Neurological letter from Kilimanjaro

Marieke C J Dekker, Sarah J Urasa, William P Howlett
Publication year: 

This letter comes from Kilimanjaro in Tanzania, a land where grateful patients may express their appreciation by giving a neurologist a cow or even by naming children after the doctor.

The United Republic of Tanzania is in East Africa. It comprises the mainland Tanzania and Zanzibar with a total population of 53 million, over 70% of whom are aged <30 years.1 Although rich in natural resources, Tanzania’s per capita income is ranked 186th in the world.1 The Kilimanjaro Christian Medical Centre (KCMC) is in the town of Moshi in the Northern Zone of Tanzania, at the foot of the highest mountain in Africa, ‘Mount Kilimanjaro’ (5895 m) (figures 1–3). It is one of four national referral hospitals (catchment population 18 million), the others being in Dar es Salaam, Mwanza in Western Tanzania and Mbeya in the South. Northern Tanzania has a very diverse geography and population. It comprises mostly volcanic mountains, the Rift Valley and large areas of open savannah epitomised by its world famous national parks and Serengeti plains. The population includes several African Bantu tribes and Nilotic tribes, in our region ranging from Hadza hunter–gatherers and Masai cattle herders to Chaggas and Pare mountain people.

KCMC was opened in 1971 and has about 600 beds and 15 medical specialties. It has had its own medical school since 1999, with a postgraduate specialty training programme and over 20 ancillary healthcare training schools. Neurology does not have its own department and is accommodated within Internal Medicine and Paediatrics. Nationally Tanzania has seven practising neurologists, of whom two are in KCMC, with a small number of trainee neurologists in various stages of their training at home or abroad. Apart from ongoing patient care (all ages), we teach and do patient-based research (figure 4). Tanzanian …