The Pharmaceutical Journal
Vol 269 No 7229 p933-934
21/28 December 2002

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The Neema project: pharmacy in rural Tanzania

The Neema project is a Village Concept Project initiated by the International Pharmaceutical Students' Federation (IPSF). The project's main aim is to improve the health status of the Kiromo, Buma and Mataya villages in Tanzania. Initially the IPSF raised money to build and equip a basic dispensary in Kiromo and fund a permanent medical officer and nurse.

Pharmacy students and recently qualified pharmacists were then invited to volunteer to work on the project for a three- or six-month rotation. The aim is for participants to work with the village communities to increase the access and availability of health care services by staffing the dispensary, initiating and participating in mother-child clinics and promoting health education. It is an international project and I spent my rotation with two participants from Denmark and one from the United States.

About Tanzania

Tanzania is one of the poorest countries in the world. The life expectancy is about 48 years and nearly half of the population are under 15 years old.

There is a great deficit of qualified doctors: in 1993 there were just 1,365 for a population of 29.5 million people. Consequently many government-registered dispensaries, like the Neema dispensary, are being built in rural areas. These dispensaries are staffed by a medical officer (who has undergone two years of medical training) and a nurse. There are therefore limitations as to what they can treat and guidelines are in place for referral to hospitals and qualified physicians.

Daily work

After a two-week orientation and intensive Swahili lessons in Dar Es Salaam we started work at the dispensary in Kiromo. Patients arrived at the dispensary and paid 300 Tanzanian shillings (about 20p) to see the medical officer or nurse (whoever was available). Consultations lasted between five and 10 minutes and were recorded, along with any treatment prescribed, in the patient's own exercise book. Patients then came to the pharmacy area where we dispensed their medicines into paper envelopes and wrote directions (in Swahili) on the front. We then explained the directions to the patients, again in Swahili, as many people are illiterate, especially in rural areas.

We had boiled and cooled water in the dispensary so that patients were able to take initial doses of medicines straight away. Many would have a two-hour walk home. We also crushed tablets and mixed them with water to administer them to babies and children, showing parents how to do this. We did not routinely use suspensions as they were expensive.

As the medical officer only had basic training we made at least one pharmaceutical intervention per day. We were often asked advice on what to prescribe and even diagnosed patients' conditions when the medical officer was away.

The most common disease by far was malaria for which the treatment was sulfadoxine and pyrimethamine (Fansidar) with paracetamol for fever. Other common ailments were urinary tract infections, pneumonia, skin infections, diarrhoea and sexually transmitted infections (including HIV). There was no treatment for HIV available in the villages and we witnessed several deaths from AIDS during our time at the dispensary.

There was also a delivery room at the dispensary (incidentally the room we kept our bikes in) and we assisted with many births.

Although we were able to treat the majority of patients with uncomplicated malaria and other "minor" ailments satisfactorily, problems came when patients were more seriously ill. We witnessed a baby convulsing with malaria whose parents could not afford to travel the six miles to the nearest hospital. We also saw a coconut climber who had fallen out of a tree and probably broken his back. Again the family were unable to take him to hospital so we gave him co-codamol and the family carried him home.

Other problems included trying to get patients to take medicines during Ramadan. The Bagamoyo area where we were was predominantly Muslim, and during Ramadan Muslims fast from dawn until dusk, not even drinking water. Although the Koran exempts people from fasting when ill, many people do not believe that malaria or infections are serious enough to break their fast.

Health education

Some of our time in Kiromo was spent on a health education campaign. During our rotation we put together a campaign on basic hygiene which we took to eight villages and three local schools. The campaign was a combination of pictures and explanations in Swahili. It covered the basics such as washing hands before cooking, boiling water before drinking and not storing food for longer than a day. Other campaigns which have been covered include malaria and HIV/AIDS.

This is a vital part of the Neema project because many people never leave their village and campaigns are the only way to educate them in health matters.

Living conditions

We foreigners shared a purpose-built house with our guide/translator and any visiting medical students from Dar Es Salaam University. The house is made from concrete blocks unlike the villagers' mud huts and has running water, the biggest luxury. There are two bedrooms each with their own bathroom, a small living room and kitchen with one kerosene stove for cooking. There is no electricity and kerosene lamps are used after dark.

Living conditions are cramped and with darkness falling before 7pm, the evenings can be long and involve a lot of card games. However, in nearby Bagamoyo there are several bars where you can enjoy the local beer and relax.

Evenings and weekends are free and it may be possible to take a week's break during the rotation. I was able to visit Zanzibar and Pemba islands and Selous game reserve for a safari.

The future

A pharmacy assistant and a laboratory technician are currently being trained at university in Tanzania to work in the dispensary. These people will be taught how to run the dispensary by the participants. It is hoped to hand over the dispensary to the Tanzanian government in 2004. Until then, a continual supply of volunteers is needed to keep the Neema project going from strength to strength.

For me, participating in the project has been a life-enhancing experience and I hope I have made a small difference, which is what it is all about.

Applications are welcome from pharmacy students and pharmacists (up to four years post-qualification). The project is also trying to recruit some medical, nursing and agriculture participants. If you want a challenge and the chance to really make a difference visit the IPSF website.