Some Final Thoughts

I am sure that this really won't be my final final thoughts on Africa, but I am killing time until I can go to my friends' place in Dar. I have some American missionary friends here that my hometown church has been supporting for a while now. I met them when I first came to town and will be spending the night with them tonight before I fly out tomorrow evening.
Wow, so many emotions and feelings as I sit here. The biggest question is how are we going to effectively move forward and which step are we, as an organization, going to take? There is so much need here and I am struggling with what is fair and equal. How do we balance charity with sustainability? Handouts versus an honest days work?  The last week that I was in Berega, the Anglican church was having a crusade. People came from all around to sing songs and listen to a message from a visiting pastor. My last day there I sat and watched all the dancing and singing. Slowly I noticed the children from the preschool coming to sit next to me or say hi and then the next thing I know, I am absolutely surrounded by a sea of little black faces. Some of them just stared at me, others touched my hair or my arm. I don't think the ones that weren't the preschool kids had ever been that close to a white person before. I watched the women dance in their bright colored dresses and fabrics, even the men really got into it. It appeared that there was a special men's singing group there as well. I didn't understand a word of it, but when it comes to God, you just kinda know what is being said. I said good bye to those I had become friends with and even had a phone call from one of the doctors wishing me well. I realized that whatever happens, these children have to be given a better future then the one their parents got. Whether that is from better schools or giving good paying jobs to their parents, I don't think it matters. Either way things will be better. Through my 3 week journey, I witnessed the operation of a 13 year old who had a typhoid intestinal perforation. The smell that came out of her belly during that operation was one I will not soon forget. Things aren't done in a hurry here in Berega, there is no true emergency. I checked on her nearly every day after her surgery so worried that she would succumb to sepsis. Thursday I went to look for her and to my great surprise she had been discharged home. That was the best news ever!!!! I couldn't help think that if she was in America, her biggest concerns would be what to wear to school to what boy liked her this week (she was beautiful) to how much homework her math teacher had assigned, not fighting for her life from a disease that can be stopped with proper hand washing and better water. That is what I want to do. Start preventing things from happening in Africa that we don't even think about in the states, give people a fighting chance through better education for everyone and better equipment for the hospital. Simple things, like painting the walls with education material in the hospital, providing books to the nursing school and helping to recruit better qualified students for the school and giving easier access to clean water for all are just some things to start with.
Its amazing how roads intersect in your life and God puts people and places together that make us question why, but in reality it was all a part of a grander plan that is still unfolding before me. I have not shed a tear about what I have experienced here and I may not or I might bawl like a baby once I get on the plane, who knows? But the one thing I do know is that I will be back and the people of Berega can count on that!

Hogwash in Africa

I use the word hogwash because I should be a little conscientious about my readers. Disillusionment may be a better word, but bullshit is a stronger word. We visited the last of the 3 outreach villages yesterday (Monday). First we were 3 hours late since the driver decided to have other plans the night before in Morogoro to where he wouldn't be arriving on time. Once we got to the village, all the leaders had gone back home since we were so late. In the meeting, I learned that there had been a project started there and then "abandoned", but I only heard their side of the story not the organization that had brought the project to the village. As I explained through a translator that H4A was trying to establish sustainability not continually provide handouts. Through sustainability and job creation, the health center would continue to operate and people would have money to sent their children to better schools. I continued to have some serious misgivings about this place. They actually have a dispensary and a couple of water sources, one for drinking and one for cooking, cleaning and bathing. They were excited about our new choos (toilets) and humanure project. This all was topped off with a huge tree across the road as we left the village. First of all, please understand that this is the WORST road/path I have ever encountered in my life. I have no desire to go on it again. H4A has to get it passable before we can start hauling semis up the mountain to bring supplies to these projects. The views from the mountain were incredible though. So, back to this tree...the fundis (craftsman) were cutting it down for timber when they say "the tree refused to fall the right way"---can we say b.s. to that? If you cut it correctly the tree will fall the way it is supposed to, not across the road. So we of course stopped the truck, got out and insisted that they needed to work to make it so we could pass. This was the biggest cluster I have ever seen. First they tell us that their chain saw isn't working, but then all of sudden what do I hear? The roar of a chain saw! They trimmed out all the branches that were hanging in the way and measured to see if the tree would pass under the widest place. They refused to measure the truck more then once and were incredibly rude to Liz and I, very argumentative. Needless to say the head fundi was the education coordinator for the Chagongwe area, the very person we were attempting to assist in improving the preschool/kindergarten. So the truck made it under the tree with about 6 inches to spare, no scratches or dents on the roof. Then after all of that, they insisted that we pay them since they had stayed to HELP US!!!! Holy S*&%!!!! I couldn't believe it. It was their mistake, not ours and they needed to make the road useable again. Basically it was a bribe so that maybe they would help us out in the event our truck broke down or we got a flat tire. Well, excuse me, but that is a risk I am willing to take. You are talking to someone who has changed a few major tires in her life (8 to big exact on my 5th wheel alone). This was so absurd. Liz was very angry and I just quietly stewed. I have no desire to go up there again. If I come and live in Africa it will be in Berega and I will oversee things here or run the nursing school. Those people can rot up there on the mountain for all I care. Another thing is the lack of respect for women around here until they want money from the white women.  Nope, no respect, no money. This isn't a hand out charity. We are here to get you all on your feet with jobs, money and decent hospitals and health centers. If this is going to work, then all this hogwash has to stop!!! 
Ok, that's my rant and thank you for reading.
Rebecca
P.S. I wrote this the day after the above event occurred. I have since calmed down and have realized that life here is full of dishonesty by few who make the rest look bad by association. I suppose this is also how it is in the US. My efforts will continue to be focused on the Berega Hospital and the nursing school, where I hope to come a teach one day. For now, I will return home and write my grant and get the supplies for the hospital. All is well. 

Thursday's story

This was my blog post for Thursday. I apologize for the delay in getting it posted, but when the generator decides to not work there isn't much I can do!

It was 0830 and the low clouds were beginning to dissipate from around the tips of the trees and the mountains. It was breezy and the sun was threatening to make for a very steamy day. Today was the journey to Tunguli, one of the 3 villages chosen for road, water and outreach clinic improvements. We were piled into the truck, two in the front and three smashed together in the back with a man riding in the bed of the truck. We always tend to take a few extra people along and drop them off at their various requested places along the way. As we started driving out of Berega, I fully expected to get on the highway but then all of a sudden we were taking the left at the fork in the road and proceeded down an all dirt road. Village after village we passed on the road that at times made you feel like you were tumbling around in a clothes dryer. Think of the worst dirt road you have ever been on and multiply by 500% and that will maybe come close to how bad this road was at times. I quickly began to figure out a sense of the financial hierarchy within these villages. If the village was comprised of mud and stick houses with grass roofs and there were no discernible stores in the area, then this village was a poorer side of poor. If the village had more brick homes with tin roofs and several stores in the area then it was at a higher income level then the mud hut village.
As my fellow passengers conversed quickly, and at times loudly, in Swahili, I became lost in my own thoughts. I watched the children as they ran to the side of the road to watch the truck pass and how the barn yard animals scattered to the honk of the horn. I wondered how things could ever be better here. The road went from a pale sand color to a burnt orange color and back again. Just when I thought it couldn’t get much worse, we veered off onto what I swear was a path-not a road- that took us to Tunguli. Upon our arrival, I looked at the clinic before me and realized how empty it seemed. They call it a health center, not quite a hospital, but definitely more then a clinic in my definition. We took a tour of the facility and it was sparsely equipped with even the basic things, like beds. There was a maternal child health outpatient clinic, a regular outpatient clinic, and women/children ward, a men ward, and of course and labor and delivery room with a postpartum room.  Each of the wards could hold 12 patients and there were maybe 4 beds in each ward. I would not want to give birth in the L&D room.  There were two “isolation” rooms and one was being used by a family with 5 children that more then likely had the measles. We saw 3 of the children arrive with their father by motorcycle as we pulled up. The mother admitted that she had not brought her children into the clinic for their immunizations. They lived 4 hours away, so I could see how that would not be a priority for her. We went and saw the water situation of this village and I was relieved to find several pumps/wells that produced much cleaner water then I had seen the day before. Today I appreciated the great cloud cover from the sun as we viewed these wells. I got a taste of what it was like to pump the water out and into buckets and came to the realization of how this activity could occupy your whole day.
We partook of chai in the morning, toured the water wells and the school, and then had lunch. I was able to speak to a couple of village women who had brought their babies to the clinic for shots.  One woman was 31 and had given birth to 5 children at home, one had died due to an illness and inability to get the child to the health center. The other woman was 18 and her one and only child was strapped to her back. She had given birth in the health center. I asked these women if they would come to the clinic if we made improvements.  Their response told me that it was not a matter of making the clinic better, it was a matter of making the roads better so they could GET to the clinic. During the rainy season these women live far away at their farms and many of the roads become impassible during this time. I saw the need for many bridges to be built!
As we travelled around the village I noticed how the children responded. The first time by they strictly stared regardless if I waved, the second time they would smile in response to my wave and the third time they would run towards the road and line up to yell and wave (still staring). I found my first child who was absolutely terrified of me. I illicited bouts of tears and screams with my very crossing of the threshold. It is possible that the child’s parents had scared him by threatening him that the mzungu (white people) would eat him. Of course this child was at the house where we had chai and ate lunch. These children were covered in the pale, sand colored dust and wore clothes that seemed threadbare and with holes but yet smiled and played.  I am sure that I was the highlight of the day for the majority of them because village life can get a little monotonous I am told.
On the way home, I watched women with multi-colored buckets on their heads begin to make the trek back to their home and wonder would we be able to make that trip shorter. We bounced our way back through the same villages from whence we came and I rolled down the window to wave at the crowds of the children and adults that were gathered along the way. Don’t get me wrong they weren’t gathered to watch for the truck, they were just gathered around, pockets of people here and there. As I waved I couldn’t help but think that it felt strangely like being in some queen of this or princess of that in a parade. Not that I have ever been that, but it was weird as the swahili conversation swirled around me and my thoughts focused on making this damn road better and bringing beds to the health center. I was no queen or princess and I was definitely no hero and I don’t even want to think of myself like that, I just want to give these parents a job with a reasonable salary to be able to provide clothes and educational essentials to their children. With their children educated comes more workers for the health center and better health for the entire area.
Improving public health involves the community. It has to for sustainability. I asked the doctor or I should say clinical officer, how we can improve the L&D area and his response was to knock down a wall to expand the one small room to one large room capable of holding 5 beds that we can separate with curtains and then put 5 beds in the postpartum room with curtains and mosquito nets over the beds. I did inform him that he cannot have the isolation room next door to the babies. That room would have to be moved and the other room would be taken up in the expansion. Its a give and take. Public health often requires creativity and if there is one thing I have learned from my friend Liz, is creativity. Take away the need for posters that tear and crumble and wrinkle away from the wall and paint all kinds of patient education material on the walls. It can not be removed unless someone paints over it. Put it in both English and Swahili and inform, inform, inform. No brochures or pamphlets needed. Plus it gives people something to read when it is busy at the clinic. Paint the common waiting areas, pediatric ward, maternity ward, everywhere there is a blank space consider putting something there. There are many things that these people don’t know and by putting a creative spin on the information people may remember it better. Needless to say, the clinical officer was all for it. Tunguli is a good place for H4A to start. No major construction other then the roads needs to be done, just overhauled and brought as up to date as possible. This was my day today.

Where there is no Maji or Doktari (this is long)

Maji is the Swahili word for water and I have quickly learned in Berega water is a luxury. Oh sure, my house has water that comes from the ground that is very salty and not safe to drink and we have rain water that has been collected from the seasons that you cook with and put through a filter to drink and I have also bought bottled water, but to everyone else, water is a luxury. For some reason God chose to put this town/village in Africa in a place where water is not in abundance. You go down the mountain a few hours and there is water in bountiful supply. Right now it is the dry season. Water is rationed at the hospital housing to two days a week. The family members of patients who stay in these small rooms behind the hospital have to go many miles to find water to bring back to cook the meals for the patient. We, Liz and I, recycle water in ways that you don't realize. Today we did our laundry and the neighbor's house girl came to get our soapy water to wash their floors and to use to flush their toilets. We collect the piped water from the ground in a tub throughout the day and wash our dishes in it. When the dishes are washed we water the plant with it. You just don't turn the water on to water the grass or wash the patio. Every drop has to have a very calculated purpose. We do have a shower that is now a hot shower, thanks to Brad Logan, and last night I couldn't help but wonder if I should be turning the water off in order to conserve it. I have only taken a shower every other day here, so maybe my indulgence wasn't too bad. This is the first major hurdle that H4A has to combat. We need water here, desperately. I have been told that you can dig for the water and in fact I have seen shallow holes that have been dug in the dry river bed to get to water. Brad has said that he has access to a water drill somewhere, but it costs $75,000 to bring here and then we have to have someone who knows how to operate it. One of my many tasks when I get home it to find some Rotary Clubs to speak to and see if H4A can gain their sponsorship for the drill.  Water and better education lead to healthier communities.
My dear friend Liz has taken up championing for the latter. She does a great job teaching preschool to 5 and 6 year olds. They know their shapes, colors, numbers to 150, letters and can make good complete sentences all in English!!! They are smart, very smart. She is also tutoring adults in English classes. I have sat in on a few of her classes and these adults know more then they think. At the end of class they ask me questions in English about me, my family and where I am from and we discuss things. During this class is when Liz and I first hear about the Hungry Time. The Hungry Time is a real thing, it happens between the dry season and the rainy season when the maize crop has gotten very low and there is no water to plant yet. The next planting takes place around February. The Hungry Time is Dec-Feb and many people, children included, will only eat once every 3 days.  We have been told that nobody dies from hunger during this time period but everyone gets pretty skinny. Liz and I have been brainstorming ways that H4A can help with this. We will have to talk to the boss about it first. We want to make sure that the children, pregnant women, nursing mothers and the elderly eat. Basically the most vulnerable population. We have a long way to go to get approval and money to do it. Please pray that this all works out and we can do the best for the most. We want to have a free feeding program where the children bring their plates and we feed them ugali (which is a maize lump of starch) and maybe beans.  There is also a stew/soup made from maize and beans with a broth.  Of course during this time the price of corn and rice skyrocket because nobody has any money but the demand is high.  So we ned money now to buy the ingredients now. But first thing is first, permission from H4A and from the village government.
Now to where there is to Doktari (yes that is Doctor is Swahili). I had an indepth tour the other day of the hospital. The lady I saw early in the week with the ascites and possible multiple tumors is still here and still has a swollen belly. She happened to be puking and all I could think is where is the Zofran!!! She looked miserable and still needed to be tapped. I saw a pediatric patient with a burned leg that had a cradle over it to keep the sheets from touching it and the flies off of it. Another pediatric patient was in with a probable intestinal obstruction. He had a NG tube down and it was draining by gravity into an emesis basin.  He may get surgery, he may not. The hospital here has 3 trained clinical officers. They aren't quite doctors and they admit it. They are more like the equivalent to Physician Assistants. As one said, "we do it all". I said " a jack of all trades and a master of none"? He laughed and agreed. So as we continued on, I got my first real look at Ward 5 which is the Maternity ward. The L&D area is 3 rooms on beds as old as dinosaurs and about as comfortable as lying on the concrete itself. There was a girl, 16, in one who had been admitted at 5pm but was probably in labor since 10am. She was uncomfortable for sure and as I reviewed the chart I quickly saw two red flags that would make any nurse cringe. There was meconium in the fluid and the baby had irregular fetal heart rate. She should have been in surgery right then. Plus she was little and the baby was big. Needless to say, she was my first c-section I assisted on as well. Before I tell you about that, I went to the premature baby room. Now being a former NICU nurse, I braced myself for the worst, but it was actually good. There were four hospital sized beds, two on each wall. Two of the beds were occupied each by one mom and one teenie tiny baby. One baby was 8 days old and weighed 1.8kg (3.9 lbs) and one was 3 days old and weighed 1.5kg (3.5 lbs). One mom thought she was maybe 32 weeks at the time of delivery and I have to think that the other mom was too. Due to lack of prenatal care, these women have no idea. This is also an education thing. These babies were snuggling dressed in sweaters, hats and wrapped with a foil sheet and blankets, lying next to mom. Kangaroo care is what we called it. The chalk board in the room  indicated that these babies are growing, so something is going well. They can be discharged when they are 2.5kg, which is a little over 5 pounds. The key will be to keep the healthy in their homes to survive to age one. I was deeply saddened and shocked at the same time. I had to pull it together to keep from crying.
Now, on to the c-section. I had been warned that things were not what I am used to, but I had come here to see everything and truly had no expectations. I was told where to change and since the scrub bottoms didn't fit my bottom, I found a scrub dress that fit. I put my socked feet in white rubber boots, found a cloth head covering and was handed a disposable mask. I made my way to the scrub sink which was two faucets with a piece of hose attached to the end to avoid splattering and the soap was a bunch of powder in a bowl. I scrubbed my hands and arms the way I had been taught and then used my elbow to turn off the water. I made my way back into the OR and was shown which towel to use to dry my hands. There was a fabric surgical gown that I put on and then donned two pairs of sterile gloves. The patient came in on a rubber gurney that is hard to describe, but there were two poles through the fabric that were used to place the patient on the operating table. Keep in mind that she is 16 and no one is saying anything to her. I couldn't say anything that she would understand.  She was scared. There was a scrub nurse there who got the instruments ready. The CRNA place the patient's arms on "the cross" as we call it. Two boards, one for each arm, outstretched. They use ether here too by the way.  Dr. Abdallah and the nurse draped her stomach after he had cleaned it with betadine. I am not sure what drugs she was given before the ether, but when he put in an oral airway, she promptly puked. The section took 40 minutes. yes that baby was sitting in pea soup and came out pale, very pale.  He was handed by the ankles to the baby nurse and she did suction out his nose and mouth thoroughly. He took a long time to come around. NRP was not happening. Finally his high pitched cries came forth. Meanwhile there was no suctioning of the blood in the uterus or the pea soup. It just ran on the floor and down the back of the patient. The closing had commenced. When he was done, and he did a good job, that's when he did a fundal massage and the blood came out the vagina. Very interesting technique.  Overall, I felt that the procedure was as sterile as could be expected out here in the "bush of Africa". Today (Sunday) I asked how everyone was doing and I was told ok. The mom was put on antibiotics and the baby would be too to prevent pneumonia. At least now I know what to do in my next c-section and I won't hesitate to get that baby crying either.
Many things have been running through my head and if I think too much about any one of them, I start realizing that maybe this problem is too extensive and nothing can ever be better. With that thought comes the feeling of suffocating. I slow down and realize that the present has been this way for centuries and it cannot change in 2 weeks, 2 months or 2 years. But things can be better. Slowly better.
First we need water and then we need supplies and then we need better education here, which isn't formal education, but health education for the mothers and for the children. The Brits are slowly pulling out and H4A can get down to the real work. Creating a healthier community one mother and one child at a time.

Welcome to Berega, Tanzania

It is 2pm on Thursday afternoon as I write this. I apologize for not getting a blog post out sooner, but alas, the generator did not work last night. Don't worry, we still have lights that run off of batteries that are charged by the solar panels on the roof. Not much has truly happened since arriving here in Berega. Getting here from Dar was alot easier on Tuesday then driving around on Monday. It was the end of one Muslim holiday and the beginning of another and so there were many people in the city. I have sat here for about 7 minutes waiting for a picture to upload, so it looks like I will have to upload all of my photos once I get to London or home. Traveling up a major highway in TZ is a lot like the highways back home, well at least on the Rez. There are lots of trucks and it is a two lane road, so there is patience in passing. There are many towns/villages that you go through and each one requires a slow down to 35mph. It is here where you run the risk of having Walmart come to your window. Oranges, apples, cold bottled drinks, packaged nuts, and live chickens if you want are offered to you for a price. Bayona wanted a chicken for his wife, but they men wanted too much money. They wanted 14000 tsh ($8.60)when you can get one frozen and plucked in Morogoro for 5000-6000 tsh ($3.50).  Needless to say it was a very different having these live chickens hanging upside down at your window! Once in Morogorro we picked up Liz, bought a few groceries, went to the Bishop's house and then ate "chips-in-my-eye" on the street. It is basically a french fry omlette  and so good with salsa.  You eat it with your fingers and finish it off with an ice cold coke or fanta. Great!!! It was very dark by the time we got to the house in Berega. We basically off loaded the truck and I went to bed.  It is very humid here and even in the dark of night the air can be thick. It doesn't matter to me, i am so tired by that time, I just shut my eyes and sleep.  
Yesterday we walked down the hill and saw part of the village. I still need to walk up the hill and see the other part. I love the kids here. They have these big questioning eyes and some will speak English to you and they are so proud that they know it. It is very formal sounding coming from such little mouths.  Liz teaches preschool here in the mornings and has adult English classes during the evening. These people are smart and they want to learn. She even has a little library started. I took a picture of that too that I will post at some point. If you have extra books that you don't want send them to me, and I will send them to her. It is better then Bookman's.  There is so much to be done here but I know that a little at a time, things will change, we just have to get started.  I just met with one of the doctor's and the director of the pharmacy and they are going to get together with the other doctors and make a priority list of equipment and medicines for me to work on when I get back.  They are very grateful for everything that has been given and for the interest that has been taken in their village. This is good, very good. I could live here, you know.
Rebecca