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.