They underestimated.
"When we first arrived in Tanzania we wondered what we had gotten ourselves into," said Fraser. "We were extremely culture shocked for the first couple of weeks."
Before leaving Canada the pair had arranged to work for eight weeks with Dr. Jana MacLeod, a Canadian who has worked in Africa for six years, at a hospital in the town of Bagamoyo, about 75 kilometres north of the Tanzanian capital, Dar es Salaam. The Bagamoyo hospital serves a region of 212,000 inhabitants with three physicians, including MacLeod.
UBC nursing students who undertake work assignments abroad can receive a fourth-year course credit for their experience with the submission of several written assignments including a paper on a particular aspect of health care in the country they visit. Morin focused on pediatrics and malnutrition, while Fraser's interest was immunization programs.
"The hospital was very primitive by our standards and short of resources. They didn't have basic supplies such as blood pressure cuffs, gloves or even mosquito nets to prevent the spread of malaria from patient to patient," said Fraser.
In the 12-bed pediatric ward, patients sometimes slept two to a bed on foam mattresses. If a child's parents couldn't provide a mosquito net or sheets, the patient went without, Morin said.
Supplies donated to the hospital were often stolen by staff who would sell them later for profit. Conditions in the hospital, said Morin, were well below the standard of most Tanzanian health care facilities.
"We found that our feelings really changed during the time we spent at the hospital," Morin said. "The morale of hospital staff was very low and the health care workers were often not very effective. We found it particularly hard to stand by and watch patients die when we felt there was a lot we could do. But we had to concede at times to their cultural traditions."
In spite of the range of problems they encountered, both Morin and Fraser said it was a great learning experience. As nursing students educated in a western university, they had the opportunity to put into practice what they had learned, and to learn from that experience and from the staff at the hospital who worked largely without the assistance of sophisticated technology.
"We found our basic assessment skills improved a lot because of the lack of resources. We learned a lot from the Tanzanian nurses in that area," said Fraser.
Fraser and Morin were also invited regularly to the local nursing school and later saw students there using some of the assessment techniques they had demonstrated while visiting the school.
Both students said experiences outside the hospital left the greatest impression on them. Morin cited a visit to a home in which eight family members were severely infested with scabies, a highly communicable skin disease. One child had died earlier of complications related to secondary infection and some family members were unable to stand due to painful sores. The pair treated the family, boiled their clothes and prescribed ointments and antibiotics.
When they returned a week later, they were surprised to find the family had taken their advice, acquired medication and were in considerably better health.
"We were very happy to see such immediate evidence that something we had done had actually helped people," Morin said.
Fraser and Morin also accompanied MacLeod on working visits to villages in the area, where they held medical clinics for local residents.
"We were really well received in these villages," said Morin. "And the challenges and rewards of assessing and treating people in those conditions is something that I couldn't have imagined without experiencing it."
The students stayed in a guest house in Bagamoyo where they estimate their cost of living was about $3 per day including accommodation, food and employing a cook to prepare it. Living conditions took some getting used to, but a busy schedule meant they didn't spend much time at their guest house.
"We had scorpions in our bedroom, cockroaches in the bathroom and rats in the kitchen, but once you get used to it, it's not really a problem," Fraser said.
"We realized through this experience the importance of entering into situations with an open mind. We went into it with certain expectations and were shocked and surprised by what we encountered," she said. "For that reason, it's important to be adaptable and patient."
Since 1988, 18 UBC students have carried out nursing studies in a number of developing countries including St. Vincent, Botswana, Brazil, Thailand, Nepal, Pakistan, Zaire, Tanzania, the Dominican Republic and Kenya.
"Through this experience in developing nations, students begin to appreciate the issues of primary health care and development, and the factors that determine health in all societies," said Assoc. Prof. Donelda Parker, course adviser for Nursing 408. "They develop cultural sensitivity and communication, learn self reliance, and improve their health-related assessment skills."