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Education And Debate

Hands across the equator: the Hereford-Muheza link eight years on

BMJ 1994; 308 doi: (Published 16 April 1994) Cite this as: BMJ 1994;308:1029
  1. J B Wood,
  2. E Hills,
  3. F J K Keto
  1. County Hospital, Hereford HR1 2ER Hospitali Teule, Muheza, Tanzania
  1. Correspondence to: Dr Wood.

    Short elective sabbatical visits have been arranged between Herefordshire Health Authority in England and Muheza Health District in Tanzania over the past eight years. Any employee can apply, and the 64 who have participated include midwives, physiotherapists, engineers, and nurse tutors. The possibility of being chosen adds to the attractiveness of working in both districts, and costs have been small. The visits are believed to have led to new ideas and a willingness and confidence to consider change.

    After 64 visits between Hereford in England and Muheza in Tanzania by a wide variety of health workers, contacts and friendships have extended into both communities to form new school, college, church, and local authority links. The beginnings, eight years ago, of this relationship between the Herefordshire Health Authority and Muheza Health District have been described1; we now evaluate the link, its effects, and the changes which have occurred.

    The two communities

    Muheza district is in northeastern Tanzania, just south of the Kenyan border, 50 km from the Indian Ocean; it is fertile and usually well watered. Drought has not affected it as seriously as much of sub-Saharan Africa. Recent rains have been satisfactory, and there has been a gradual improvement in living standards despite very severe inflation. Almost everyone cultivates a garden (shamba) to supplement wages. Malaria remains by far the most serious medical problem, but infection with HIV is increasing. Hospitali Teule serves about 250 000 people. It is a joint government-mission organisation. There are 260 beds and often many more inpatients than beds.

    Herefordshire in the west of England is also fertile, beautiful, and well watered, but it is much less dependent on a rural economy. The population of about 170 000 is increasing and growing older, and many people retire to the county. Diseases of prosperity, degeneration, and old …

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