Här nere i Moshi jobbar jag på St. Joseph Council Designated Hospital. Det är ett ganska stort sjukhus (i tanzanianska mått mätt, går liksom inte att jämföra med typ Salgrenska) som varje dag tar emot och behandlar mellan 300 och 400 patienter. St. Joseph är ett kristet sjukhus där många nunnor arbetar men självklart tar det även emot patienter som inte nödvändigtvis är kristna. Varje morgon inleds med ett morgonmöte där läkarna kan diskutera speciella fall (herr om dagen var det om patienter som blivit ormbitna, om jag blev nojig? Ja!) Eller andra saker som händer på sjukhuset. Under det här mötet ber man också ”prayer for peace”, det är ganska fint.
För att få bli patient på sjukhuset behöver man köpa en journal som kostar 50 000 shilling, alltså ungefär 250 SEK, och man får heller inte köpa sina mediciner på några andra ställen än i sjukhusets apotek, trots att de tar nästan dubbelt så mycket betalt än andra apotek inne i Moshi. För att förhindra att folk ändå köper sina läkemedel på andra ställen så får patienterna inte veta namnen på medicinen som de behöver. De måste också köpa egna sterila handskar som vårdpersonalen behöver vid gyn-undersökningar och vid förlossningen, inga handskar – ingen undersökning. Som patient betalar man även för sin sängplats och det kostar 250 000 shilling (125 SEK) och många av kvinnorna på min avdelning delar då säng med en annan för att hålla nere kostnaden.
Byggnaden med avdelningarna är den högsta byggnaden i hela Soweto och har tre våningar. På baksidan finns det även en ramp så att folk som inte kan gå kan rulla upp istället. Min avdelning – mödravården, är på markplan. Där finns det ca 30 sängplatser och alla sover i en stor sovsal. Den första våningen är en avdelning för män och är uppdelad i två – en medicinsk sida och en kirurgisk sida, båda dessa sidor har ca 20 sängplatser var. Den andra våningen är precis likadan som den första fast för kvinnor. Och den tredje våningen är för barn. Men istället för att dela in den i medicinsk och kirurgisk är den uppdelad i diarré och medicinsk/kirurgisk. På barnavdelningen får man vara upp till 11 års ålder och det spelar ingen roll vilket kön du har.
Bortsett från vårdavdelningarna så har även St. Joseph ett laboratorie och provtaging, röntgen, akut (och flera högutrustade ambulanser) och två operationssalar. I dessa två operationssalar görs de flesta ingrepp – allt ifrån kejsarsnitt och skrapningar till att operera bort tumörer. Trots att jag inte varit med på någon operation ännu så har jag hört från andra volontärer på sjukhuset att det ska vara så långt ifrån nordisk sjukvård man kan komma. Till exempel så får patienterna nästan aldrig tillräckligt mycket anestesi, det börjar ofta med att patienten rycker till och rör på vissa kroppsdelar till att sedan börja skrika av smärta innan läkarna reagerar och ger mer narkos. Och i den andra operationssalen är väntrummet inne i samma sal så medan läkarna opererar en patient så sitter det fem andra patienter på en bänk och väntar på sin tur.
Komplikationer efter operationerna är också vanligt. Det jag sett mest av är kvinnor som tidigare gjort kejsarsnitt och som under deras andra graviditeter inte kan föda vaginalt längre på grund av för stora ärrvävnader och som även kan göra att fostret eller bebisen får onormala kroppsformer (tex huvuden som är mer lika honungsmeloner än vanliga huvuden). Det är också vanligt med infektioner i sår och att dom inte läkt och vätska sipprar ut ur såret.
Det här med privatliv är inte heller så där jättevanligt i Tanzania och i förlossnings rummet finns det tre sängar med en liten vägg imellan. Jag tycker ju lite synd om den patient som måste ligga i mitten sängen där dörren är rakt framför och personalen springer fram och tillbaka hela tiden eller som har fem volontärer över sig som ska titta, känna och klämma på allting.
Trots att St. Joseph skiljer sig väldigt mycket ifrån svensk sjukvård så gör de så gott de kan med de resurserna de har och det är ett väldigt fint sjukhus med en innergård och personal som vill lära ut. Något som de jobbat väldigt mycket med under de senaste åren är att försöka övertala kvinnor att inte föda i hemmet då det är en stor riskfaktor och det har gett bra resultat då de flesta kvinnor nu för tiden väljer att åka till sjukhuset istället när förlossningen väl sätter igång. 
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If you’re still on the fence: grab your favorite earphones, head down to a Best Buy and ask to plug them into a Zune then an iPod and see which one sounds better to you, and which interface makes you smile more. Then you’ll know which is right for you.
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Sorry for the huge review, but I’m really loving the new Zune, and hope this, as well as the excellent reviews some other people have written, will help you decide if it’s the right choice for you.
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