Friday 12 June 2015

37. “Are we nearly there yet?”



When our eldest daughter was 7, the other three were aged 5, 3, and 1 respectively.


  
For holidays, we would usually pile in the car and set off for a week’s camping on the Continent. Long car journeys, (and preparing for them), therefore, were seminars in applied child psychology:

“No, it’s not an ugly plastic rucksack I found in the park, (with nothing wrong with it except a broken zip, by the way), it’s a special magic fairy suitcase I borrowed from a princess!”

“Look! Dolly and Teddy are going for a wee before we set off! Does anyone else want to squeeze out a wee?”

“Eat up your food so you don’t get hungry on the way. Dry bread is a special treat! Who can eat theirs first?”

“Look! Dolly and Teddy are throwing up on the roadside before we set off. Does anyone else want to get car-sick before they even get in their seats?” …
“No, not you, mummy…”

“Right! Who would like to have the special snuggly seat in the boot with all the luggage?” …  
“No, not you, mummy…”

Etc.

However, once the journey is under way, the real psychological deal-breaker is the management of the deadly phrase, “Are we nearly there yet?” As plaintive as a baby’s cry; as irritating as Kim Yong Un’s haircut; and as impossible to ignore as a bevy of bickering tom-cats being struck by a falling piano. Yet ignore it you must, for the sake of your sanity. (Unless, of course, the questioner is the driver, your saintly relative by marriage, after she notices that her navigator has been asleep since Milton Keynes).







Yes, long journeys then were a real mission, full of the unexpected, and, what was worse, the expected.

However, what I failed to appreciate in those days of discovering that we should have turned right at France, is this: any number of factors might prevent you from spending a week in Marais-Isolé de Mouches, but almost all of them wreak their negative effect before the journey starts. By the time your car engine coughs into life, reaching the destination is almost guaranteed. Sooner or later. Often later. But nevertheless you arrive. It may be that you are not nearly-there-yet when you realise after driving fifty miles that you left teddy on the doorstep, but you know that, eventually, you are going to be.

And so it is that I am delighted to report that the EMBRACE-Tushikamane journey, after two years of careful planning, is finally about to begin. I wanted to say that it has been a tough two years, but, in reality, it hasn’t.

We needed first to decide how exactly we were going to tackle the awful maternal and child mortality in the rural areas served by hospitals such as Berega. You three regular blog- readers will remember that I went there for a couple of months in 2013, in the naïve hope of influencing the deaths in childbirth by improving the maternity services. It transpired that seven out of eight deaths occurred in the community, due to tantalisingly remediable causes such as lack of transport when needing a caesarean; having no money for any health intervention; lack of antibiotics in septicaemia; ruptured uterus from taking traditional medicine; lack of early recognition of blood pressure and therefore death from eclampsia; bleeding to death for lack of a simple injection to deliver the placenta, etc, etc.

This litany of awfulness would have been overwhelming had it not been for the pioneering work of Prof. Anthony Costello, Mikey Rosato, and the team at UCL, London. Anthony is the Director of Global Health, and he and his colleagues were only too well aware that charitable interventions in utterly resource-poor settings often produced only dependency and transient benefit. They therefore devised and fine-tuned a mechanism for getting each small community to participate in determining its own destiny, beginning with setting up women’s groups. Success followed success, and eventually their methodology became official WHO policy:


A charity was set up to perpetuate the aims – ‘Women and Children First’ – and at the same time as the system produced huge success in Malawi, under the leadership of Florida Banda:






http://www.maimwana.org/
https://vimeo.com/15751446

Fortunately for EMBRACE-Tushikamane, we have had enormous support from Mikey Rosato at W&C First, from Florida Banda in Malawi, and from Prof. Costello himself ...





... reprising his supporting role of forty-six years ago, when he played Scrooge to my Cratchit in the school play:





“A must-see triumph! *****!” (Blackheath Herald).
“Wood brought tears to my eyes!” (Belmont Hill Spectator).  
“I brought tears to Wood’s eyes!” (My mum, when I then failed my exams).
(Note the black stuff on top of my head, by the way. One day I woke up and it was gone.)

Countless other happy coincidences, (if coincidences they be), have created the circumstances for the successful start of the journey: 

  • the good will of the hospital hierarchy and the leaders of the community; 
  • the drive and determination of Prof. Arri Coomarasamy at the University of Birmingham and the charity Ammalife, in housing the project, finding it support;
  • the provision for Helen Williams to centre her PhD thesis on the project; 
  • the help of ‘Hands4Africa’ in mapping the roads; 
  • the support of the Diocese of Worcester and the charity Mission Morogoro being ready to respond to at least some of the needs which will be articulated by the women’s groups; 
  • the generosity of many of you supporters, in providing for the financial costs thus far;
  • the free provision of materials, advice and technical support from Mikey Rosato at W&C First; 
  • and finally the creation of partnership with key individuals such as Dr Godfrey Mbaruku at the Ifakara Health Institute1, and Prof Senga Pemba at the Tanzanian Training Centre for International Health2, who hope to use our project as a pilot for spreading the programme more widely in Tanzania. 
Additionally, the hospital itself is getting ready for any future influx. The Nursing School at the hospital has just had its registration made full instead of provisional; the paediatrician David Curnock annually visits Berega to top up skills in care of the newborn; the obstetrician Dr Ahmed Ali will be going again to Berega next month to help improve maternity services; and his wife Elizabeth, a midwife-tutor, is amidst plans to be able to foment the engagement and training of traditional birth attendants.

However, none of this journey preparation would have been of any use without a driver, and the driver needs to be in the car, not 5000 miles away in the UK. What a delight to report then, that Dr. Greg Kabadi will be taking on local leadership of the project.



Greg is Tanzanian, with 15 years of experience in project management of community-based maternal health programmes. Indeed his PhD was closely linked to the work we are doing, and he is passionate about reducing maternal death in rural Tanzania. He is a public health and African community project management specialist rather than a medic, and that actually suits our purpose better.

He will begin his association with us by seeing how this work has already achieved a major impact in a similar setting. At the beginning of July he will be visiting the Malawi team and villages, and will get first-hand experience of how the process works and of what it can achieve.

Some time in the autumn, when all is ready, he and I and Helen Williams will visit Berega and Tunguli, to meet the key people. We will finalise recruitment of staff, finding local champions of women’s issues to begin to help the women of the villages find their voice.






And so, finally, we begin.

“Are we nearly there yet?”
Of course we are nearly there! We have set off.