In December 2004 we were fortunate to spend two weeks in Tanzania, including one week at Mvumi hospital. The official reason was to teach neurology to medical officer students, but it also provided an opportunity to see how Tanzania in general and Mvumi in particular had changed since our last visit nearly ten years ago.

It was clear from the moment we arrived in Tanzania that enormous changes have taken place. The most striking was that mobile phone and internet had arrived. Even in Mvumi – in particular one corner of the old football field – a strong signal is available and phone calls are easy, if not cheap for villagers. There are distinctive wooden booths with catchy slogans to attract customers to the owners’ well thumbed and dusty mobile phone. The only other piece of equipment required for would be entrepreneurs is a stopwatch used to over-estimate phone call duration! Although the internet was not accessible in Mvumi, the service is easily available in Dodoma. These two factors are opening Tanzanians to a larger world and creating a divide between those with access to benefits brought by modern technology and those without. It cannot surely be long until Mvumi village has its own cybercafé.

On our first morning it was clear that Mvumi hospital had not changed much – relatives wrapped in red blankets after a night caring for patients, the endless sound of sweeping away of dust and – in parts - the pungent smell of drains. The buildings had, however, recently been spruced up with fresh coats of white paint and it was clear that new construction was underway. We were happy to meet some friendly faces who remembered us, including Fwezi (a former catechist, now working in outpatients) and medical officer Dr Dunstan.

Unfortunately, the third year students were away on field work, but those from the first and second years were all very keen to be taught and kept us very busy. We were initially fortunate to have access to a laptop and projector (which came with a free scorpion in its bag!) but soon realised that students took this as a signal to copy every slide verbatim. As a result we changed to small group and clinical skills sessions in order to keep everyone’s attention. Mvumi has some very gifted and hard working students. Although we believe that Swahili is something Tanzania can be very proud of, it became clear to us that a good grasp of spoken English is critical to these students’ formation as medical officers. There were a few Kenyan students and their better knowledge of English gave them an edge.

In addition to the teaching sessions we were able to advise on management of some neurological cases in the hospital. We were shocked by the social stigma attached to epilepsy in the community: sufferers were hindered in education, work and marriage. Many patients reported having tried traditional therapies before coming to the hospital. Mvumi hospital is fortunate in being able to supply phenobarbitone, an effective and cheap antiepileptic. This drug is not, however, normally used in the U.K. where safer, but much more expensive, products are available.

We were particularly pleased to meet Dr James, a former student of the Mvumi Clinical Officers School. He is now working on one of the medical wards and is clearly a great asset to the hospital. Born in Mvumi and a graduate from the Clinical Officer school, he was an example of what training at Mvumi should be about. We found it very informative working alongside him, looking at some of his patients and seeing the difficulties of remaining motivated and clinically-up to date. Unfortunately, these problems were underlined by excess drinking in at least one senior colleague.

Tanzania is clearly changing and it is important that Mvumi hospital and its staff should not be left behind. Challenges are not, however, just about access to better drugs and new technologies: there are still basic needs to be met in patient care and student training. For example, we were struck by a student nurse using a copy of the British National Formulary of drugs dated 1986! There are still plenty of challenges for the people of Mvumi and Friends of Mvumi to tackle.

We would like to express our thanks to everyone at Mvumi for their hospitality. Although the purpose of our visit was to teach, we feel that we learnt a lot more than our students.