Salma Hashul is a general practitioner in Stone Town, Zanzibar. She works at the Mnazi Mmoja government hospital. She is a very ambitious woman and she gives us an insight in her career and life.
When did you know you wanted to become a doctor?
My mother was a pharmacy technician. I used to go to the hospital a lot to visit my mother and I loved her white coat. I wanted to be like her. At first I wanted to become a phamacist but I missed the scholarship application. A new opportunity presented itself when the government of Zanzibar and Cuba initiated a new medical programme in Zanzibar. The goal of the programme was to teach and train doctors in Zanzibar. When I learned of this amazing opportunity, I immediately decided to apply.
What was your medical training like?
My medical training took seven years. The first year consisted of pre-med and a Spanish language course. Spanish was important for us to communicate with the professors from Cuba. After a few months the professors learned English and Swahili and the communication between us improved. The next five years was mostly theoretical, but from the third year we would some have practical and clinical lessons. For example, if you would have a surgical rotation, one would go to surgical ward. The final year is called pre-intern and comprises of mostly clinical work and just a few hours a week of theoretical lessons at school.
After these seven years there is a final examination. When you pass this test the government demands you to do one more year of real interships. This includes three months of obstetrics and gynaecology, three months of general surgery, ENT and orthopedics, three months of internal medicine and three months of paediatrics. After eight years you can be employed by the government and they offered me a job at this hospital.
What do you do at the hospital?
Currently I’m a general practitioner. I work at the fast track department of the hospital, where I see patients with health insurance. The patients without health insurance have to wait longer for their out patient consultation or if they want to be admitted through the fast track they will have to pay in cash. I combine my work as a GP with clinical work at the dialysis unit. The dialysis unit is in de new paediatric building and we have six dialysis beds in our ward.
What do you like the most about your job?
I like everything. I love being a doctor and helping people. It kills me to see someone suffer because of any kind of disease. So I love every moment and every bit of it, despite the challenges.
What are the biggest challenges?
There are a lot of challenges. One issue is the logistics in the hospital. When a patients needs multiple medical tests, we have to move the patient to different buildings to complete the work-up. We have a CT-scanner and I can do an interpretation of the scan myself but the official radiologist rapport usually takes a day. Fortunately, when it’s an urgent case, it’s possible to get the rapport the same day.
Another example is the shortage of medication. Sometimes a patient needs medication that’s not available in our hospital and the patients can’t afford to buy it somewhere else. This can be very disappointing.
How many days do you work?
I work five days but I can have on-call shifts for 36 hours in a row. Unfortunately the salary is not satisfactory. Some doctors go abroad or to the mainland, Tanzania, because the salary is better.
What is the difference between a government and private hospital?
In Zanzibar we have three main private hospitals. They have more than 90% of de medications on the shelf and a lot less waiting time. They can have specialist fly in from abroad and it’s run much more like a business. In our government hospital everything is free, from dialysis, to an MRI. That’s also the reason I want to work here, because I want to help everyone.
What do you hope changes in health care in Zanzibar?
When you are a young GP, you dream about the perfect hospital. My hope is that every department is under one roof, that the medicals tests are done quickly, there is only a limited waiting list and that the hospital provides a good environment for patients and doctors.
What is your ambition for the future?
It’s my dream to become a nephrologist. To become a nephrologist I have to do three years of internal medicine and then three more years of nephrology. I received a scholarship to do my internal medicine training in Cuba.
What is your family life like?
I have two girls and they both have brachial plexus injury from shoulder dystocia at birth. This means they have some physical disabilities. My husband lives in Arusha, in Tanzania. At the moment he is in Zanzibar and I often go to Arusha to visit him. I find that family life is always difficult to combine with the life of a doctor.
Being a specialist is a dream many general practitioners in Zanzibar have. On one hand I want to spend time with my girls, but on the other hand I want to specialise to provide them with a good future and to serve my country more. Unfortunately it is not possible to take my children to Cuba and I don’t have a scholarship for the University of Tanzania.
Do you have advice for young doctors?
Being a doctor is not only wearing a white coat. If you want to become a doctor it should come from your heart. There are a lot of challenges during your training. You won’t have time to go shopping, go to the beach or party. You need to sacrifice most of your time to become a doctor. And most important: a good doctor has to focus on one thing, and that is the patient. The patient comes first.
I spoke to Salma in September of 2018 and she started her training in Cuba in November 2018.
