Journal Club-Tanzanian style

Hi all,

Today was another interesting day at Muhimbili.  Shelton and Erica had a the opportunity to experience Journal Club.  Our resident, Imran, was presenting for journal club this week and his paper was a recent New England Journal paper about peanut allergy in infants.

Presentations such as Journal Club or Grand Rounds are an experience here.  Everywhere you go people have sort of “assigned seats,” we all just tend to sit in the same place when we attend certain events.  Well, at pediatric presentations it is official.  The room is organized such that the medical students sit in the back of the room, then the interns, then the residents, then the registrars and then there is a row of special seats in the front for the attendings/specialists.  Then when the presenation finishes the lead asks by section if there are any questions.  I haven’t been to a ton of these over time but it seems there are never questions from the medical students or the interns and rarely by the residents.  Occasional questions that are good from the registrars.  Then come the specialists.  They always make comments or ask questions and the learning style is quite diffferent than we are used to.  I’m not sure that the questions are so much geared at helping the group learn as they are at making the presenter feel moderately uncomfortable.  Per Imran, several interns have already cried this year during presentations.  Very different system.

So, it occurred to me today after Journal Club that our style of teaching involves a lot of asking questions to promote discussion, such as “What is your differential diagnosis?”  “What are you thinking when you are deciding to make that plan?”  “What do you think is going on with this patient?”  And it occurred to me that perhaps that might be intimidating to the docs here because of the system they train in.  That they might think I’m trying to trip them up.  So we discussed it and I clarified that when I ask questions I’m not specifically looking to point out something they are doing wrong, just to promote group learning.  They told me they had figured that out about us over the years but the resident and past-resident did say they wished their system of learning was more like ours.

After Journal Club, this woman who I have never met before announced that the medical students should come meet with her and then pointed at the 3 of us and said we were to come too.  I told her that we were not medical students but I was told we were to come at 10am to her office.  I was a bit taken back by that summons not knowing who she was or what the purpose of the meeting was in the middle of rounds.  Our Tanzanian Master’s Students apologized to us for her stating that was her personality and that she was the Head of Pediatrics.  Well, turns our she just wanted to know who we were and that all went fine after I clarified that I and our group had been coming for many years.  She is new from previous years so this was never a requirment in the past.  We’ll remember it for the future.

Aside from that I helped with a couple of difficult bone marrows today, we rounded, Shelton took a field trip with Shakilu to radiology to get a couple of CT reads that we have been waiting on since last week, and we continue to hope that tomorrow the flow machine might be fixed so we can figure out what some of these leukemia patients have.  One repair person came from Nairobi last week and couldn’t fix it and another one was coming today.  So cross your fingers–only if you are in the US, because here it apparently means something rude.

That’s about all for me today.  Hope everyone is well at home!



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