DAY 4 Comprehensive Cancer Center at KCMC

 As a retired health administrator and founder of the Global Health Ministries (GHM) Consulting department, I’ve seen many projects, but few as significant as the one that began in 2016: providing administrative consulting for a new cancer center at 

Kilimanjaro Christian Medical Centre (KCMC) 

in Moshi, Tanzania.

Tanzania’s Healthcare Hierarchy

To understand the impact of this project, it helps to understand the national tiers of care:

• Dispensary: The first point of contact, essentially a medical clinic staffed by a nurse.
• Health Center: A referral level staffed by clinical officers.
• District Hospital: Higher-level care staffed by physicians.
• Regional Referral Hospital: Providing specialized district-wide services.
• Zonal Referral Hospital: Specialized care for specific regions; KCMC serves roughly 15 million people in Northern Tanzania.
• National Hospital: The highest level of care.

Evolution of the Cancer Center

Before KCMC developed its Cancer Care Centre, Tanzania had only two such facilities for a population of over 60 million. 

KCMC

 became the third, with a fourth now under development.

I have followed this work for years, but visiting it this week was truly eye-opening. The Foundation for Cancer Care in Tanzania (FCCT) and the Tanzanian government have transformed it into a Comprehensive Cancer Center, featuring:

• Outpatient Clinics and Infusion: Opened in December 2016.
• In-patient Wards: Opened in December 2020.
• Radiation Therapy: Beginning next month, powered by a new linear accelerator currently undergoing calibration and training.

The Ethical Dilemma

Our group discussed a persistent global health struggle: Is it better to invest heavily in high-level care for a few, or use those same resources for broad public health?

On one hand, the cost of a linear accelerator could fund basic medicines for thousands or even surgical procedures like the amputation mentioned in Yusra’s blog. On the other, many argue that donor funds specifically for sophisticated technology would not simply "move" to basic care if the high-tech project didn't exist—meaning the resource would be lost entirely. In addition, it may be that improving health at a sophisticated level increases the visibility of even basic care. It remains one of the most difficult questions in global health resource allocation. What's your opinion?

Cindy

Day 3

 I’m Yusra - a third year family medicine resident that has joined the annual trip to Tanzania this year. 

The three days we’ve spent here have been very interesting. We started off the first two days in Moshi and spent today travelling to Dar Es Salaam. Moshi was lush, green, and quiet whereas Dar is a giant metropolitan city - busy with people of all walks of life, traffic with non-existing lanes, and 90% humidity. Cole, Tawa and I went on one of our daily walks after landing in Dar and spent the majority of our time trying to evade motorbikes running into us! 

In between these two cities, I’m already noticing significant socioeconomic differences. While at KCMC, we had a chance to accompany a nurse, Anna as she travelled around Moshi for home palliative care visits. From a gangrenous foot in a 40-something year old female who could not afford an amputation, to a rapidly progressing soft tissue sarcoid tumor with purulent drainage and pathological angiogenesis, Anna spent time talking to them and performing wound cares.  All 5 patients were financially restricted to gain treatment, resulting in their disease process worsening and now seeing Anna for palliative intent. The level of poverty was striking; most of these residences did not have any flooring let alone electricity, and one house did not even have a toilet.

In contrast, during our first night in Dar, we were graciously taken to a rooftop hotel overlooking the Indian Ocean for dinner. Most guests were impeccably dressed, with hotel staff escorting us inside with remarkable courtesy.It was a great dinner and really showcased Tanzania as the beautiful country that it is. 

It is really challenging sometimes to see the stark contrast in the level of poverty we see and the lives we get to live purely due to geographical luck. As someone who works at a safety-net hospital in the US, I’m not unfamiliar with many socioeconomic barriers that many of our patients face. However, continuing to see barriers to health especially in the extent that we’ve seen here, is a challenging and completely helpless feeling especially knowing that it is in the hands of people a lot more powerful than us to improve these conditions on a national scale.

There's no immediate solution to relieve economic disparities. However, what I plan to take from this experience is to reflect on the privileges handed to us and not letting myself be desensitized as I get further in my training. Anna’s caring nature and her compassionate care has been inspiring and I hope to be like her one day.

We are headed to Ilula at 06:30 tomorrow so I am headed off to bed! Thanks for reading :) 

Yusra 

Day 2

 Day two of our trip to Tanzania. I am writing this reflection in the quiet hours of the morning—not because I am a night owl, but because jet lag has finally caught up with me. Last night, I tried to stay awake for the AFCON match between Senegal and Egypt. By halftime, with the score still 0–0, sleep won. Now, fully awake at 2 a.m., I find myself reflecting on an experience from yesterday that has lingered with me.

For the first time, I am witnessing clinical care being delivered to a patient population I have long held close: patients with cancer. In my country of birth, my exposure to clinical care was limited, primarily within obstetrics and gynecology. I did not have the opportunity to observe patient–clinician interactions across internal medicine—the field in which I now train—making this experience both personal and formative.

I sat in a red chair beside Dr. N, a Tanzanian oncologist, as a patient made a slow walk toward the consultation room. For a brief moment, time seemed to pause. Outside, the heat and bustle of the city blended with the chatter of the waiting area. Inside, the atmosphere shifted—the steady hum of a fan and the rustle of paper creating an intimate space for conversation and decision-making.

The four patient encounters that morning revealed the deep collectivism that shapes care in many African societies. Each patient was accompanied by at least one family member. In three of the four visits, the patient themselves was not physically present in the room. Instead, daughters, brothers, cousins, or spouses spoke on their behalf, advocating fiercely and compassionately.

They described the emotional and financial weight of illness—often absorbing it themselves. Some spoke of selling land or a car to afford treatment. Others had traveled long distances from remote areas in search of a diagnosis. Still others came hoping to negotiate delays in treatment because the cost felt insurmountable. The central role of extended family in these encounters stood in stark contrast to what I am accustomed to seeing among my patients in the United States.

This model of care feels deeply holistic, offering patients support that extends beyond the physical. Yet it also raised difficult questions for me. What is the unseen cost borne by caregivers? The responsibility frequently falls on women—wives and daughters—though this is slowly changing. I also wondered whether the patient’s absence is by choice, necessity, or exclusion? Whether this approach limits patient autonomy? Does autonomy itself carry the same meaning and priority and is it expressed differently for example, by delegation within collectivist societies. finally, what is the burden of the clinician in the room?

This experience reminded me that health care does not exist in isolation. It is shaped by culture, family, and economic realities. As a clinician training in global health, I am learning that providing meaningful care requires more than clinical knowledge—it requires humility, cultural awareness, and a willingness to sit with complexity, even when there are no clear answers.

Yours,

Tawa Alabi

Moshi, Day 1, pictures

Moshi, Day 1

I drew the short straw and am the first blogger… 

We are staying at a quaint, relatively hidden bed and breakfast in Moshi called the Neneu Hotel for 3 nights. They serve amazing, fresh mango and mango/passion fruit juice. 

Today, Wednesday, 1/14, we went to KCMC (Kilimanjaro Christian Medical Center), having Dr Randy Hurley as our guide, to visit the relatively new regional Cancer Center, which I may let Randy and others speak more in depth about.

As a referral center hospital, KCMC offers a broader range of diagnostic and treatment capabilities across a wider range of specialties compared to Ilula Lutheran Hospital. It is a huge campus that houses a medical school, various medical residencies, and various other professional healthcare training programs. Today, the focus was largely on the Cancer Center/oncology department and its recent advancements, and we attended the first of what is to be a monthly Oncology Research Unit Meeting. Tomorrow, the focus will be on visiting and shadowing clinicians in the ophthalmology, orthopedics, psychiatry, and oncology departments.

There were a lot of interesting tidbits from the day, but one thing that stood out to me was the unexpected news that the HIV/AIDS clinics and antiretroviral therapy (ART)/mycobacterium tuberculosis anti-infectives, which have been, in large part, funded/provided by USAID, have remained operational despite USAID being axed. The day-to-day operations have been run by Tanzanians, with logistics and administration handled by USAID staff. For the time being, the government is picking up the slack, but no one is certain how long this will last. In addition, European NGOs that also support these projects have not cut funding. The result is that ART/TB treatments are being administered as they were several years ago. The TZ government's support so far has been reassuring, but several TZ physicians were unsure how long it would last.

It does bring up the question that often runs through my mind about whether international aid prevents local populations/governments from investing in their own people/infrastructure. One argument for continuing aid like this is that withdrawing aid will create a gap in care, with no guarantee it will be filled. As above, the TZ government did step in (as it should), even if only temporarily.

The trip thus far has been great. There have been a few hiccups, including my luggage being lost for 1.5 days, but all is well that ends well. The weather has been beautiful, and it’s so nice to be back in TZ, where the pace of life is so much slower. We will be flying to Dar Es Salaam on Friday before taking a train across the country to Ilula.

I'll add some photos when I'm able.

Robert "Cole" Pueringer

Unplanned Circumstances.

 Addendum: Life circumstance strikes again and not in a pleasant way. One of our Travelers is facing the death of his grandmother and may be forced to alter his travel plans. Not easy when it will lurk just behind all our thoughts. 

Ken

Departure

 Seven of the Travelers are leaving today and will stay in Moshi for the first few days under the tutelage of Dr. Randy Hurley while visiting the cancer center there. 

The other five will be departing at the end of the week and the two groups should become one shortly thereafter.

We will count on them to inform us of their activities in the next couple days.

Ken