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Dispatches from Dar
  1. Teri A Reynolds
  1. Department of Emergency Medicine and Global Health Sciences, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Teri A Reynolds, Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA 94143-0208; reynoldst{at}gmail.com

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I'd left the hospital and was running late for the airport. But I wasn't running. I was sitting in traffic in Dar es Salaam—the wide, deep, unmoving kind of traffic where you move through predictable stages of rage, despair and acceptance—only to have the acceptance disrupted by hope when there's a few metres of progress, wiping the slate clean for the return of rage.

It had been a difficult period in the hospital where I'd come to work. Tanzania has a per capita annual income of around US$500, an average life expectancy of 51 and an overstressed pyramidal health system that feeds patients up to a small number of referral hospitals. There is no prehospital system and almost no access to emergency care. Ours was the first ED in the country, a new addition to a huge national public facility that was oversubscribed, under-resourced and simply overrun by needs it couldn't meet. The new department had radically raised the bar for early resuscitation and stabilisation, replacing a barely staffed room where patients waited in metal chairs until they died, or someone from an inpatient service came down and tried to take care of them. We were now seeing 100 patients a day, triaging within minutes, stabilising trauma and resuscitating sepsis and training, training, training. Lives were saved in our little world, probably every day, but the interface with the rest of the system was far from smooth.

We had two ventilators …

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