1
HEALTH CARE ABROAD
Iringa Regional Hospital
Projet d’intégration en sciences
IRINGA, TANZANIA
This project was written
both in French and in
English since we are
graduating
from
an
International program at
Collégial
International
Sainte-Anne de Lachine

During the month of
April and May 2013, we had
the chance to travel to Iringa,
in Tanzania, for a premedical internship at the
Iringa Regional Hospital. The
placement was done through
the organization Gap Medics.
This was truly a valuable
experience, during which we
have learned a lot about
many
departments
in
medicine. Also, it was an
eye-opening experience that
allowed us to discover a
whole new health care
system that is quite different
than the one in Québec.
Ce projet est écrit en
français et en anglais
puisque nous graduons3
d’un cégep international
au Collégial International
Sainte-Anne de Lachine
Médecine - Système médical
Lors de notre séjour en Tanzanie, nous avons
eu la chance de suivre plusieurs médecins dans
divers départements. Ainsi, les informations apprises
durant ce stage sont diversifiées et sont regroupées
dans ce document en différentes capsules qui tentent
à la fois d’expliquer ce que nous avons appris et de
comparer brièvement des caractéristiques de notre
système de santé et celui de Tanzanie. Il est possible
de retrouver des capsules sur le cheminement
nécessaire pour arriver à un diagnostic, les différentes
maladies traitées, des informations sur le
département d’obstétrique et différentes facettes du
VIH que nous avons pu observer dans les
départements.
2
Index
Introduction…………………………………………………………………………….………1
Présentation de l’équipe……………………………………………………………………….2
A Day to CTC……………………………………………………………………………….3 - 5
Mother-To-Child Transmission of HIV/AIDS…………………………………………6 - 11
Prevention of Transmission of HIV…………………………………………………….12 - 17
Un manque de ressources influençant la pratique………………………………… 18 - 23
Les principales maladies et les ressources mises en place pour les patients………24 - 26
En conclusion………………………………………………………………………………….27
Références………………………………………………………………………………….28-29
3
THE TEAM
Authors of this work
I have currently graduated from collegial SainteAnne de Lachine in health science. Biology and
chemistry
are
two
subjects
that
I
find particularly interesting. I believe that the human
body is an incredible and wide field of study that I am
passionate to learn all about. I would like to continue
my studies in university in the domain of health science
and medicine. I love to travel and I am happy that this
project will allow me to do so. I am hoping to learn
more about the science, cultural and social aspects of the
country during this project.
I personally believe that this placement has
brought me so many positive things. To begin, I am very
fortunate to have had the change to visit a new country.
Since I love learning about cultures and traveling,
discovering Tanzania and its rich culture was a blessing.
In addition, it is inevitable that the internship was an
amazing learning experience. Not only will it help me in
my future studies and profession, but it was also a huge
eye opener. I will never forget this experience and I am
grateful for all I have learned and the friendships I have
made.
I am a student at Collégial international SainteI am
a student
Collégial
international
Sainte-Anne
Anne and
I am
finishingatmy
last year
in health sciences.
and I this
am finishing
last year
in health
I chose
this
I chose
program my
because
the two
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courses of
it;
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chemistry,
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since my
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chemistry,
interested
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since
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high
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years.
years. In a few months, I will be studying neurosciencesIn a few
I will beat
studying
neurosciences for my undergrad at
formonths,
my undergrad
McGill University.
McGill University.
This internship was a once in a life time
experience.
ThisI learned
internship
so much
was a about
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timebody,
opportunity. I
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things
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and I met different
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different
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4
A DAY AT THE CTC
As it is known, HIV/AIDS is one of the leading viruses in Africa. During the
placement in Iringa, I have come to notice the importance of the presence of this virus.
Iringa ranks on the list with the highest infection rate of HIV/AIDS within the country. It
has become clear to everyone that immediate attention should be given
to this continuously growing epidemic.
Next to the Iringa Regional Hospital, there is the CTC clinic.
This department has a main focus on HIV/AIDS patients. In this
clinic, the patients must always sign in and out, see a counselor, have
a periodic visit with the doctor and finally pass by the pharmacist
whom is also present at the clinic. This CTC clinic is open for
children, women and men. All HIV patients are referred to the CTC
clinic. Nevertheless, it is common for patients not to show up to the
clinic for many reasons. The different steps of the CTC program will
be explained more in depth in the following paragraphs.
To start, by signing up on entrance to the clinic, it is possible to keep track of the
visit history of each patient. The staff will be able to know if the patient is in fact attending
the clinic and if he or she is coming back in time for the suggested date of visit by the
doctor. Also, it allows to keep a data of how many infected patients are getting the
appropriate care and treatment. This data can be used for research and statistical projects.
To continue, we could all agree on the fact that education is key in life. Through
education, awareness is built amongst the population. In the case of HIV/AIDS, without
the presence of an education of the virus, the transmission will inevitably grow. In Iringa,
the individuals have access to complementary counseling sessions with professionals at
the CTC. During these sessions, information about ways to prevent the transmission of the
disease is offered. Some prevention methods will be explained below.
5
In addition, during each visit, the patient must consult a doctor whom will
undergo a general evaluation of the patient and the progress of the virus. Also, the
doctor will prescribe and renew the appropriate medications for HIV infected patient
and will suggest steps to follow in order to keep the patient in the best possible shape.
Following the consult with the doctor, the patient passes by the pharmacy that
will give him the medication earlier prescribed by the doctor. The treatments consist of
ARV prophylaxis and ART, which are explained in the following sections: MOTHERTO-CHILD TRANSMISSION OF HIV/AIDS.
6
MOTHER-TO-CHILD TRANSMISSION OF HIV/AIDS
HIV during pregnancy is one of the indirect causes of
maternal mortality. It can affect the mother by lowering her
QuICK SWAHILI
QuICK
LESSONSWAHILI
LESSON
immunity, which increases the risks of infection and may also be
the cause of a stillbirth.
During our placement, we have heard several times
doctors speaking about MTCT: Mother-to-Child Transmission of
HIV/Aids. It was drawn to our attention that many infants each
year are indeed infected with this virus before, during or after
giving birth. Without the PMTCT services, 5-10% of infants are
Welcome- Karibou
Hello- Mambo
How are you- Habari
infected during pregnancy, 10-15% while delivery and 5-20%
after delivery, while breastfeeding.
Luckily, there is the presence of PMTCT services in many
facilities, which stands for Prevention of Mother-to-Child
Transmission of HIV/AIDS. In fact, UNICEF recorded in 2010
that 90.4% of ANC (Antenatal Care) facilities offer PMTCT
services. The issue rises from the fact that not all pregnant
women attend the ARC facilities. According to the data collected
Good- Nzuri
Thank you- Asante
Please- Tafadhali
Sorry- Samahani
Goodbye- Kwaheri
by UNICEF in 2010, around 92% of pregnant woman had at least
one visit to the ANC. However, only 43% of these women had at
Consectetuer:
least four visits to an ANC facility. The presence of PMTCT
services reduces the risk of MTCT by offering counseling, testing
and medical services. Below are some examples of services
offered in order to reduce the risk of transmission.
To begin, the PMTCT services include testing for HIV in
pregnant woman. UNICEF recorded in 2010 that 86% of of
pregnant women were tested for HIV. Therefore, the remaining
14% of women whom have not tested might transmit this virus
by simply not knowing if they are indeed carrier of the virus
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7
(Continuation)
and therefore not taking the measures necessary to protect the infant. Hence, the importance of
frequent visits to the ANC is undeniable as it offers guidance and help necessary for a pregnant
woman to protect her infant, as much as possible, from the risk of transmission of HIV/AIDS.2
PMTCT- Drugs and treatment
To continue, pregnant woman are offered antiretroviral therapy (ART) and antiretroviral
(ARV) prophylaxis as treatment. These medications are free of charge for all pregnant women in
Tanzania. The role of ARV drugs are mainly to slow as much as possible or block the replication
of the HIV virus, to boost the immune system by increasing the body’s ability to fight the HIV
infection and finally to minimize the viral load (amount of HIV in the blood) in the body. In fact,
HIV attacks healthy cells in the body such as T-cells and CD4 cells, which are essential in the
human body to overcome diseases and infections. Therefore, the immune system of an HIV
patient is compromised. Hence, it is important for the ARV drug to also play a role in insuring a
boost in the immune system. The ARV drugs interfere with either proteins or enzymes. The target
proteins and enzymes are the ones that are used to make copied of HIV inside the body’s cell by
HIV itself. Drugs must be used in order to minimize the replication of HIV itself, which will allow
saving healthy cells in the body from being attacked. To insure the best treatment options, ART is
offered to patients living with HIV. The ART therapy signifies that the patient must take a
combination of at least three ARV drugs. This method has been shown to be very effective. It
offers a long-term effectiveness in comparison to the ARV drugs taken alone. Hence it is also
know as HAART: Highly Active Antiretroviral Therapy. The combinations are also key in
prevention of a situation of drug resistance in the body. It is the doctor that decides on the
treatments, as there are many options of drug combinations. Over the last few years, many
treatments have been used. Thankfully, progress has not stopped and ART is now a highly
recommended treatment due to its effectiveness in suppressing the HIV viral replication and to
slow down the progress of this disease. The different treatments offered allow to expand the life
of the patient and to reduce risks of transmission to a partner or to an infant. Also, infants whom
are HIV exposed also receive these treatments in order to minimize the risks of transmission of
the virus.
There are four main groups of ARV drugs that attack the virus in a different and specific ways.
Here is a list of the four groups with a small description of each one:
4. NRTIs

Stands for: Nucleoside Reverse Transcriptase Inhibitors

Reverse transcriptase is an enzyme that is essential for
If
HIV to reproduce itself and to infect healthy cells in the
body. Therefore, NRTIs inhibits these reverse transcriptase
enzymes that work in favor of HIV. Furthermore, the
NRTIs stop the completion of the HIV DNA chain, hence
not allowing the HIV to replicate in a cell.
3. NNRTIs

Stands for: Non- Nucleoside
Reverse
Transcriptase
Inhibitors

a
woman
has
not
previously been tested for HIV and is
tested positive during labor, she must
take a combination of two drugs:
Nevirapine (NVP) and Zidovudine
(ART).
1. PI

Stands for: Protease Inhibitors

To begin, protease is an enzyme used to cut down
NNRTIs mainly play a role
proteins. However, HIV also uses it for the purpose
in inhibiting the conversion
of self-reproduction. These protease used by HIV
of HIV RNA into HIV DNA.
have a specific role of breaking down proteins and
NNRTIs differ from NRTIs
by the way they bind to the
cell’s Reverse Transcriptase.
By blocking the conversion,
NNRTIs allow to slow or
stop
the
spread
and
duplication of HIV.
2. Fusion/Entry Inhibitors

enzymes in smaller pieces. These smaller pieces
become the cause of infection of other cells. As the
name indicates, PI inhibits the HIV protease. This is
done prior to the protease break the protein and
enzyme, stopping the their fragmentation. What is
interesting about PI is that they have the ability of
working on cells that are already infected.
Fusion/Entry Inhibitors block HIV from entering healthy cells. This fourth
group differs from the three groups listed above as it interferes before the entry
and infection of HIV in a cell. These inhibitors attach themselves onto a protein
found on the surface of HIV. This protein is called gp41. Thanks to these
inhibitors, gr41 proteins are blocked; hence the HIV looses its ability to fuse
with the cellular membrane. Therefore, HIV cannot entre the cell and
reproduce. 3
9
PMTCT- Labor and birth
Despite the presence of PMTCT services in most
ANC, some pregnant women still entre the maternity
ward with an unknown HIV status. This was the case of a
few women at the OBS and GYNAE ward while we were
shadowing a doctor at the Iringa Regional Hospital.
Luckily, the hospital offers the blood count necessary to
find out the serostatus of the patient. This is essential to
help the health care professionals determine the right
obstetric procedure to reduce all risk of transmission of the
virus. Therefore, PMTCT services are also offered in
maternity wards. This will minimize the chances of transmission of the virus to the infant.
A mother that is HIV positive must stay strong during her pregnancy in order to protect
the baby. Therefore, she receives complementary medications for prevention of malaria
and to raise her hemoglobin levels. To continue, the placenta plays a big role in transfusion
of the virus from a mother to her child. Micro transfusion of blood from the mother to her
infant is indeed done via the placenta. Therefore, an
infection or the parasites of can weaken the placenta,
allowing the blood to be transfused to the infant.
Hence, the HIV virus can be transfused to the fetus. It
is also the case in which strong uterus contraction can
rupture a part of the placenta and allow blood flow.
Also, a prolonged rupture of membrane can increase
the chances of transmission through the infant’s
exposure to the mother’s blood or cervicovaginal
secretions to the infant. Therefore, the health care
professionals must be ready to deliver the baby at any
given moment where the risk of transmission is important.
4
After delivery, it was
explained by a midwife at the Iringa Regional Hospital that a baby born from an HIV
positive mother must immediately take prophylaxis. After a few weeks, if the baby is
tested positive for the HIV virus, he or she will need to start treatment instead: ART.
10
PMTCT- Breastfeeding
It
is
know
breastfeeding
in
circumstances
beneficial
that
normal
is
to
very
an
infant’s
development. However, in the
case of a mother that is HIV
positive, breastfeeding could
be of a great challenge and can
be
the
cause
transmission
child
of
of
the
mother-to-
transmission
of
HIV/AIDS. After giving birth,
the mother has two options when
it comes to feeding her child: exclusive breastfeeding for six months or only giving her
child formula. To begin, it is obvious that a child fed with formula eliminated the risks of
transmission of HIV through breastfeeding. However, not all families in underdeveloped
countries can afford to buy formula. Also, some individuals living in rural areas do not
have access to sanitary food or drinks, causing a baby’s health to be at risk because of
infections and malnutrition. Therefore, breastfeeding might be the only option certain
mothers. However, if the mother and the infant are on ART, the risk of MTCT while
breastfeeding is decreased. As mentioned earlier,
the breastfeeding must be exclusive for 6 months.
In fact, mixing breast milk with other food might
injure the infant’s gut. Once the gut is injured, the
body of the baby is more susceptible of invasion of
the HIV virus. All in all, the mother must
consciously
choose
between
formula
or
breastfeeding while taking into consideration her
ability to provide adequate nutrition and the
11
Summary- Strategies to avoid MTCT
To sum up, there are a few strategies that are in
favor
or
reducing
the
risk
of
Mother-To-Child
Transmission. To name a few, prevention education is
essential for the mother and family members to know the
measures that must be taken to insure a good health of
their infant. Also, it is important for the mother and the
child to receive the appropriate treatment decided by the
doctor. Finally, the mother must receive professional
care at a medical institute during delivery to reduce
MTCT during labor and birth.
12
PREVENTION OF TRANSMISSION OF HIV
In Iringa, we have learned that many services are offered to the population in order
to reduce the transmission of HIV, especially after being named as the top prevalence of
HIV. To begin, family planning consults are available, free of charge, at local Health Care
centers. This service offers counseling on protective measures, reducing the amount of
partners and abstinence as well as free contraceptive pills and condoms. Also, mothers
and the families receive the counseling necessary with PMTCT services to reduce the risk
of transmission of HIV from a mother to her child. To continue, in the past years, it was
shown that circumcision help reduce the risk of infection of HIV. Therefore, voluntary
medical male circumcision has become of great importance in the region of Iringa. Being
covered by the government in addition to international aid, the amount of males in the
region to get circumcised had greatly increased, moving one step forward in the urge to
minimize HIV transmission.
Problems and reality
Although there is an important presence in Iringa of services offered to reduce the risk
of HIV transmission, many problems are still present and slow down the progress of these
facilities. To start, stigma is one important factor that does not contribute to reduce the
spread of the infection. The caregivers at the hospital explained to us that many men and
women do not like to enter facilities such as CTC for the reason that they do not want to be
pointed by the finger from society. They do not want to be judged, treated or looked at
differently because they are carriers of the virus. Entering these facilities might include the
risk of being rejected by society and even by family members. In fact, many women are
scared to get tested in fear of their husbands leaving them or asking for a divorce if the
results of HIV come back positive. As a result, these individuals will not receive the
appropriate medical treatment and counseling they need. Also, a pregnant woman who does
not know her serostatus will not be able to take the measures necessary to reduce MTCT.
Furthermore, a lack of medical attention increases the amount of children who will need to
be sent to orphanages as a result of untreated HIV virus taking the life of many parents.
Here we see the importance of the services offered to HIV patients, but an even bigger
importance should be given to changing the mentality of the society since this is not a small
issue.
References
13
OBSTETRICS AND GYNECOLOGY DEPARTMENT
While our placement in the OBS and
GYNAE department, we have noticed that an
important number of women had cesarean
sections rather than natural deliveries. Many
were for obvious reasons such as a wrong
positioning of the fetus, making a natural
delivery impossible to take place. However, one
of the doctors who were our mentors pointed
out a very interesting fact of why many women
fail to have a natural birth. One of the essential
P’s is missing in many cases.
During
our
placement
in
this
department, we have learned about these
four P’s of a natural delivery. They must all
be present in order to have an effective
delivery. The four P’s are: Power, Passage,
Passenger and Psyche.
14
Power is the first P that stands
for the mother’s contractions
and ability to push when
necessary. The contractions will
be responsible of dilating the
cervix. In many of the cases at
Iringa Regional Hospital,
although not all medications are
always accessible, oxytocin was
available and given to increase
the contractions.
Passage is the second P. The
pelvis must be sized properly
for the baby to make his or her
way out of the mother’s body.
15
Passenger is the third P. It is
representative of the fetus that
must be placed in a position
where natural delivery is
possible. A position where the
baby cannot fit through the
passageway securely calls for a
cesarean section.
16
Psyche is the fourth P. It stands for the emotional state of the
mother during labor and birth. Stress, anger and fear are
examples of factors that influence a woman’s ability to give birth
naturally. Also, support from family members and the caregivers
play a huge role in this situation.
In a week, we were able to observe that most women arriving to the hospital were
mentally and emotionally unprepared to deliver naturally their baby. Many different factors
played a role in the mother’s psychological state. Below is a brief presentation of these
factors that were mentioned by the caregivers at the hospital.
To begin, an involuntary pregnancy can have an effect on the mother’s emotional
state. While family planning and contraceptive pills are offered free of charge at the health
care centers, some girls at a young age do not take advantage of these services because they
are too shy to ask for them. Also, it was explained that some of these young girls are afraid to
ask their parents for permission or for their help to go to one of these facilities, ending up
having unprotected sex. Therefore, unwanted pregnancies become a reality in their lives.
Hence, when it is time to give birth, many might be scared and feel unprepared for what is to
come.
To continue, our mentor explained to us the importance of the role parents plays
while raising their child by informing them about reproduction. Most importantly, he
pointed out the need for a mother to explain to her daughter the process of pregnancy, labor
and delivery. Unfortunately, not all the girls have this opportunity. This could be due to the
fact that they do not live close to home in order to go to school. Therefore, while in labor,
some women do not understand what they are going through and have a strong fear when
they start to feel pain. This fear arises from knowing why they feel this pain and not being
told what normal labor pain would be like.
In addition, during our placement in this department, the midwives discussed about
17
In addition, during our placement in this
department, the midwives discussed about the lack
of staff. On many rotations, there were only two
midwives that had to take care of about to 10-15
patients. Therefore, it is impossible for them to give
too much of their time to one patient. Hence, the
patients might feel a lack of support, attention and
affection, which often caused them to be nervous
and feel unprepared to deliver a baby.
Also, any family members could not
accompany the pregnant women in the delivery ward. This is due to the fact that
the sections in the ward that women stayed in were not isolated. Therefore, they
were exposed and it is not appropriate for others to see them while giving birth.
Also, these compartments were far too small to fit more than the patient and the
caregivers.
Finally, it is important to be aware that the emotional state of the mother can
have an affect on the cervical dilation, the descend of the baby and even on the
ability of the mother to push when needed often with the lack of self-confidence
and the great amount of fear. All in all, one missing P out of the four is enough to
schedule a C-section.
18
Un manque de ressources influençant la pratique
La première chose qui saute aux yeux lorsque l’on
met les pieds dans un hôpital tanzanien est le manque de
technologies nécessaires au dépistage et au maintien de la
santé des patients. En effet, à Iringa Regional Hospital, il est
possible de retrouver deux sortes d’appareils c’est-à-dire
un appareil d’imagerie utilisant les rayons X pour faire des
radiographies et un appareil d’ultrason. Puisque les
ressources sont limitées, les diagnostics réservés aux patients sont basés en grande partie sur
l’expérience des médecins comparés aux diagnostics posés au Canada.
19
Que ce soit en Tanzanie ou au Canada, il existe plusieurs étapes entre l’arrivée d’un
patient et le moment où il reçoit son traitement. Bien que le cheminement puisse différer
légèrement, le but ultime est de remédier aux problèmes de santé du patient. En Tanzanie,
ce cheminement comporte 10 étapes bien distinctes les unes des autres :
1- Noter les informations de base du patient c’est-à-dire son nom, son sexe,
des noms de relatifs, la religion, etc. Ces détails sont importants puisqu’ils
peuvent influencer le traitement général du patient.
2- Prendre en note la complainte principale du patient, autrement dit, quelle
est la majeure raison de sa visite à l’hôpital et depuis combien de temps
persiste le mal.
3- Demander des précisions sur les autres symptômes ressentis par le patient,
pour pouvoir donner un diagnostic précis à la fin de la prise des
informations.
4- S’assurer du bon fonctionnement des onze systèmes composants le corps
humain : le système urinaire, le système cardiovasculaire, le système
digestif, le système endocrinien, le système reproducteur, le système
nerveux, le système respiratoire, le système musculaire, le système osseux,
le système tégumentaire et le système lymphatique. Tous les systèmes sont
complémentaires, donc un débalancement d’un système peut en influencer
d’autres.
5- Prendre l’historique de la famille pour s’assurer qu’il n’y ait pas de
maladies génétiques.
20
6- Prendre l’historique social, c’est-à-dire les habitudes de vie qui peuvent
influencer la santé en général comme l’absorption d’alcool ou de drogues,
les habitudes concernant la cigarette et les habitudes sexuelles.
7- Faire un examen général pour vérifier l’état du corps. L’examen se fait de
la tête aux orteils par le médecin.
8- Porter une attention particulière à la cage thoracique et à l’abdomen après
l’examen général. Lors de cet examen, l’abdomen est séparé en 9 parties
plutôt semblables en superficie et chaque partie va être plus ou moins
spécifique à un organe, ce qui va permettre un diagnostic plus précis.
9- Continuer l’investigation en prenant les signes vitaux, le niveau
d’hémoglobine ou même une radiographie si nécessaire.
10- Diagnostiquer et traiter le patient avec les ressources disponibles.
21
Le manque de technologies entraîne un diagnostic plutôt basé sur
l’expérience que sur les résultats des différents examens comme
c’est le cas au Canada. Les patients qui arrivent avec des signes et
des symptômes typiques d’une maladie comme la malaria par
exemple, peuvent être traités sur le champ, même s’ils n’ont
pas été testés auparavant. Ce fut le cas d’une patiente de 14 ans qui
arriva avec différents signes et symptômes de la malaria. Automatiquement, elle reçut par
intraveineuse le médicament contre la malaria c’est-à-dire la quinine, un anti-paludisme provenant
d’un arbuste. Après avoir absorbée la médication, ses prises de sang sont revenues du laboratoire et
ont été testées négatives au paludisme. Dans ce cas, malgré le résultat, la médication a fait effet et la
jeune adolescente se sentait mieux par la suite, mais dans d’autres cas, la médication aurait pu
empirer les symptômes puisque son utilisation n’était pas vraiment valider ou même venir interagir
avec les prochains médicaments.
Ceci est un exemple qui démontre que l’expérience prédomine en Tanzanie dû au manque de
ressources et de temps. Au contraire au Canada, les médecins vont se baser sur leurs connaissances et
sur les résultats des différents tests pour porter un diagnostic et agir en conséquence. L’erreur
commise au Canada par un médecin va avoir des grandes répercussions sur sa carrière, donc il doit
s’assurer d’avoir des preuves à l’appui de son résonnement, tandis qu’en Tanzanie, l’erreur commise
par un médecin va plutôt servir d’exemple à ne pas reproduire, mais il n’y aura pas de conséquences
direct sur le médecin. Ce facteur influence le cheminement pris par les médecins dans les deux
différents pays.
22
Comme il a été dit précédemment, il y a seulement deux appareils en place à Iringa Regional
Hospital qui permettent une plus grande investigation des divers symptômes des patients. Pour
commencer, l’appareil d’ultrason est peu utilisé dans l’hôpital puisque le personnel ne sait pas
comment s’en servir, à l’exception d’un médecin spécialisé en obstétrique. Cet appareil fut donné par
un hôpital italien qui a un partenariat avec l’hôpital tanzanien. Pour continuer, l’établissement a en sa
possession un appareil de radiographie utilisant les rayons X comme outils d’imagerie.
Malheureusement, l’appareil représente
une source de radioactivité qui peut être
dommageable puisque l’appareil n’est
pas nouveau.
Nous sommes exposés à chaque jour à une petite quantité de radioactivité provenant de
notre environnement. La quantité de radiation absorbée par le corps humain est calculée en
sievert qui représente des joules par des kilogrammes 5. Nous recevons environ 3 mSv par
année 6. Pour donner un exemple, une radiographie d’un poumon faite par un appareil de rayon
x au Canada
représente 0,02 mSv, soit environ 2,4 jours de radiations dites
naturelles 6. Cela n’est pas énorme, mais si une radiographie
nécessite une plus grande quantité de radioactivité pour être
efficace, comme c’est le cas des technologies moins récentes
utilisées en Tanzanie, et que le patient en prend plusieurs durant
une année, l’accumulation de toute cette radioactivité peut
représenter un risque potentiel pour le patient 7.
23
En effet, il a été prouvé que la radiation peut causer le cancer. Cela se produit puisque les
rayons X sont des ondes ayant une très grande quantité d’énergie et qui se promènent sous la forme
de photons. Lorsque les photons sont absorbés par les différentes molécules composant les tissus du
corps humain, il arrive que des électrons excités s’échappent de l’attraction de leur noyau, ce qui
modifie la nature des molécules et entraîne des mutations pouvant causer le cancer 7. Ces mutations
sont dues à la modification de l’ADN de la cellule, ce qui peut entraîner une reproduction
incontrôlable et non désirée des cellules non viables, ce qui représente le développement du cancer.
Le cheminement utilisé pour l’attribution d’un diagnostic peut différencier selon les pays, mais
le but ultime dans chacun des cas reste de remédier au problème qui gêne la santé de la personne
demandant de l’aide. Ce processus est grandement influencé par les ressources disponibles pour
obtenir des réponses. Que ce soit une simple machine pouvant prendre la pression sanguine ou un
CT scan, il est important d’utiliser tous les outils à notre disposition pour s’assurer du meilleur
traitement possible.
24
Les principales maladies et les ressources mises en place pour les patients
Le Canada et la Tanzanie sont deux pays
qui ne se retrouvent pas dans les mêmes régions
du globe ce qui entraîne inévitablement des
différences dans les micro-organismes possibles
pouvant causés des maladies. Ainsi, avant de
partir dans un pays plus exotique, la prise de
vaccin est fortement recommandée pour prévenir
différentes maladies. Dans les vaccins et les
médicaments pris avant et pendant le voyage, il
est possible de retrouver un vaccin contre la
fièvre typhoïde et des médicaments prévenant la
malaria, deux maladies grandement répandues
en Tanzanie.
Premièrement, une bonne partie des patients traités en médecine générale sont causés par un
manque de salubrité et d’éducation général. C’est le cas de ceux atteints de la fièvre typhoïde, d’une
des multiples sortes de gastro-entérite, d’un empoisonnement alimentaire, de l’hépatite A et même de
la malaria. Les micro-organismes qui
causent ces différentes maladies peuvent se propager de
différentes façons et ces moyens de propagation sont intimement liés à l’hygiène. Que ce soit par voie
oro-fécale, comme c’est le cas d’un empoissonnement alimentaire, de l’hépatite A et de la fièvre
typhoïde, ou par l’absorption d’eau contaminée, les moyens de propagations pourraient être réduits
par de simples actions. Par exemple, le simple fait de laver ses mains après urination ou défécation
réduit grandement les risques d’infecter une autre personne si nous sommes porteurs de la maladie.
De plus, une bonne gestion des déchets réduit le contact avec les mouches et les moustiques porteurs
de différentes maladies comme la malaria.
25
Deuxièmement, il est important de souligner la
présence en Tanzanie des deux maladies les plus
meurtrières des dernières décennies, c’est-à-dire le
VIH et la tuberculose. Le VIH, ainsi que les
mesures de santé destinées à la prévention et au
traitement, vont être discutées amplement dans
une autre capsule. En ce qui a trait à la
tuberculose, le majeur moyen de prévention est le
vaccin BCG administré intradermique, autrement
dit sous la peau, après la naissance de l’enfant. Ce vaccin va permettre la création d’anticorps qui
vont être capable de reconnaître la bactérie Mycobacterium tuberculosis, celle qui est responsable du
développement de la maladie 8. Le vaccin contient des bactéries vivantes, mais peu actives, ce qui va
permettre la création d’anticorps spécifiques. Il existe trois majeures caractéristiques qui sont propres
aux anticorps 9. Pour débuter, ils vont détruire les antigènes, c’est-à-dire des molécules qui ne sont
pas propre à notre organisme. En d’autres mots, ils sont capables de faire la différence entre les
composantes du soi, c’est-à-dire toutes les molécules et les cellules nous composant, et les
composantes extérieures. De plus, les anticorps sont spécifiques et se souviennent. Ils sont créés après
l’infiltration d’une sorte précise de micro-organismes dans notre organisme et ils vont avoir une
réponse dans le cas où il y a la présence de cet antigène dans notre organisme 9. Si un nouvel agent
pathogène se retrouve dans notre organisme, il va y avoir la formation d’anticorps et cela est le but
ultime du vaccin. En introduisant des bactéries vivantes, mais non dommageables, la réponse de
l’organisme va être la création d’anticorps spécifiques pour la sorte de bactérie causant la tuberculose
et à l’avenir l’individu pourra éradiquer la bactérie
avant qu’elle se propage et crée des dommages
permanents 9. L’efficacité du vaccin est d’environ 50 %
puisqu’il existe plusieurs variantes de la bactérie
causant la tuberculose 8. Heureusement, le vaccin dure
entre 50 et 60 ans.
26
Troisièmement, il ne faut pas oublier les maladies causées par les défaillances de notre propre
corps. Les maladies reliées au système cardiovasculaire, le cancer et le diabète sont présents à travers
le globe. Malheureusement, en Tanzanie, le manque de ressources fait en sorte qu’il est difficile de
traiter les patients atteints de ces maladies, à l’exception du diabète. Puisqu’il n’y a pas de dialyse,
peu de transplantation d’organes, sauf les reins, et de traitements contre le cancer comme la
chimiothérapie, les patients souffrant des maladies dites précédemment ont souvent un avenir peu
optimiste. Cela contraste avec le Canada où un diagnostic comme celui-ci n’est pas synonyme de
décès. Malgré les nombreuses ressources disponibles pour
traiter
les
différentes
maladies
ici,
les
maladies
cardiovasculaires et le cancer sont les deux principales causes
de décès et représentent la moitié des décès. Par exemple, en
2009, 29,8 % des décès sont causés par le cancer et 20,7 % sont
causés par des maladies du cœur 10.
La pression sanguine; un des principal signe avant-coureur des maladies cardiovasculaires
D’un bout à l’autre du globe, certaines maladies changent et évoluent tandis que d’autres
pathologies restent inchangées, mais toutes aussi meurtrières. Que l’on parle du VIH ou des maladies
cardiovasculaires, il est important de cibler les maladies les plus ravageuses pour pouvoir y remédier.
Cette éradication passe par la prévention, l’éducation et la recherche.
27
En conclusion …
Il est certain que les principales maladies traités dans les centres de santé à
travers le globe se rapportent au mode de vie et au milieu dans lequel chacun vie. La
récurrence de certaines maladies va entraîner la recherche et le développement des
ressources pour remédier à ces problèmes de santé, ce qui entraîne une spécification
des différents milieux de santé dépendamment de la situation géographique et
économique. Ainsi, les différentes parties du monde sont spécialistes dans les
domaines qui les affectent, mais il est important d’assurer une équité, car tous les
êtres humains ont droit à l’accès aux services hospitaliers. De plus, il est important de
mettre l’accent sur la prévention qui se fait majoritairement par l’éducation, puisque
c’est la première étape pour améliorer la santé de chacun.
28
References
**ALL INFORMATIONS PRESENT IN THE TEXT THAT DOES NOT CONTAIN SOURCES
ARE TAKEN FROM THE NOTES WE HAVE WRITTEN DURING OUR PLACEMENT AT
THE IRINGA REGIONAL HOSPITAL**
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29
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