A doctor's tale of rural experience in Tanzania

From working in the hard-to-reach areas of the country to occupying a region’s top medical office, Dr Kusirye Ukio, the Morogoro Regional Medical Officer (RMO), is an epitome of resilience in leadership and public health.

Today, Dr Ukio, aged 42, recounts his story as a leader and medical doctor who, for over a decade, has seen the highs and lows of the country’s health system—its progress and setbacks.

Thirteen years ago, at the age of 29 he was awarded a mkapa fellowship upon successful application among hundred applications and was posted to work in Simanjiro District, Manyara; a region where healthcare resources were limited in every sense of the word.

“I was a Mkapa Fellow from Mkapa Foundation. We were a team of three and I was the first medical officer then,” he recalls.

However, it bordered on the adventurous for Dr Ukio who had been used to life in the country’s major city of Dar es Salaam, before being posted to the rural area.

“By then, I was a graduate with a lot of expectations and career ambitions. But there was a job in front of me and the team. It was indeed tough but we had to do it for public good,” says Dr Ukio.

The Benjamin William Mkapa Foundation (BMF) by then known as the Benjamin William Mkapa HIV/Aids Foundation, embarked on a programme in 2005 known as ‘Mkapa Fellows’ to improve rural healthcare by extending health services to the areas and bridging the human resource gap.

Health workers were sent in many districts of the country including Simanjiro, to manage HIV/Aids patients.

Dr Ukio bears a good testimony of how the Mkapa Fellows programme has grown over the past ten years, as the project looks forward to further spreading services to communities across Tanzania.

Life in Simanjiro a decade ago

In collaboration with the district’s health team, Dr Ukio and his team managed to set up clinics for the HIV/Aids patients. “When we arrived in Simanjiro, our goal was to scale up care and treatment for people afflicted by HIV/Aids and other associated services,” recalls Dr Ukio.

He says, “It wasn’t easy. The district’s geographical area was so vast and everything, including provision of services was still at infancy. As fresh graduates, we also had little experience in the field.”

The task ahead was huge for Dr Ukio and his team. Having been the only medical doctor in the area at that time, Dr Ukio could sense the need for the district to have more doctors.

“I had been attending to almost every patient, in addition to providing HIV/Aids services. So, there was a serious need for more professional medical care,” the Mkapa Fellow says.

The hurdles

Surviving in Simanjiro back then was not easy, according to Dr Ukio. He says, “Simanjiro was indeed tough. As we speak, there is a lot of improvement, I must say. The government has made a lot of improvements.” But back then, as Dr Ukio recalls, there were big challenges. There was no electricity supply. Water was a big problem.

“To get water, one had to walk miles to a place called Njoro and line-up with buckets at the water source for several hours. At times, we had to depend on a 20-litre bucket for two days. The water was also too salty. But, as a human beings, there is always a way of acclimatising in such hardships.” There were few vehicles by then. The roads were too bad. This was also compromising the quality of health services, Dr Ukio paints a picture of the infrastructure.

“Take a scenario where you want to refer a patient to the nearest referral facility, which was Mount Meru Hospital in Arusha, another region.”

“It would take at least 6 hours to arrive in Arusha because of a bumpy road. You can’t be sure the patient will arrive safely. There were cases of death on the roads or premature labour.”

Serving humanity

The role of Benjamin Mkapa Foundation was to take health workers like Dr Ukio to serve in places where most staff wouldn’t have wished to go.

“Despite the fact that we were young medics and ambitious, it dawned on us that we were bound to serve humanity and actually forego our earlier dreams for the sake of saving lives,” says the doctor.

Adding, “If it was my own decision, perhaps I couldn’t have gone to Simanjiro under normal government procedures. But, one thing that kept us going was the team-work spirit that we had been blessed with as Mkapa Fellows.”

Winning the race

Dr Ukio and his team worked as Mkapa Fellows for two years; that is from 2006 to 2008. After this, they were main-streamed into government employment. By then, Dr Ukio was still working as a medical doctor.

“But, as a team, we collaborated with the Council of Health Management Team, CHMT of Simanjiro. They were very responsive,” he says.

Dr Ukio then went on to become the District Aids Control Coordinator. “Our collaborations were further strengthened. But my roles went beyond providing HIV/Aids services. We would provide clinical care in various ways,” Dr Ukio says.

In 2009, Dr Ukio was appointed as the District Medical Officer of Simanjiro. At that time, he had to take the lead and institute initiatives that would improve people’s lives and health.

He says, “So, I began working with the team to ensure that we put up a health centre with the capacity to provide surgical services.” Adding, “As we went on with this, we decided to work in collaboration with the Lutheran Church to build a district hospital where caesarean sections could be done. We were focusing on how to reduce maternal and new born deaths.”

His team began by putting up a big maternity ward in 2009. They began with strategic locations. “We set up one in Okesmeti and another in Mirerani. They were highly populated and major sources of maternal death.”

Dr Ukio says, “We thought that empowering them with medical commodities and human resource would help reduce maternal mortality. So, we had to take many health workers to school. We were able to sponsor some of them.”

Team-work

In 2012, Dr Ukio and his team had the right human resource to carry out caesarean section and other services. “We ensured that we intervened in all areas notorious for preventable maternal and new-born deaths. All this was done through team work. I don’t really deserve all the credit,” the doctor says.

“So, this was a long-term process but there had to be a pioneer. The most important thing is on the succession plan and seeing the importance of small pioneering efforts and initiatives that aim to curb primary healthcare challenges.”

The leaders who came after Dr Ukio and his team, have recognised those efforts and worked to strengthen the services even further. But more importantly is that the current government is building more and more health facilities.

“We are in the right direction and I believe, as a country, we will be able to deal with maternal and new-born deaths still occurring in many corners of the country,” Dr Ukio says.

He stayed in Simanjiro from 2006 to 2015. He was then transferred to Meru District Council as a District Medical Officer. He worked in Meru for two years.

New life, new challenges in Meru

Up to 2017 in June, Dr Ukio experienced another life with new challenges. That was now an urban setting. But there was a human resource gap in this area.

“It was a place closer to the highway so there were many emergencies. The population was so high and the maternity wing was overwhelmed,” Dr Ukio recalls.

Dr Ukio sat with the team and they drafted a paper to expand the maternity wing. They were able to secure a sponsorship. In the first phase, they were given $60,000 to begin the construction of the first wing-maternity, which has so far been completed.

The team embarked on strategic financing mechanisms so that as a hospital, they weren’t highly dependent on the government.

“The aim here was not to make profit but to find ways of taking services closer to those who didn’t have them and raise the capital to serve those who didn’t afford the services,” Dr Ukio explains.

Dr Ukio and his team built a state-of-the art dental unit whereby they obtained medical supplies from stakeholders and stocked the unit with new equipment.

“I have always believed that when you have a good health facility, it’s easy to convince a client to appreciate the value of the services and pay for them. We did much more in putting up a stand-alone pharmacy,” Dr Ukio says.

A vibrant community in Lindi

From 2017 to 2019 June, Dr Ukio was taken to Lindi Region. He was welcomed by a highly responsive team that dreamed of nothing other than development.

Dr Ukio recalls, “We worked to ensure that people don’t have to go to private health facilities while there is a public facility with a large number of well-trained health workers and equipment.”

How Mkapa Foundation shaped him

From June, Dr Ukio was transferred to Morogoro where Dr Ukio is until to date. “The role of Mkapa Foundation was to build my ability to go to places that I wouldn’t otherwise have wished to go and serve. They taught me discipline, resilience and to be open-minded,” adding, “I had always dreamed of becoming a surgeon and my strategy was to work for Mkapa Foundation and to go study further.” But, what made Dr Ukio stay, was the feeling he got when he saw that people surrounding him were in great need of better health services.

He says, “But, the advantage of working in harsh conditions, it’s easy to show the results of your efforts. Whatever small improvement you do is noticeable and contributes to significant change. The resources are usually meagre but there are always ways.”

Dr Ukio, a good example

Dr Ukio, who now plays government roles at regional level, represents a large number of doctors who have transformed over the years.

Since then, the number of doctors in resource-limited region has risen, thanks to BMF’s interventions as it focusses on the underserved areas of the country .which are mainly rural.