The history of the development of orthopaedics and trauma care in Tanzania is closely connected to personal initiatives and devotion of a few individuals. As in many countries of the world, orthopaedic care was initially about care of people with disabilities of the musculo-skeletal system. From there it developed to the orthopaedic and trauma care of this century. Development in Tanzania went through the same steps starting with operation of a Rehabilitation Centre for disabled children.The Rehabilitation Centre, in Kiswahili, ‘Kituo Cha Kurekebishia Viungo Vya Walemavu’. A Non-Government Organisation (NGO) was originally founded in 1961 and was known as the Mgulani Rehabilitation Centre. The centre was constructed under the assistance of the World Lutheran Federation and OXFAM. The initial centre was entirely supported by a voluntary organization, made up of people who were devoted and interested in the problems of the physically disabled, so as to assist in solving their problems and to enable them to enjoy life as people with no disability do.
Due to the increasing number of children in need, it was clear that the existing centre could not accommodate all of them. So, finally a permanent centre was set up at the Muhimbili hospital. The centre was registered under the Societies Ordinance of 1954, and was administered by a Caretaker Committee. The activities of the centre were to provide for medical rehabilitation of those with physical disabilities. The activities included operations, physiotherapy, occupational therapy, manufacture and supply of orthotics and walking aids. The Centre was capable of admitting 33 patients. 20 beds were for adults and 13 were baby cots. Children paralysed from poliomyelitis, and children and adults who for various reasons had their limbs amputated were also eligible for admission. The Centre operated in collaboration with an attached Red Cross Appliance Workshop in supplying patients with surgical appliances, callipers, artificial limbs etc.
The Centre encouraged the children to acquire skills, which would help them make a living in future. Some of the children had no education at aN, due to either the belief by their parents that with their disabilities no school would accept them, or due to lack of appliances to assist them walk, sit, etc. So the Centre established a primary school recognized by the Ministry of education as a branch of the Mgulani Salvation Army Primary School, to enable children learn how to read and write.
With the return to Tanzania of Prof. Philemon Sarungi from his studies in Hungary and Vienna as Tanzania’s first qualified orthopaedic surgeon, 1971 was a turning point for the development of orthopaedics and trauma care in Tanzania. Against resistance of the administration of Muhimbili and many of his colleagues from the general surgery side, Professor managed to get ward 9 in Kibasila, at Muhimbili under his care. The start of an orthopaedic ward led to one of the first strikes within Muhimbili, as Prof. Sarungi demanded a lot from the staff of the ward. After three days, and witnessing Prof. Sarungi’s devotion in the care for his patients, the entire staff returned to work, and orthopaedic care started afresh in Tanzania. Trauma and orthopaedic care to adults were, from there on, conducted first in Ward 9, then in Ward 10 of Kibasila and later, part of Ward 2 in Mwaisela started to accommodate injured female patients. The care for the children continued at the Rehabilitation centre, which was enlarged with a theatre and a pool by a group of volunteers.
In 1983 Prof. Sarungi went to Davos, Switzerland, for a postgraduate AO training in modern trauma care. During
that course he met Dr. Uma Grob, a young Swiss lady surgeon, who had just gone back to Switzerland after having worked in a
mission hospital with the Benedictine fathers in southern Tanzania. During long discussions, Prof. Sarungi convinced her, that
it was the obligation of Switzerland as the leading country in orthopaedic and trauma care, to support Tanzania in its attempt to
improve its services in this important field. In the course of several years, Dr. Uma Grob tried to find support for Prof.
Sarungi’s ideas in official Swiss Government departments. Yet despite her being well connected, all her attempts failed.
The Swiss Government did not agree to include orthopaedic care in one of its sectoral priorities in Health. In 1989 Prof. Sarungi
decided to make a last attempt and sent Dr. Uma Grob a contract to lecture at Muhimbili. Although Dr. Uma Grob’s career
had been planned differently, she accepted and came to Tanzania.
On arriving at the department of orthopaedics and trauma, which also housed the unit for neurosurgery, she found Prof. Sarungi
as the Director General of Muhimbili and also realized quickly, that nearly all the infrastructural facilities and equipment,
which would allow teaching and training and giving proper service to those in need of them, were missing. The theatre at
Muhimbili, in particular, would not allow big or more sophisticated operations without endangering the health, and sometimes even
the lives of patients. Dr. E. Kessi, Tanzania’s second orthopaedic surgeon and then Head of the department of orthopaedics
at MMC shared these trials and tribulations. The frustration experienced and shared with all the well-trained staff in the
orthopaedic department led to the idea of constructing better theatres. It took no time, however, to realise that the existing
bureaucracy and especially WHO’s policy which was also that of the Tanzania Government, of primarily allocating funds to
preventive and Public Health Care, would not support funding of such an idea, whether the funding was from internal or external
sources. Furthermore, it became clear, that even if it were possible to find funds for the necessary investment, the financing of
the heavy recurrent costs of highly sophisticated curative care facility could only be met through a completely new approach to
financing. Shifting funds from the preventive and PHC sector, which had to remain first priority, to the curative sector could
not be right, as it could also not be right to expect the funding for the recurrent budget from external donors. Such a dependency
was considered as the first step of constructing a “white elephant”. All this led to the firm conviction that only
tapping the “not yet tapped resources” within the country could be the right answer to the problem, and this new
approach could only be implemented in an autonomously managed and functionally independent institution - which of course had
still to be planned and constructed. This new institution could act as a model hospital for new mechanisms for financing the
curative health sector, and as a pilot project of a new approach within the Health sector.
This was the first step in developing the idea of a private I public mix under the roof of a public hospital. It was believed that the necessary resources to finance the recurrent costs could actually only come from the private sector. Missing proper orthopaedic, neurosurgery and trauma care necessitated spending several million US Dollars annually for patients who had to be referred overseas on Government expense. This was also, of course, the excuse for years of misuse of such referrals and establishment of networks of local and overseas doctors. Politically and socially, it was very important to establish an infrastructure and expertise within Tanzania which would assure accessibility and equal care to everybody and not just to a few.
With these ideas and conviction, MOl project was developed and discussed with all concerned partners. Through her father’s connections - at that time principal of the Swiss Federal Institute of technology - Prof. Krame, the head of the department of architecture of the same university agreed to plan a new hospital on the private I public mix concept free of charge. Accordingly budgets were established and fund raising activities in Switzerland conducted. In 1992 Dr. Uma Grob founded, in Switzerland an NGO with the name of the “Swiss Association for Orthopaedic Surgery in Tanzania” (SAOT). In 1993 a bilateral agreement was signed between the Ministry of Health on behalf of the Government of Tanzania and the Swiss NGO. Coincidentally, Prof. Sarungi had in the meantime become Minister for Health and was signing the agreement with his counterpart, the then Minister for Health in the canton of Basellandschaft,
Switzerland, Mr. W. Spitteler. Fundraising turned out to be difficult, but in 1994 the foundation stone was
laid for the construction of MCI’s first phase. The inauguration of that phase took place in August 1995 during Hon. Zakia
Meghji’s term as Minister of Health and was honored by the presence of former Tanzania President Ally Hassan Mwinyi.
Since its inception, carefully selected Tanzanians underwent further training in Switzerland and Germany, in order to enable
them become leaders and trainers in their fields at the new Institute. There were several orthopaedic surgeons, two neurosurgeons
and staff from anaesthesia, orthopaedic workshop, physiotherapy, hospital administration, orthopaedic nursing as well as from the
operating theatres.
Preparations for implementation of the private / public mix concept, as well as modern financial and human resources management
took several years, and many hurdles had to be overcome. In order to establish the concept on a legal and sound basis, a cabinet
paper was prepared, which, after five years under the wise guidance of Hon. Zakia Meghji, Minister of Health led to the Act. No.
7 of 1996. This act established MOI as an autonomous institution and as a role model for sustainable modern hospital management
and self-financing schemes. Based on the act of parliament MCI finally could start its operations in spring of 1996.
Implementation of the concept as well as creating awareness and understanding among so many individuals turned out to be the most difficult part of all. The Public Service Reform Programme of the Tanzanian Government hadn’t started yet, and hospital reform was still far off. MCI’s management ideas were resisted both internally and externally. MCI stood out as an island in the ocean. People who were used to being sent overseas realized that this benefit would be curtailed with the start of operation of phase 2. They fought back. At one stage possibly half of the political leadership supported the MOI concept; the other half was against. For three years there were bitter battles. But with perseverance, endurance and the will to keep the vision in sight, as well as application of the most modern management methods, including a change management process, the success that is MOI today was reached.
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