Being one of the very few Tanzania hospitals where physiotherapy exists, the physiotherapists working there were inundated with referrals and visiting outpatients. You can imagine how 'in the way' we felt as we arrived in the department, hoping that the physiotherapists could oversee us whilst we were there. I worked alongside two Tanzania physiotherapists; Mr Shayo and Sister Mary, treating mainly stroke patients, both on the medical ward and with outpatients. They were warm and friendly and dedicated to their patients. This was my first experience of treating stroke patients and the first week was quite overwhelming. From my limited knowledge I guessed the basics of the treatment was the same as used at home and I was able to take on my own patients by the second week.

Whilst working with Mr Shayo and Sister Mary I became beware of the difficulties they were working against. Not only the number of patients they were responsible for, but the lack in structure and facilities. There was no rehab ward and once the patient had become 'medically stable' they were discharged home by the doctors, often without them conferring to other health care professionals involved in the patients care. This happened to a couple of my patients and meant that I couldn't give them the appointment card they needed to return for outpatient treatment. Others who did get a card couldn't return as they were to far away or didn't have enough money to afford the vital further rehabilitation. There just seemed to be a lack of any system, particularly for those who could not afford the treatment they so desperately needed.

Another difficulty was the lack in modern training techniques. We were basing our whole treatments from the dated books in the library. It felt as if the treatment we were providing was limited. Mr Shayo and Sister Mary were both desperate 'for modern training from abroad so they could advance their treatments. Whilst I was there I had seen a start in this, a visiting physiotherapist from Norway presented a course of lectures and two of the physiotherapists are currently studying their Masters at Northumbria University. This is promising however all of them are keen for more. The hospital does get a lot of aid and support from foreign countries and there are a number of missionaries working in the hospital. Slowly improvements are being made and I admire the faith and perseverance of the missionaries working there. They give the hospital and the staff hope. It was great to see the arrival of two forty-foot long containers from England stuffed full with hospital equipment and beds organised by 'Friends of KCMC'. It was funny to see two machines I had only just used in my last placement at Ashington Hospital turn up in Africa!

Looking back I realise how much I learnt. Mostly from just giving things a go and always referring to a couple of books stuffed in my pocket. What I gained mostly from this placement that I haven't from my other four placements is my increase in self-confidence and the ability to persevere. In situations where usually I was found running for advise from my tutor, I was instead stepping forward and making a decision on what I thought was the best treatment for my patient and if it didn't work, I would try something else (and quickly!). I guess it the nature of the placement, having less support and some people thinking you had all the answers. This was definitely not true and made things difficult but it meant you were pushed forwards into situations where you had to find a way of coping. This was made even harder when all your morning outpatients turned up at the same time just before lunch – this was a popular phenomenon! It was a difficult working environment and I have huge respect for the staff in the hospital. If I didn't have my faith to fall back on then sometimes I would have been swapped. Having a faith really gave me a goal and hope, which I found fundamental. I hope I will never forget this, or forget the incredible people I met and the humble feeling that God is truly your Rock and Provider in all situations. I like to thank all who made my trip possible and gave me the chance to work in this extraordinary hospital.