“There are no roads in Shirati, just red sand. When you approach the hospital the first thing you see is a big Coca-Cola logo, and under that, in very small letters, ‘Shirati Hospital’”, Von Salmuth says of her first impressions in 2015. “It’s quite large, around 150 beds. I was overwhelmed by how crowded it was. Bed next to bed, no private rooms. Men and women are separated, but other than that you’ve got everyone lying next to each other, with different diseases, infections and injuries. Initially there were dogs and cats roaming around as well. Just imagine the smells and the sounds. My first thought was, what have I got myself into?”

As the only intern, it was a matter of rolling up her sleeves and getting to work. Von Salmuth joined the doctors on their rounds and gradually came to learn how things worked. The way people dealt with life and death was very different to what she was used to. “I found that really hard. I was the only one who ever went running to an emergency. They were probably thinking, what’s that mzungu [white person] doing here, why is she in such a hurry?

More people there die than here, that’s just how it is, so why run for one emergency? I often thought that if this or that patient was in the Netherlands we could have saved them, could have done all sorts of things. But there you have very limited resources. You can’t request lots of tests, so you have to diagnose the patient on the basis of a physical examination. I do think it makes you a better doctor, because you learn to trust your own hands and skills.”

Uniform

She wasn’t the first to come up with the idea of a food programme. A kitchen had been built in 2009, but due to a lack of funding the initiative never got off the ground. Thanks to the Shirati Food Programme, the kitchen has since been renovated and fitted with additional ovens and stoves. There are now four cooks who prepare one hot meal per day, seven days a week, not only for the maternity ward but for almost all needy patients. “I got to personally meet the cooks, which was very special. They wanted uniforms rather than new pans, so we organised that for them. People couldn’t tell that they worked for the hospital, and for them it’s important that people can see they have a function. I’ve learnt that my expectations don’t always accord with what they find important.”

Cultural differences

Being patient and accepting cultural differences – these are essential skills, in Von Salmuth’s view. Many patients only turned to the hospital when their conditions had already progressed to an advanced stage. “By that point it’s too late. They’d go to a traditional healer first, and we’d often see intoxications of the herbs they’d been treated with. During my last visit I saw a young man of 18 who was in a lot of pain and having trouble breathing. The week before he’d gone to the traditional healer. Within five hours his condition deteriorated to such an extent that he died in our hands. Nobody knew what herbs he’d been given and how much, so there’s nothing you can do; you’re powerless. There’s still a strong belief that traditional healers are better, and cheaper too, so the cycle just keeps repeating itself.”