fee at lunch and dinner (usually
rice and beans and vegetables). Residents often go to town for dinners at local
restaurants.
� Shared bathrooms, but usually there is hot water
� No internet
� Shared house phone
� Local residents/students and prior visiting residents have reported it to be
potentially to walk alone at night. Walk in groups or call a cab.
� It is safe during the day, but always watch valuables and don’t carry wallets in
back pockets.
� Residents from Cornell medicine, pediatrics and occasionally ob/gyn also will be
living at the house. Occasionally residents/attendings from Germany, Chicago,
and Boston rotate through.
ARRIVAL AT BUGANDO MEDICAL CENTER
� Go to Hilkka Albicht’s office first. She is one of those “can do” people who is able to
help you with everything from hospital concerns to general Mwanza questions. She
is located in the administrative offices in H4 and also can be reached at 073‐445‐
4724 or bugandohospital@gmail.com.
o To get to her office, walk up your first set of stairs after entering the hospital
(just past the Bugando Canteen), turn left after exiting the stairwell, pass
through the glass doors, and turn right down the hallway. Her office is at the
end on the left.
� As noted above in the Swahili introduction, greetings and being welcomed into the
hospital for a rotation are EXTREMELY important. Hilkka will be able to facilitate
meetings with the following people:
o Dr. Charles Mijinge (Hospital Director)
o Dr. William Mahalu (Dean of the Medical School, former Chairman of Surgery
and cardiothoracic surgeon)
o Dr. Japhet Gilyoma (Chairman of Surgery)
� You will note that physicians are called either by their first or last name, with the
addition of “Dr.” in front. It is probably easiest to introduce yourself as “Dr. John” or
“Dr. Jane,” rather than your last name.
� Depending on the availability of these people, Hilkka will advise you whether it is
best to wait to meet them, or continue with your day.
o If it is a Tuesday or Thursday, both Firms (see below) will be conducting Major
Ward Rounds on E6 or E9 from approximately 9 a.m. to noon.
o If it is a Monday, Wednesday, or Friday, you should go to the operating
theatre. One of those days is usually clinic for specific attendings, but you
can decide later which clinic you would like to attend.
17

ROTATION PLAN and ORIENTATION
� Plan to attend morning report at 7:30A daily (M‐F) on E9. Theatre usually begins
immediately after this; major ward rounds and clinic begin at 9:00 or 9:30A.
� Theatre usually runs until ~6P, clinic until the mid/late afternoon, and major ward
rounds until ~noon. On your free T/Th afternoons, you can spend time in the
Casualty Ward (ER) helping interns with suturing and other procedures. You also can
arrange with the students a time for a lecture, practice presenting cases, or
practicals (FAST, knot tying, etc).
� You are not expected to be in the hospital on weekends. There is no morning report,
formal rounds, or scheduled operating theatre at this time. Students are not
present. Attendings might be present at times for emergencies, or to see selected
private patients.
� Decide which “Firm” to rotate with – there are two. The patients of each Firm can be
found in the same wards (E6, C9, E9, (occasionally C6), and ICU in F2)
o Firm 1: Mabula, Phillip, and Emmanuel
o Firm 2: Gilyoma and Chandika
� Emmanuel and Chandika are the most interested in visitors and teaching, particularly
Emmanuel. Gilyoma also teaches.
o Emmanuel: Clinic Monday, Theatre W/F
o Chandika: Clinic Wednesday, Theatre M/F
o Gilyoma: Clinic Friday, Theatre M/W
� The Firm with which you choose to rotate is the one you will round with on
Tuesday/Thursday, but you are not bound to doing surgeries only with those
attendings. It simply will provide some structure, as well as give a better opportunity
to become acquainted with the staff and students, and have a regular clinic
schedule.
� On Tuesday/Thursday, there usually is a powerpoint lecture given by a resident or
intern. You can ask one of the attendings when it would be best for you to present.
� There is no M and M
� Once you’re acquainted with the wards, you can begin to help students with bedside
teaching/important physical exam findings (e.g. EC fistula, hernia) on rounds. You
also can identify good cases for discussion after rounds, though the students often
are in a rush to make their meal at the mess hall before it closes.
� If you would like, it is possible to take 2 nd call in conjunction with one of the surgery
residents. One of the Bugando residents should be on record for any case for legal
reasons and for follow up (so patient is not forgotten about). There are no pagers,
so you can give your cell phone to the resident on call.
� During the month‐long rotation, you are permitted to take one three‐day weekend
for safari or other travel. If you would like to take a more extensive trip (i.e. hike
Kilimanjaro or enjoy resorts on Zanzibar), you must use your two‐week vacation time
either at the beginning or end of the trip.
MAJOR WARD ROUNDS
� Daily rounding on the rest of the patients (usually about 100 for each Firm) is
conducted in a loose fashion by the overnight ward intern with notable
occurrences presented at morning report (usually just deaths and complications).
18

ICU ROUNDS
CALL
� Major ward rounds occur on Tuesday and Thursday. The entire team
(attendings, residents, interns and students) will walk through the wards and see
patients. Surgical plans are made at this time.
� Students sometimes present a particular patient, whose case is then discussed by
the group.
� Interns, students, and registrars write notes and orders. Registrars prepare the
subsequent day’s operating theatre schedule. This is then approved by the
attending to which the registrar is assigned.
� Feel free to offer ideas or ask questions if you are confused about a patient’s
history, exam, or management (there will be confusion). The students are
usually very happy to help translate from Swahili.
� Things invariably will be done differently than in the United States. If you have a
concern, the best thing to do is make a polite recommendation and leave it at
that.
� ICU rounds, in general, occur immediately after morning report daily. Usually
individual attendings see their patients by themselves, or are accompanied by a
registrar or small group of students.
� The ICU is located in F2, and is both surgical and medical
� Medical officer Joshua Masikini (AMO) oversees the ICU and presents the patients
and plans on rounds. They are presented in a truncated fashion, rather than as the
extensive ICU presentations we do.
� The overnight ward intern is also responsible for surgical patients in the ICU. At
morning report, he or she will present major events from the previous 24‐hour
period.
� Interns are on call every 4 days, switching between the ward and casualty every 24‐
hour call cycle. There are always two surgical interns on call at a given point. They
are termed the “1 st on call.”
� The “2 nd on call” is one of the surgery residents (R1‐3). They generally are on call for
48‐hour cycles, although not always.
� The “3 rd on call” is always an attending and specific for their specialties (general,
urology, orthopedics, ENT, and chest).
� The best way for visiting residents to be involved in this cycle is to give your phone
number to the 2 nd on call, so you may be contacted for emergency cases or
questions.
EMERGENCIES
� Emergencies present to the Casualty Ward via foot, private transport, or emergency
transport.
� Patient may arrive directly from Mwanza, or may be referred from district hospitals.
� The triage system for emergency care still is being refined, as the most acute cases
are not necessarily seen first by Casualty Ward staff.
� Interns are assigned in 24‐hour shifts to cover all surgical patients presenting to
Casualty.
19

� The emergency room is staffed during work hours (until 3‐5P) by Dr. Ngingo, a
general practitioner. At night, it is staffed by nurses and overnight interns.
� Plans and admissions are discussed with the 2 nd on call (a 1 st ‐3 rd year resident). If
there is a plan for surgery this is approved by the 2 nd on call.
� In general, emergency surgeries are conducted by the 2 nd on call with the assistance
of the ward intern. The 3 rd on call (attending) is rarely present.
OPERATING THEATRE
� The General Surgery services operate on Monday, Wednesday, and Friday.
Orthopedics, ENT, and Urology also operate on these days (they are considered part
of General Surgery).
� Ob/Gyn operates on Tuesday/Thursday. Dr. Mahalu (CT) currently is operating on
these days as well.
� There are 5 operating rooms with three for General Surgery and two for
Orthopedics.
� An operating team usually consists of an attending, one or two intern/residents and
+/‐ a MD‐5. No more than three people are scrubbed in on any given case.
� The third person acts as the scrub nurse (if there is a third person). The students
very often are the scrubs, as this is the way they learn the instruments.
� No one scrubs in and out. E.g. an unscrubbed student or resident would not scrub at
the end of the case to help close.
� Given that there is a high ratio of residents and students to attendings and there
already are limited opportunities for residents to gain operative experience, there is
a good possibility you will be observing.
� Also, there is some difference in regard for needle safety, so it would be wise to
observe until you feel comfortable with different attending and resident technique.
� Sometimes attendings run a second room and one of the third years does his own
cases (thyroids, prostatectomies, etc).
� Ob/gyn is attempting to initiate laparoscopy, but this is not used by the general
surgeons.
� There are neurosurgical trays, but supplies and training are limited. There is no
specific vascular, colorectal, plastic, or endocrine surgery. There was an OMFS
surgeon from India until 12/09, who potentially could return in late spring 2010.
� Occasionally water runs out or the hospital lift (elevator) breaks, and all cases (save
emergencies) are postponed. This occurs ~every two weeks. Electrical outages are
rare because the hospital owns a reliable back‐up generator.
� Suction and cautery are not routinely used
� Subcuticular stitches are rarely used
� Vicryl, silk, catgut, prolene, and occasionally nylons are used
� Agents used for anesthesia are as follows:
o Induction: Atropine, Thiopentine, Suxemethonium, and Kentamine.
o Maintenance: Diethyl Ether, Pancuronium, Propofol, Isofluorane, or
Halothane.
PATIENT CARE
� Do not direct or provide patient care alone.
20

� Do not communicate patient care plans/independent ideas directly to parents or
patients; this should be discussed with/through your firm and its constituents
(primarily the interns).
� If you are concerned about a patient, call the senior surgical resident on your firm to
discuss the patient and formulate a plan.
CONFERENCES AND TEACHING
� Residents might ask you questions, but your primary responsibility is to assist the
teaching of medical and AMO (assistant medical officer) students. The students also
will be the most interested in your presence.
� The AMO students (Assistant Medical Officer students) usually have practiced as
Clinical Officers in village dispensaries. They are taking two years off from their
salaries (most have families) for additional education and to be promoted to AMO’s.
They are very, very interested in learning and tend to ask very clinical questions.
They also tend to be older than the medical students.
� The students have an oral exam at the end of their rotation, so it is helpful to review
case presentations with them.
� Presentations to the residents and interns occur on Tuesdays and Thursdays
following morning report. This is the best time to present; however, discuss your
plan ahead of time with a senior resident so they may have the projector available.
� Students are supposed to have lectures by the attendings in the afternoon every
Tuesday, Thursday and Friday. This is a good time to present to students since
attending lectures are inconsistent. Plan ahead.
SUGGESTED LECTURE TOPICS
A website, series of lectures, practicals, and theatre topics geared specifically to the needs
of Bugando students is currently in the works. In the interim, it would be helpful to discuss
any of the following Bugando “top” topics and give 2‐4 lectures during your stay:
Top Ten
� Goitre
� Breast Cancer
� Esophageal Cancer
� Peritonitis
� Intestinal Obstruction
� Appendicitis
� Bladder Tumors
� Tonsillitis
� Diabetic Foot
� Fecal Fistula (anorectal malformations)
Second Four
� Hernia
� Hydrocephalus
� Nasopharyngeal Tumor
� Nephroblastoma
21

Additional Topics
� Burn
� Trauma
� Soft tissue tumors (sarcoma, teratoma, desmoids very common)
� Volvulus (Sigmoid volvulus most common cause of LBO in Tanzania)
Format of the presentations
� Definition, presentation, differential diagnosis, history, physical exam, investigations
(i.e. workup), management, and complications
� Use white background with black print (projection quality sometimes poor)
� If you have a Macintosh, bring your DVI adaptor for projectors
� TALK SLOWLY and CLEARLY
� Keep slides to ~20 and emphasize major learning points applicable to Bugando
SUGGESTED PRACTICAL TOPICS FOR STUDENTS
� Scrubbing/sterile technique
� Surgical instruments (they tend to be the scrub nurses in cases)
� Basic surgical technique (suturing, tying, etc)
o Also possible to spend time in Casualty Ward and help with suturing
technique
� Chest tubes
� Venous cutdown (central lines are rarely, if ever, used)
� FAST (Dr. Chandika has the portable ultrasound)
� Intubation
MISCELLANEOUS
� The wards consist of common rooms and private rooms. In the common room, you
may find up to two patients per bed with 10 beds per room. The private rooms are
at the beginning of each ward and house one or two people per room.
� On the pediatric ward, E9, you may find up to three children per bed (with mothers
or fathers on duty).
� The families are responsible for helping with feeding and cleaning the patients.
Visiting hours are twice daily. Oftentimes, the families stay overnight to care for sick
patients, and you will see a mass exodus in the mornings from the wards.
� Dressings are changed by nurses (generally one or two nurses per floor). It is
sometimes helpful to offer assistance, at which time you can point out things like the
benefits of wet‐to‐dry dressings and granulation tissue formation.
� Vital signs on the wards are done daily (not always done, however). In/outs are
rarely recorded except in the higher care rooms.
� Many patients wait indefinitely for surgery, a plan, or occasionally to die. Waiting for
surgery can sometimes take longer than a month.
� You will notice that very few patients receive CT scans. One of the criteria for CT
scan is the ability of the patient to pay for it (~$250). If a patient does receive a CT, it
is of the head. Ultrasounds and plain films are used for abdominal imaging.
� There are no c‐collars for trauma
22

MEDICAL TRAINING IN TANZANIA (IN PARTICULAR AT BMC)
� To become an MD in Tanzania, students first must complete a 14‐year primary and
secondary education modeled after the British system.
� They then enter five years of medical education. Their fourth and fifth years are
clinical.
o In the fourth year, they rotate through surgery, medicine, pediatrics, and
ob/gyn for 12 weeks each.
o In the fifth year, they have senior rotations in medicine, pediatrics, ob/gyn,
and community medicine. They also do specialties of anesthesia,
orthopaedics, ophthalmology, ENT, and urology.
� Medical school is followed by a one‐year rotating internship in medicine, surgery,
pediatrics, and obstetrics and gynecology.
� After this time, they may become a general practitioner or apply to become a
registrar.
o Registrars are either selected to work in a regional or district hospital and
focus within one specialty.
� Following this registrar year, they may apply for residency in their specialty; they
must have received at least a “B” in their specialty in both medical school and
internship.
� This residency lasts three years and involves completion of a thesis/dissertation to
obtain a master’s degree. After this time, they may practice independently.
A DAY IN THE LIFE…
� A day in the life of an intern on surgery begins by waking up in the hospital (the
interns live in the hospital in J block).
� The on‐call ward intern pre‐rounds on the ICU patients prior to morning report.
Morning report runs from 7:30am to 8:15am or so.
� Following morning report, interns and students eat breakfast prior to going to the
operating room or major ward rounds, which begin around 9 or 9:30am.
� If it is an operating room day, they spend the day in the operating room attached to
an attending from their firm. Operations continue until 4pm to 6pm. Emergencies
can occur at any time.
� The interns begin their call at 4pm.
� Ward call consists of covering all of the patients on the surgical wards (~200‐250
patients) and helping the 2 nd on call in the OR for emergencies.
� Casualty call is responsible for seeing and admitting any surgical patient from H2 (the
emergency department). Their call lasts until 8am the following day, but they stay
on the wards until 4pm post‐call.
� The number of calls taken per month is dependant on the number of interns rotating
on surgery, but is usually Q4.
� A day in the life of a post‐graduate/resident in surgery includes the same operating
days, major ward rounds, and morning reports.
� They rotate being the second on call (taken from home and coming in to the hospital
if needed)
23

� Their number of calls/month is determined by the number of 2 nd and 3 rd year post‐
graduates and the registrars in the program. Call most often in 48‐hour blocks.
� They have additional academic responsibilities which include completing a graduate
research project and dissertation which is required to complete their training.
SALARY AND COST OF LIVING
� While salaries are somewhat variable based upon length of time working at a
particular hospital, the average intern at Bugando Medical Center (BMC) makes 451K
Tsh/month and the average registrar or post‐graduate makes 564K Tsh/month (taxes
are deducted only for registrars and post‐graduates).
� The majority of trainees live in hospital/college housing that surrounds BMC. The
average cost of housing is 10‐25% of the monthly salary. In the case of interns living
in the J Block, their room and board is 54K Tsh/month.
� Students receive a daily stipend of 5K Tsh for each day of the academic calendar
year.
� A trainees’ salary is deducted 3% to cover mandatory government health insurance.
� Salaries of the medical staff are provided for by the Government of Tanzania.
Salaries of non‐medical staff at BMC are paid for by the hospital and Catholic Church.
PATIENTS’ MEDICAL BILLS
� The cost to open a file (which is needed to be cared for as a patient) depends upon
the mechanism of referral.
o Patients referred from a government hospital pay 2K Tsh to open a file.
o Patients referred from private hospitals or coming directly from home pay
10K Tsh to open a file.
� Operations costs 30K Tsh + per item expenses
� ICU care costs 10K Tsh/day
� A private room costs 5K Tsh/day
� For children < 5 y/o, studies performed and medications are free; children > 5 y/o
pay for studies and medications.
� The majority of patients do not have health insurance. Those employed by the
government have mandatory government health insurance. Private health insurance
is available but costly.
� Patients need to pay their medical bill prior to being discharged. Those unable to
pay their bill must meet with the social welfare office to prove that they cannot pay
and attempt to have their bill covered.
24

APPENDIX
SUPERMARKETS
� Bugando Convenience Store: Turn right out the gate of the guest houses. Walk 200
yards, and it is on your right side. Basic supplies. Also has a bar/restaurant with a
deck and view of the lake.
� SD: Closest in‐town market with more extensive supplies. Cab fare 2‐3K Tsh
� Lavena: On other end of block from SD. Less extensive than SD, but oftentimes can
find things there that SD doesn’t have
� U‐turn: Farthest away, but by far the best selection in town. Cab fare 5‐7K Tsh
RESTAURANTS
*Most places are outdoors, so be sure to wear your Ultrathon and long sleeves/pants*
� Hotel Tilapia: Good fish (try the whole tilapia) and Indian. Also has Thai selection
and Tepinyaki huts. Beautiful outdoor location on lakeshore. Cab 7K Tsh
� Ryan’s Bay Hotel: Good for Sunday brunch and otherwise very good, diverse menu.
On the water and left‐hand side just before you head down dirt road toward Tilapia.
� NSSF (Nyumbani Hotel): Rooftop pool w/ bar and gorgeous views of lake. Great for
after‐work or pre‐dinner drinks.
� New Mwanza Hotel: Good Indian. Cab 2‐3K Tsh
� Kuleana Pizza: Next door to New Mwanza. Good vegetarian pizzas, fruit salads, and
“brunch”
� Isimilo Lodge: Rough taxi ride or long walk through dirt roads of Isimilo, but pretty
view and good international fare once you arrive. Cab 7K Tsh.
� Tunza Lodge: Good fish and vegetarian options. Large indoor/outdoor bar area,
outdoor seating, beach, and sunset views. Cab 10‐15K Tsh.
� Diner’s: AMAZING Indian. Must try. Just around the corner from New Mwanza.
Cab 2‐3K Tsh.
� Yun Long Chinese Restaurant: Beautiful lakeside setting, but food leaves much to be
desired. Cab 5K Tsh.
� Binti Maringo: Mix of ex‐pats and locals. Supports program to help street children.
Also Maringo brand (made by young adults in the program) clothing and furniture for
sale. On right on airport road just after the last traffic circle in town. Cab 4‐5K Tsh.
� Malaika Hotel: Brand new in 2010, with gorgeous views and amenities that outshine
Tilapia (though Tilapia still has more character – Malaika is more like a large resort
w/ three different restaurants). Cab 15K Tsh.
RECREATION
Swimming
� Hotel Tilapia or Isimilo International School
Yoga/Workout
� Sunset yoga taught by local man, Mussa, at Tunza Lodge each Monday and Thursday.
� New Mwanza Hotel reportedly has small workout room. 1K Tsh fee.
25

Shop
� Hike Dancing Rock, the highest point in Mwanza with gorgeous views of the
surrounding villages and lake. On the road toward the airport. Taxi driver
Emmanuel should know how to get there.
� Large market in center of town has every possible fresh food item (fruits, vegetables,
grains, fish, meat) as well as an area for souvenirs (baskets, wooden items, jewelry).
� Better quality gifts are at the New Mwanza Hotel Gift Shop and just around the
corner (opposite from Diner’s) at Rafiki Women’s Centre. Best to support Rafiki
because it directly profits the artists and women’s causes.
� Additional gift shops are on the block just before you arrive at U‐turn (see map), as
well as a game shop with items such as fishskin wallets near the New Mwanza Hotel
� Mwanza is home to the Sukuma tribe, but there is a very small Massai population
here as well. You can find the Massai and their crafts and herbs if you turn left after
the Lavena supermarket and continue walking for ~1/4/mile
� Sunday market on the road near the U‐turn supermarket is more open air and
(somewhat) less crowded than the market in the center of town. Prices also can be
better.
Safari
� May be booked at one of the many safari companies (Fortes most popular), New
Mwanza Hotel, Tilapia Hotel, or Precision Air or Air Tanzania. About $300‐500/day
(includes guide, accommodation, food) and usually have 3 or 5‐day trip options.
Zanzibar
� Stonetown is an amazing, unique place—North Africa meets India meets tropical
island. There are multiple budget options available, and the best high‐end “treats”
are Serena and Swahili House. Note that if you want to take a day trip to a beach
resort, you will need to take a 2‐hour taxi ride from Stonetown (approximately $40
one‐way).
� If you’d rather forgo Stonetown for a relaxing resort on the beach, many people
chose the Northern resorts. The benefit of the Northern part of the island is that the
tide never goes in or out, so you can swim at all times of day. Lagewa‐Royal and
RasN’uungwi are the big hotels on that part of the island. Auwggu, Z‐hotel, and
Langi‐langi are mid‐range. Baraka, Jambo, and Paradise are of the budget price.
� Seif Tembo is one of the oldest and best‐known taxi drivers on Zanzibar (he even has
his picture in an old “Rough Guide” book). He speaks excellent English, has a very
safe driver with him, and is an expert on everything Zanzibarian (e.g. knows which
Spice Tours speak the best English). However, he tends to have very firm ideas
about what tourists visiting Zanizbar should do (i.e. can make your entire itinerary
for you – which some people like, and other people don’t). However, it honestly is
worth it to know you’re with a reliable, timely, and safe driver who won’t take
advantage of wazungu! His number is +255‐713‐620‐699 or 713‐620‐669.
INTERNET
� While staying at the Guest House, you will need to go to town (about 3K Tsh cab ride
each way) and use an internet café there.
26

o At the internet cafes, you may purchase time in 15/30/60 blocks.
� Cost is approximately $1/30 mins.
o The internet cafes are not fast enough to send large documents
(powerpoints, etc) or Skype.
o Tilapia Hotel is the most scenic and popular place to use the internet, and you
oftentimes can pick up a free signal rather than pay their usage fee
(approximately $2/hr).
� You also can pay 100K Tsh for a mobile broadband card from Vodacom, which will
provide unlimited internet from any location in Tanzania for the entire month.
o This only works with PC’s
o If you’re very lucky, you might make it work with an older MacBook.
o The Vodacom modem supports Skype audio (not video) at very low usage
times (approximately 3‐5 a.m. Tanzania time).
� The BUCHS library has some computers with internet capacity, but they usually are
full and not always fast. You also can use the wireless or ethernet hookups on your
laptop. If network usage is low at the time of your connection, it can be moderately
fast. However, the connection itself is not always reliable.
� If you have any trouble with your computer while in Mwanza, a good contact is Zahir
Virji at 0784‐74‐29‐28 or zahirvirji@yahoo.com
PHONES
MAIL
� During Standard (Daylight Savings) Time, Tanzania is 8 hours ahead of NYC
� Minutes are per‐paid: purchase pre‐paid cards (1‐10KTsh) at any canteen or store
with Vodacom sign. Easiest is Bugando Convenience store, where as a courtesy, they
often recharge it for you.
� Charging the minutes yourself: dial *104* immediately by code on the card you
purchased #
� Check remaining minutes by dialing *102#
� Text paging is approximately 50‐100 Tsh/page; calling can cost up to 1K Tsh per call
� To place a call:
o To call USA from Tanzania: 000 (exit country code) + 1 (country code) + area
code (3 digit) + number
� It is the least expensive to text someone in the United States (dial +1
and then area code and phone number) to tell them to call you.
o To call from USA to Tanzania: 011 (exit country code) + 255 (country code) +
area code (2 digit without the “0’) + number
o Calls within Tanzania:
� To land lines: area code (Dar Es Salaam 022; Mwanza 028) + number
� To cell phones: area code (most cell phone #’s start with 078, 075, or
071) + number
27

� Post offices in town near TTCL/New Mwanza Hotel and also at entrance to Bugando
Hospital.
� Most large hotels have a gift shop, which sells stamps and stationary/post cards.
� Standard mail to the United States usually takes 10‐14 days.
� There is no mailing address at the Guest House. If you need something mailed to
you in an emergency, best to ask Hilkka or Rob Peck for advice.
BANKING
� Approximate conversion: $1=1,300 Tsh
� Money exchange at New Mwanza Hotel is easiest (no lines like at banks), though
they exchange at a rate of $1=1000Tsh
� There also is a bank (National Bureau de Change‐NBDC) outside of the Bugando
Medical Center, where USD can be exchanged
� ATMs in Mwanza:
o VISA accepted outside of Bugando hospital at NBDC and CRDB
o Mastercard accepted at Stanbic Bank (main town roundabout/clocktower on
Nyerere Road) and Exim Bank (roundabout that takes you to Hotel Tilapia)
28

HEALTH AND SAFETY ADVISORIES IN TANZANIA
� Take your anti malarial medications daily and be wary of the symptoms of malaria
(fever/sweats, extreme fatigue, muscle aches, nausea/vomiting/diarrhea).
Malanone is 90% effective, but there still is a chance you could malaria despite the
prophylaxis. If you experience any of the symptoms above, tell one of the
attendings; they can write you a laboratory request for a blood smear.
o If you are MPS positive (1 or 2 parasites is a low number, but above 5 usually
warrants hospital admission), go to the Bugando Pharmacy and buy a 3‐day
Coartem course. You will begin to feel much better after the loading doses,
and the symptomatology (aside from residual fatigue day 4) should be mostly
gone after the course is finished.
� Use precautions to minimize insect bites (pants/long sleeves, keep windows or
screens closed at all times, use mosquito nets when sleeping). Wear Ultrathon on
exposed skin everyday, especially around dusk when there are the most mosquitoes.
o Also note that mosquitoes like to lurk on the surgical floors, operating
theatre, bathrooms, and operating theatre locker room.
� Use boiled/bottled water AT ALL times (+/‐ brushing your teeth, depending on how
immune you are to traveler’s diarrhea) WITHOUT ICE
� NO swimming in fresh water such as Lake Victoria, due to endemic Schistosomiasis)
� Swimming in the ocean/chlorinated pools is safe
� Do not hang any self‐washed clothes outside of screened areas. If you do so, you will
need to iron the clothes in order to kill mango fly larvae. (The larvae hatch when
exposed to body heat and bury into human skin.)
� It is recommended you take the stairs rather than “lift” (elevator) at Bugando. The
lift does not have a safety feature on the door and it is possible for body parts to be
smashed while the lift continues to move.
� BE CAREFUL when walking. Drivers in Mwanza do NOT stop for pedestrians, so look
both ways SEVERAL TIMES, cross very carefully, and watch for wayward drivers near
the sides of the roads.
� Lock your passport and any other valuables. It is not recommended you use credit or
debit cards on a regular basis, and most places in Mwanza only accept cash, anyway.
� There are many men running illegal orphanages in Mwanza, and will approach you to
visit or give money. They frequent tourist areas, particularly the pizzeria next to the
New Mwanza Hotel. It is best to say you’re too busy with your work at the Bugando
to visit their orphanage.
29

HOTELS IN MWANZA
The Serengeti Guest House is only for physicians (and even then, space is limited). There are
several hotel options for family members or visitors who accompany you to Bugando.
Special thanks to Dr. Johnson, Jen Downs, and Beatrice Im for the information contained
below.
Hotel Tilapia
� +255 28 2500517
� The premier hotel In Mwanza, located on the shores of Lake Victoria down a dirt
road approximately 15‐minute drive from Bugando. Tilapia has popular tiki bar
overlooking the lake, pool, international cuisine restaurant, Tepanyaki grill, and
magnificent sunsets.
o Full hot breakfast included. Wireless internet, satellite flat‐screen t.v., same‐
day laundry service, safe in rooms, hair dryer, and air conditioning.
o $85 for standard double bed, $120 for suite with king, double, and
kitchenette
New Mwanza Hotel
� + 255 28 2501070
� Located in the heart of town. Clean but very dated rooms. Several lobby gift shops,
good Indian restaurant, and nearby casino. 10‐minute drive from Bugando.
o Laundry service, in‐room phone, air conditioning, business center, small gym
o $80 for standard double, $120 for suite. 10% off for guest staying longer than
one week
Hotel Kembice:
� +255 28 2542267 email: hotelkembice@yahoo.com
� At bottom of Bugando Hill next to Lavena supermarket, this is the closest hotel to
the hospital. Treehouse feel with new rooms and thick mattresses. Lively bar and
understaffed restaurant.
o One computer with internet access available behind the reception desk for
2K Tsh/hr. Air conditioning in executive and VIP rooms. Cable t.v.
o $35 for standard double (fan but no a/c), $70 for VIP two‐roomed suite with
a/c
There are at least two brand‐new hotels in town (just opening for business; no websites
yet): Malaika (resort on the water near airport) and Ryan’s Bay Hotel (on the water near
Tilapia). Stay tuned for more information on these.
30

UPON RETURNING: REIMBURSEMENT
� Save all of your receipts
� Reimbursable items:
o Flights (save boarding passes)
o Visa
o Anti‐malarial prescription
o Work‐related expenses
� Overweight baggage on airplane (due to books/other supplies taken
to Bugando)
� Any receipts in Tsh require the USD exchange rate written on them for
reimbursement
� Upon your return to Weill Cornell, email Erin Byrt at emb2009@med.cornell.edu for
the Cornell Business Travel Form.
� WITHIN 15 DAYS OF YOUR RETURN DATE, the travel form must be filled out and
submitted with all original receipts to Shannel Grant, shg2013@med.cornell.edu.
Center for Global Health Weill Cornell Medical College 440 East 69 th Street NY NY
10065. Telephone 212‐746‐6680, fax 212‐746‐9744.
� You will be responsible for all other expenses including a room and board fee
charged by the Bugando Medical Center of $20/day.
� A 1‐2 page narrative is required which describes your experience, why you decided
to go to Tanzania and what you got from it; major positive and negative aspects and
would you recommend it to a fellow resident. Please elaborate on your teaching
activities. This should be submitted within 15 days of your return date along with
your reimbursement. Failure to submit this report will result in withholding your
expense reimbursement.
31

BUGANDO PHONE DIRECTORY
Bugando Administrative Office
Hilkka Abicht 073‐445‐ 4724 bugandohospital@gmail.com
Internal Medicine Cell Phone Numbers:
‐ Phone 1: 07‐862‐16‐067
‐ Phone 2: 07‐865‐12‐701 (has Arabic writing on keypad)
Mwanza Taxi Drivers:
Name Cell Phone English Fluency Comments
Emmanuel 075‐569‐5274 Good English Works until 7PM – takes either
Sat/Sun off. Very reliable.
Nelbert 078‐773‐2720 Limited English Most reliable. Works until 10PM
7days/week
Thomas 078‐795‐1790 OK English Works more at night
Joseph 071‐326‐3479
Deo 075‐476‐9396 Good English Works until late in the evening
Bugando Mwatex Serengeti Guest House Administrative Personnel:
Name Title Phone number Responsibilities/call for…
Dorethea BMC Project Manager 078‐490‐2781 In charge of staff at Bugando
guesthouse; call for problems &
maintenance issues.
Mr. Mkufi BMC Procurement
Manager (Super)
078‐750‐4370 Electric bill payment
Mr. Mbilinyi BMC maintenance guy 075‐443‐4536
Bugando Medical Center Attendings:
Name Title Phone/E‐mail Comments
Dr. Robert Peck Medicine Attending 078‐658‐5765
Very helpful in
(Med‐Peds) (Medicine liaison
from Cornell)
rnp2002@gmail.com
emergencies
Dr. Majinge Hospital Director
Prof. Magori 074‐445‐4724
Weill Cornell Center for Global Health
Name Title Phone # Call for… E‐mail
Dr. Warren
Johnson
Director 212‐680‐6680 wdjohnso@med.cornell.edu
Dr. Daniel Co‐Director 212‐746‐6680 Dwf2001@med.cornell.edu
32

Fitzgerald
Gladys
Rodriguez
Administrator 212‐746‐6317 Glr2007@med.cornell.edu
Erin Byrt Research Aid 212‐746‐9739 emb2009@med.cornell.edu
Shannel Grant Financial
Advisor
212‐746‐6680 Shg2013@med.cornell.edu
Other contacts
Name Title Phone Comments
TTCL: Lucas (boss) TTCL Manager 073‐480‐7947 If interested in
Main Office: 028‐ completing setup of
250‐1551
internet & phone
access at Serengeti A
Guesthouse
Manase BUCHS‐BMC Driver 075‐589‐3695 Does airport pickups
& drop offs. Needs to
be arranged for you.
TOUCH Personnel (Tanzania):
Name Cell Phone Call for… E‐mail
Liz Pavlovich 078‐772‐0622 Liz_pavlovich@mckinsey.com
Feizin Amlani 078‐721‐1847 feizin_amlani@external.mckinsey.com
TOUCH Personnel (Main office in NYC):
Name Phone #’s Call for… E‐mail
Meaghan Johnson C: 917‐892‐7032
P: 212‐446‐7355
F: 212‐446‐7080
Meaghan_Johnson@mckinsey.com
33

EMBASSY INFORMATION
US Embassy in Tanzania
� Location: 686 Old Bagamoyo Road, Msasani, Dar es Salaam
� Mailing address: P.O.Box 9123, Dar Es Salaam, Tanzania
� Telephone: [255] (22) 266‐8001 ext. 4122
� Fax: [255] (22) 266‐8247
� Email address: DRSacs@state.gov
� Hours of operation: M‐Thr 8AM – 4PM; F 8AM‐10AM
� Closure dates: official American and Tanzanian holidays as well as the last
� Wednesday of each month
� Emergency consular services are available 24/7 to Americans & their families
� In distress due to illness, destitution, arrest, crime, death or disaster @
o [255](22)266‐8001 ext. 4122 during working hours and @
o [255](22)266‐8001 ext. 4111 when the Embassy is closed
� Services: information for travelers, legal assistance, public services, medical assistance,
report birth abroad, federal benefits, passports, crisis abroad, death of an American
abroad
� The Embassy does NOT offer any visa services
Tanzanian Embassy in NYC
� The permanent representative of the Republic of Tanzania to the UN
� 201 East 42 nd street, Suite 1700
� New York, NY 10017
� TEL. 212‐972‐9160
� FAX 212‐682‐5232
� Please see Visa section for hours & further details RE visa application.
34