04. Beginning by being here
14th July 2013
14th July 2013
I hesitate to tell you my dream
for mothers and children in rural Tanzania. Aspiration – yes. Plans – even
better. But dream? Dreams are vague. Dreams are frenetic. In dreams, you are at
the theatre, supposed to be on stage in two minutes, but you haven’t written
the play yet, when someone, initially your mum or possibly your sister but you
gradually realise that it is your biology teacher, comes in to hurry you, but
you discover that you have no clothes on, so a friend, who is later a different
friend, takes you backstage, which opens onto city rooftops, so that you can
fly with him, who is now them, pursued by your brother who has got your shoes,
which when you put them on you realise are rugby boots, and your antagonistic
nemesis from primary school passes you the ball, and it turns out that you can
actually run faster than you can walk, if you didn’t need the loo so much, but
as you approach the try line, your friendly workmate redirects you onto the
stage, where the audience awaits your first words, increasingly disquietedly,
until you are saved by the fire bell going off so relentlessly that you wake
up. (Is it just me that has dreams like this?) (I’ve just re-read that
paragraph, and even I can see that I need help.)
So a dream is perhaps not the
best way ahead when thinking about sustainable development. It is too easy to
leap haphazardly hither and thither, prompted by the exigencies and
consequences of deep-rooted under-development in this worrying corner of the world.
We are beginning, therefore, to collect together our thoughts into an
aspiration; and to distil how we might take the first steps in turning that an
aspiration into reality. Choosing those first steps, however, is not quite as
easy as it seems.
When I was in Africa before, I
made many mistakes. A characteristic one was to assume that just because
something sounded like a good idea, that I was thereby empowered to ram it down
the beaks of the chicks in my keeping. A few cuckoos in this way were nourished.
A decade and a half later, I was teaching the management of change, on a
two-year sabbatical. (On the basis of what qualification, you might reasonably
ask? These were the Blair years, I would point out. I looked like I knew.) (And,
more importantly, I knew how to be engaging by not wearing a tie.) So there I
was, teaching others what should happen when you unleash a vision statement or
Gantt chart or project manager. Dreams would become reality. System development.
Admirable and well worked tools.
I had never grasped then,
however, and probably still have not now, what actually makes human beings
behave in the way that they do. If you are a husband, for example, married to a
loving and beautiful spouse, why is mowing the lawn the second thing you think
of when you wake up on a sunny summer Saturday morning? Is it the prurience of
your garden maintenance management consultant? No. Much more likely, your plans
and actions are manifestations of a devoted adherence to your woman’s unspoken
desires. And if you are a wife, married to a loving and near-perfect husband, why
is giving both verbal and written guidance for the conduct of your beloved’s
day, both the first and second thing you think of before breakfast? Project
management? Surely not. It is the joyful desire to give your man the
opportunity of a day well spent. What really controls behaviour is not so much good
ideas, as relationships. It all depends on relationships. I can only sustain
positive change in that of which I am a part. So we begin by being here,
together, where we are.
But in Africa, where we are is
not always a good place.
When I began the maternity ward round
on Tuesday morning, I was feeling buoyant. During the night, I had assisted
Hizza at two caesareans, both done with ease and skill using his newly-honed
techniques. In each case, the midwife had dealt well with the (anaesthetised)
baby, taking account of previous nudgings and admonitions. The second
caesarean, despite being at 5.30am, with an exhausted team, was ready to start
within 35 minutes of the call. Very satisfying. And – the team were relieved at
the lack of time-wasting! Massively satisfying. But when I later arrived on the
ward to ask how the first lady was doing, I was told, ‘fine’. She pointed to
the woman half way down the ward, un-nursed, lying on her back with an airway
in, still deeply unconscious.
“Has she had any observations
yet?”
“Yes.”
“And…?”
“Blood pressure nil”
“Blood pressure nil!!!?????”
“Yes.”
“And she’s fine?”
“Yes”.
Actually, she was fine. The nurse
has just not been able to find the BP because the BP cuff was faulty. Guidelines
for post-op care of course exist in Tanzania, but they might as well not, written
as they are by someone else, somewhere else. Here, the culture in which we work
has been “if you die, you die”. That is not neglect; it is the way. In the next
bed was Joyna. In a previous night, Joyna had made the motorbike journey from
Mtumbatu, just 20 bumpy minutes away, in labour in her sixth pregnancy. Two previous
caesareans had led to two healthy children. We added another to each tally.
Three home deliveries, however, had resulted in three stillbirths. Despite
this, she had had no antenatal care. A quick survey of the ward showed that
more than half of the women with previous pregnancies had had at least one baby
die. Indeed, two women on the ward had lost their babies this time round – one to
eclampsia, and one to congenital abnormalities. (Her fourth successive child to
die at full term). Death is where we are. Whatever the first steps on our
journey to a new reality, they will not be the pinning of guidelines on the
wall, and the pointing of an angry finger at those who do what they always did.
(That comes later?)
The first steps then. We have
already begun, and my part is tiny, so don’t get the impression that I am
Ghandi. What I bring is simply knowing that it does not have to be like this,
and falteringly imparting this to the staff. The vehicle in which we will be travelling
is their belief that it can be different. Slowly, we are gathering an impetus
fuelled by getting it right. Emergencies dealt with promptly. Babies well
nurtured. Surprising survival, achieved together. Where we hope to be, as soon
as we can, is that in every common mother or baby emergency, we do a good job, (mainly),
based on the knowledge that we can, and the understanding of how. With that
solid beginning, we can think of progress. We plan to engage with the people;
with the TBAs; with the ten births that happen out there for every one that
happens in here; with the Village Health Workers and their utter lack of any
resource; and with the communities that Hands4Africa will be financially developing,
educating, mobilising, and empowering. On Monday we have a meeting where we
will decide the next steps. More of this next week.
By the way, I forgot to mention
last week that Barack Obama came to visit. Not actually to Berega, and not
specifically to see me, (as it turned out), but nevertheless he chose Tanzania
over his native Kenya to water his flock on his pastoral sojourn across the
planet. In a completely unrelated item of news, Tanzania has found some new
mineral resources in the south of the country. How strange for me to be just a
few hundred kilometres away from the leader of the free lunch. Only joking. I meant
free world of course.
You do get the wonderful feeling
of a free world here. As I write, harmony singing is ringing across the valley
from the gathering place on the hill. When there is no singing, the chattering
of children and the clucking and clicking and cooing fill the spaces in the African
sound. The evening fires at the entrances to homes welcome back the workers. Then
the stars come out, and the Milky Way is painted in a rough white stripe overhead.
It really exists. For the last five or six nights the moon has simply failed altogether
to pitch up, but, to be fair to the moon, this has allowed us to see the Milky Way
in all its glory. There is even such a thing as starlight. (The other night, I
lay in bed in deep darkness. I passed my hand several times right in front of my
face, two inches from my nose. I could see absolutely nothing, not even
movement. I opened my eyes and it was not much better, but a hint of starlight
told me what my hand was up to.)
What else can I tell you of my
week? I have lost 6kg already, since landing in Dar Es Salaam bursting with
Emirates’ Foil de Poule au Genu. If I carry on like this, within a month and a
half I shall be back to my birth weight. It may be of course that I have a
zoonosis, (that is an infestation with a family of nematodes or amoebae), but
if they have a family and I am just an unemployed man of working age, we have
to wonder who has more right to be in my body.
I tried to address the weight
loss on Wednesday, when the complete lack of any sustenance whatever in our
kitchen led me to take the day off, and make the two-hour trip to Morogoro.
Morogoro market is a wonder. In the market you can get not just fruit and
vegetables, but kettles and cooking pots and string and bags and contraptions and
tools for removing leeches from goats’ fetlocks, and a thousand other things
more, and then more again. Innumerable stalls and makeshift displays are rammed
into an old colonial shell. Rusty, broken, part-lengths of corrugated iron are
woven together into jagged irregular projections of roofing, nailed to crazy wooden
frames, to protect the goods from the hot, sweaty sun. (I cannot be sure that
the sun sweats, it being a star, but in Morogoro market, it seems to.) There is
no fruit you cannot buy – except, bizarrely, apples. Heaps of pawpaw, mango,
passionfruit, banana, tangerine, avocado, and untold others are laid out in
little piles, each pile costing 500 Shillings – 20p. (But no Pink Ladies. No Coxes.
Nothing makes you want more to be munching on Granny Smith, than her total
absence.) Then the vegetables, the ginger, the garlic, the tamarind, the cumin,
the spices I have never heard of, and endless sacks of things to soak for a
week before boiling for a couple of hours then throwing away.
In several shiploads, I bought
enough for ten-a-day for a decade, and then my reward: Protein! At the Morogoro
Hotel, I ordered half a chicken, which I reasoned should be enough at least to
put weight back on my shoulders, so that I would be able to undo the top button
on my shirt without it slipping noiselessly to the ground. Sadly, I had
forgotten about East African chickens. When they peck around your door all day,
and from time to time perch immediately outside your window to practise crowing
for much of the night, they look not-far-off normal-sized. It must be all
feather. If you hide a Tanzanian chicken drumstick in a box of Bryant and May,
you’ll never find it again. I duly gnawed the bones, marvelling that these
creatures had the strength to walk, far less scrimmage.
And so back to Berega, privileged
to be arriving by car, with food.
In every direction around, small
red mud dwellings, wisps of smoke and
noises of evening marked the villages and communities that the hospital serves.
Bands of smiling ragamuffins waved us past. Women with babies on their back and
unlikely loads of firewood or well-water on their heads eyed us curiously. The
dry river beds and straggling weedy patches of maize in our remoter and higher
part of the land contrasted with the rich watered fields around Morogoro.
Might this be the very generation
in which we make a different expectation for the people of remote African
villages?
We have a dream.
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