More on the 10th Ilula Minnesota Healthcare Conference

 Thursday and Friday were devoted to presenting our tenth annual Ilula Minnesota International HealthCare Conference.  Starting in 2014, Shoulder to Shoulder has presented the annual conference for our colleagues in Tanzania.  All our presenters did a great job and all the healthcare professional teams that attended gave positive feedback and will return to their hospitals with quality improvement ideas to implement based on what they learned. We are in the process of compiling the feedback from the evolutions, but the initial informal feedback has been overwhelmingly positive, both from attendees and presenters.

Our first course was presented in January 2014 with 30 attendees.  Based on extremely positive feedback from the initial conference, our partners in Tanzania encouraged us to significantly expand the conference to offer this educational experience to a much larger audience of caregivers.  As a result, we expanded the conference to include all 26 Southern Zone Lutheran Hospitals and the program has grown to include 130 healthcare professionals.   From each hospital we invite one doctor, one nurse, one pharmacist, and one administrator. 

Our conference is based on 5 principles:

1. Lifelong Learning.  We believe all professionals should contribute to a culture of learning and continuously learn to improve our practice.  

 2. Interprofessional teamwork.  We include nursing, pharmacy, administrators, and physicians in both the attendance and presentations.  We emphasize teamwork throughout the conference.  We each bring unique knowledge and skills to share; specifically Tanzanian presenters emphasize tropical medicine and HIV, American presenters emphasize the growing global problem of chronic and non-communicable diseases.

3. Mutual Respect.  We emphasize the ability for all our participants to teach and learn from each other, in spite of our differences in practice setting, culture, and socioeconomic situation.  We include local leaders in planning the conference and select topics based on feedback from participants.  Presentations are delivered by both US and Tanzanian professionals.  The program is based on a foundation of a longstanding and ongoing relationship. The second day of the conference was clinical talks delivered entirely by Tanzanian health professionals. 

4. Continuous improvement.  Learning should drive improvement in practice.  This year we devoted the entire first day to learning about quality improvement. 

5. Sustainable Impact.  We believe that education and improvement are some of the most valuable ways to promote a sustainable positive impact on the health of our partners’ communities.

Our conference is accredited by the Education Department at the Fairview to provide participants with educational credits for participation in this program.

Funding for the course is provided through generous contributions from several foundations and individuals including Global Health Ministries, The Peter J King Family Foundation, and Fairview Health System. All funds raised go entirely to hosting the conference, and support for local Tanzanian staff to attend, including meals, travel and lodging expenses.  We want to thank all our donors for their generous support. I would also like to thank fellow Course Directors Dr. Mufwimi Saga and Fr Manfred Mjengwa, Shoulder to Shoulder founders Randy Hurley and Gary Moody, Ken Olson, and all the presenters for all their hard work and critical contributions.  Special  thanks to Cindy Wilke, Shana Steinbeck, and Judith Kiliani for presenting on quality improvement. 

We believe that fostering leaning through the conference principles is one of the important ways we can improve the health of the population in and around Ilula. Overall the conference was a great chance to learn together, build relationships, and plan together to improve healthcare in Tanzania.

State-of-the-Art Wastewater System

On the first day we started our hospital tour at the decentralized wastewater treatment system(DEWATS). What a complex, state-of-the-art system!

Mr Kikoti, Dr Malamala and Dr Petro led us to the DEWATS site at the bottom of the hillside below the guesthouses and nursing dormitory. Oscar Mbekenga, CEO of Obsen Environmental Engineering in DAR, explained the construction and operation of the system. We learned that he had been trained in Europe so that may explain his knowledge and skills for the sophisticated 3 stage waste treatment system.

Oscar showed us the nearly completed first treatment stage. The raw sewage enters two oval biogas chambers and methane producing organisms digest the organic material to produce methane gas. A biogas outlet pipe transports gas to be used in the hospital to heat water or any other combustion purpose. Next, we could see where water will overflow into a multi-chamber, baffled settler where remaining solids settle and treated water continues. 

He then walked with us to see where water will overflow into a yet-to-be-built root treatment system of a planted, gravel filter for final treatment to make it suitable for agricultural irrigation. 

The result will replace the century old, minimally functioning septic tanks with a system that protects the ground and water from contamination, produces methane gas for heating needs of hospital and ends with treated water for irrigation. 

Our group asked many questions to clarify details and Oscar was able to answer them all. 

For me personally, I feel a bond with Oscar because he and I shared frustrating problems in getting the first wire transfer of funds to get to his bank account. We can now laugh about tens of  thousands of dollars held in the SWIFT banking system for 2 weeks but at the time it was a quite a scare. Subsequent banking adventures had no drama. Meeting Oscar in person and hearing his detailed explanation of the system was a great experience!

Kent

Ilula-Minnesota International Medical Conferece

 

The Ilula-Minnesota International Medical Conference, held in Iringa, Tanzania, brought together doctors, nurses, pharmacists and administrators from southern Tanzania Christian hospitals and the U.S. to talk about healthcare advancements and share knowledge. Held over two days, attendees learned about a quality improvement model, tools, and advancements in specific healthcare practices. I’ll let one of the doctors in attendance describe the specific health care practices. In this blog, I’ll talk about the specifics related to administration.

The first day of the conference was all about the quality improvement model and learning about and using process improvement tools such as pareto, run and flow charts. Most participants were new to this methodology and tools. Key themes included keeping it simple, starting small and expanding, recognizing that all improvement requires change, and viewing all work as a process.

On the second day of the conference, I led a break-out session of the administrators – attended by approximately 30 individuals. In our break-out session, we discussed topics that were highly relevant to all the hospitals. Our topics were: competition, insurance denials, compliance with electronic medical records, new streams of revenue, customer care and quality improvement.

Competition

Competition is recent in Tanzania, especially the rural area. The government built health care facilities throughout the country, often close to existing faith-based health facilities. The facilities are new and fully staffed due to the government’s higher salaries and reported lax management style.

We discussed that faith-based facilities have a competitive advantage because the community trusts them, and they offer prayer to patients, families, and staff. We focused on using this new competition to improve care and service to the community. SafeCare is an internationally accredited standard for resource-restricted settings. As members of the Christian Social Services Commission, a SafeCare self-assessment tool is available free of charge to the hospitals. Many of them believe they will try this new tool.

New Revenue Streams

Participants shared examples of new revenue streams that they were exploring, like adding specialty doctor services, reducing the amount of denials from the claims submitted to the National Health Insurance Fund, and producing agricultural products like maize, trees, sunflowers, and goats. The discussion was especially welcome as the hospitals shared how they had worked to overcome pitfalls in beginning and operating these new ventures.

Conclusion

In conclusion, the Ilula-Minnesota International Medical Conference provided a valuable platform for knowledge exchange, networking, and innovation, paving the way for a more collaborative and resilient global health community.

Cindy Wilke

Eight Days in Tanzania: The Tungamalenga Dispensary

The Hurley family (Randy, Kari, daughter Angela and 7 yr old grandson Wyatt) were in Tanzania 10 days before the medical group arrived to coincide our visit with Wyatt’s Christmas break schedule. We were able to visit Barnabus Khawage, the recently retired clinical officer at the Tungamalenga Dispensary. The new clinical officer is Dr Asajili Sanga; Dr Asajile was born and raised in Ilula Tanzania and is a graduate of the Ilula Clinical Officer training school. As it is here in the USA, it often is hard to attract health care professionals to serve in rural locations. In the USA, as in Tanzania, most training programs are located in urban areas and once finished with training, it is often difficult to attract health care professionals to practice in rural locations. One of the original goals of the Ilula Health Institute was to identify local students, train them locally then have them serve locally in rural dispensaries operated by the Tanzanian Lutheran Diocese. Mission accomplished: Dr Asajile is a great example of that philosophy in action! Tungamalenga is paired with Shepherd of the Valley Lutheran Church in Apple Valley: they recently completed construction of a lab at this dispensary.

Randy and Kari Hurley

Dr Asajile at Tungamalenga Dispensary

The recently constructed outpatient lab

Examples of lab tests available: (for comparison Tsh 2500 is approximately USD $1) UPT: urine pregnancy test; Widal test is a typhoid test; MRDT (Malaria rapid diagnostic test) and HIV testing are provided by the government at no cost

Meet Happy

 It is finally my turn for jet lag to kick in as I lay restless in my bed. I guess it is a good time to post to the blog. I’d like to tell you about Happy, the social worker at Ilula Hospital. Ilula Hospital is a faith based institution and is the reason for Happy’s pull to this place. She started at Ilula as a community officer and went back to school to obtain her bachelors degree in social work. I admittedly did not know much about social work in Tanzania and was inspired by how she leads and drives every decision with her super big heart. A very caring heart. She is compelled to advocate for the children and specializes in social work for children who experience abuse (sexual, physical, emotional, neglect).  On a typical month, she helps find a safe home for 15-40 children. Yes, each month! 

I had the opportunity to hop into the hospital vehicle with her and a few colleagues Meade, Diane and Katelyn. The vehicle fit 2 people in front, three in the middle row and one “seat” in the way back (the back did not have a seatbelt and Meade graciously took that spot and was an amazing trooper along an extremely bumpy ride). We drove about an hour and a half east of Ilula into the mountains, driving along a congested highway of truckers (and some monkeys!). Happy brought us to a region called Nyanzwa ward and we stopped to pick up the chief of police from Ruaha mbuyuni police station. Her name was Umpendo. The two of them have been partnering together since 2019 to educate the community about child abuse, the laws that pertain to it, and how to safely report. We continued another 30 min down more bumpy roads to the schools. The duo spoke at 4 schools (elementary and middle school aged) and educated the children with songs (No Touch-y Touch-y) and teachers (stern reinforcement of the Tanzanian law). We ended our day in jail. No, not locked up but rather to see Umpendo’s police station that she governs.

Happy is an important person at Ilula Hospital. Her services are needed in this community and is yet another way for Ilula Hospital to continue to serve its patients, including those who do not have a voice. She has a goal to return to school for her masters degree. When asked why, she of course brought it back to the children of Ilula area and how to better serve the hospital. She hopes a masters degree with increase her knowledge of Tanzanian law to better represent the Ilula children in court. In addition, she hopes to bring government supported research to the Ilula area, looking into areas of child abuse. 

Happy is all heart and a critical role to the Ilula Hospital team. I was so glad to be able to get a small glimpse into her work and share memories with everyone along for the bumpy ride to the villages. 

Shana

Heartwarming hospitality

 A group of us (Kent, Cindy, Jennifer, Alan and Diane) traveled to Ihimbo Dispensary (medical clinic) today.  We were joined by Dr. Petro, Secretary of Health for DIRA (the Iringa Diocese) and Kirsten Levorson, Director of Bega Kwa Bega. We were warmly greeted by staff and given a tour and an update of the current usage of the Dispensary. This was personal for Alan and me, since Alan’s parents, Will and Jan Carlson, helped fund the facility, which was expanded and dedicated in 2009. Sixteen years later, the rooms are clean, records are organized and the facility is well maintained. We were impressed.

As moving as the arrival at Ihimbo Dispensary was, the best was yet to come. Next up was a service at the church at Ihimbo, where pastors and many church members gathered to extend their hospitality and appreciation for having the medical facility available to them. Alan and I were truly humbled and in awe of their gratitude. We were treated to the gift of song by two different groups. At the end, our entire group was given gifts from the local people to show their gratitude. Next up was lunch at the pastor’s house, prepared and served with love by community members.

It is hard to put into words all the emotions of today. People are people, no matter our skin color, nationality or financial status.  To respect each other and show love and gratitude is a a gift. I am joyfully overwhelmed and pray to show love and gratitude to others as we were shown today. 

Diane 

“We live well together” - Meet Dr Mussa Nguva

This post is dedicated to Mussa Ngova and his role in patient care at Ilula Lutheran Hospital. As the solo dentist in our group, I. have had the privilege of spending most of the past two days in the one room dental clinic, with dental therapist Mussa Ngova. 

Immediately, as we had our first few discussions and patients, it was clear that Mussa is engaging, witty, and very knowledgeable. As the hours continued, I observed his deep compassion and empathy for his patients, and his skills as a clinician. He has been at Ilula Hospital since 2014, and upon asking him what has kept him staying there so long, he answered simply: “we live well together.” I was a little confused at first, I had to clarify… he then explained that he has a great relationship with his coworkers and the leadership at the hospital, that he is happy to be a part of the team caring for his patients alongside the other department providers. He spoke also about his passion for oral health education; in Tanzania, preventive dental care (routine twice yearly exams/xrays and cleanings as we have in the US) is not available/practiced, rather patients appoint only when they are having pain. And so we both agreed that “patient education is the prevention.”  He desires to do more in person outreach to the surrounding villages to educate on oral health and prevention methods, but he said the funding to do this (paying for transportation, gas etc) just isn’t available right now. 

As we spent the morning with his patients, I observed Mussa functioning as a dentist would in the US - examining, diagnosing, and then completing treatment (local anesthetic and extracting teeth) and writing prescriptions/giving post op instructions. But unlike in the US (with a team of reception and dental assistants) he also charts, sets up and cleans up after each patient, and sterilizes the instruments. And he does ALL of this for every patient BY HIMSELF - he is the only person in the dental clinic. This alone is a feat - it is grueling work without a break - and he had a very steady and busy stream of patients both days. On top of this, include the emotional drain of caring and calming each very anxious patient; he spent time re-assuring his patients and was empathetic. Side note - yes! in case you were wondering, fear and loathing of the dentist transcends cultures 😂.)  We were both also curious about many things, and asking each other lots of questions, and this definitely added more to his plate.     Lastly, and of most impact, is that Mussa’s working with vastly different resources and technology than what you would find in a typical dental office. 

And yet, Mussa did this all with SO MUCH JOY. And I kept thinking, he has worked hard caring for patients and “lived well together” with the Ilula Hospital team for 10 years - what an amazing health care provider, with such an incredible contribution to the Ilula community.