13. Ammalife, hats and wandering nibs

13. Ammalife, hats and wandering nibs

20th October 2013

My blog style to date has been to start on a thematic journey, meander seemingly unhingedly, but then, with an attempt at an elegant literary double backflip with pike, deftly to return to base camp at the end. This time, however, I do not think I have managed it.

This fortnight’s blog turns out to be more of an A to B journey, of the sort that husbands make.

(I say this fully aware of the dangers of gender stereotyping, and I would be more than happy to accept into the category of A-to-B-journeying-husbands, anyone of whatever chromosomal make-up, as long as they exhibit the trait. The husbandly trait is this: Not only do they know the shortest way to the supermarket, avoiding traffic lights, pedestrian crossings and roundabouts, but they know it in metres, in minutes, and in points of the compass, and would disembowel themselves rather than look it up on GPS. On tougher journeys, they actually relish the challenge of getting there just as quickly, despite it being school-drop-off time in the rush hour on the South Circular, with the home team playing a morning fixture, on the day that the National Union of Lumberjacks had injudiciously planned their traditional annual parade in memory of the Great Fire of London, at the same time and place that Greenpeace were lobbying Parliament on the deforestation of the inner cities. Furthermore, if achieving this on-time arrival involved off-road segments, river crossings, the Spanish Steps, or squeezing through a little-known defect in the wire fencing around a disused aerodrome, then so much the better. If this is you, and if you have been known to cut off all communication with your spouse for a week because s/he went through an unnecessary traffic light on the way home, then you are, of whatever gender, a husband.)

One of the main reasons for this husbandly directness is that I want to leap straight in and tell you about Ammalife, (http://www.ammalife.org/), who have adopted under their wing the Berega plans for saving the lives of mothers and children in the remote area of Mnafu. (See separate post for the most recent summary). Ammalife, whose purpose is to make a difference to mothers throughout the world, is a rising star amongst such charities. Their founder trustee, Prof. Arri Coomarasamy, is one of the top researchers in International Womens’ Health, and has collaborations in many countries, including Tanzania.

(I remember him, though, when he was a doe-eyed youth. He was my houseman/junior intern many moons ago, and perhaps he is the man he is today because I did not stint in using on him the well-honed tools of the day for nurturing intellectual growth: humiliation; bombastic overbearing outbursts; and insistence on the punctilious use of outmoded and sometimes dangerous therapies. (“Coomarasamy! Why did you not lance these leeches before mixing them into the linseed-and-sparrow-liver poultice?” “I am truly sorry Sir, but it seemed as if her piles were already improving with the honey-and-hedgehog-skin gamgee.”)

Anyway, Ammalife gets things done. They make a difference, and what’s more, they put considerable effort, at no expense to the charity, in finding out what it is that does make a difference. (With their high-profile partners, they apply for grants from international organisations to run large and well-constructed studies in under-resourced settings in many Asian and African countries, their most recent one published in the Lancet). Their interventions are often simple things. In a remote part of Pakistan, for instance, they have issued pregnant women who come to antenatal clinic with a taxi voucher. When the woman goes into labour, the voucher is presented, and, when time might truly mean life or death, none of it is not lost trying to find transport; nor money for transport. The cost to Ammalife is in pennies, and the saving is in lives. It is not surprising then, that Arri Coomarasamy representing Ammalife, has been asked to lead on one of the UK’s main charity collaborations, to advise on sound intervention in maternal & child health.

There is a reason I am bigging up Ammalife, and it is this. It is much more than a shot in the arm to have had the health care aspects of the Berega /Mnafu project housed within their organisation. They are not just being nice – they like what we are doing. They think it hits the spot. What is more, I will be reporting to them twice a year, and drawing on their wisdom and, hopefully, critical friendship.

So look out on the Ammalife site for a page on our plans to make a difference in remote Tanzania. (And check out the ‘my-donate’ link which you will pointed to.)

Talking of making a difference, I have to share with you this photo:

This was knitted by the worthy women of Guildford, UK. (The hat, not the baby). When Dr. Blanché Oguti visited Berega this year, she was shocked to discover that vulnerable new-born babies cannot be adequately resuscitated if they are cold. Death and brain damage from this ironic cause in a tropical country are all too common, where newborn clothing is wet and thin. So when Blanché  returned to the UK, she talked to her mentor, Dr. Debbie Donovan. A few months later, the charity KOFIA has already knitted 1000 hats, and the picture you see is of the first ever use. The baby will keep the hat, and perhaps, one day, these Kofias might be the hall mark of a looked-after childbirth – one where the woman and her baby have been cared for in the right place at the right time, by those who know what they are doing. Those hats, back in the village, will send a deeply poignant message, from the privileged to the grateful.

I have much more to say, but will save myself until next time, when all the meetings and first phase groundwork of the plans will be complete. In particular, the charities Hands4Africa and BREAD are vital. Their frequent visits to Berega, to trouble-shoot and to develop, have had huge and progressive impact over the years: on primary schooling/education; the establishment of a nursing school; helping the hospital do its job; helping the community with transport, buildings and agronomy; and more. When we are all completely clear as to who is doing what, where, and when, we will then be ready to sign off a collaborative plan for stepping boldly into Mnafu, to begin walking with them on their journey into the twenty-first century. Each step must be solid, and each step will take us further from the numb toughness of the past. It’s really happening.

Well, I have used my time and word count, and seem to have taken you from Ammalife to BREAD, (via to KOFIA & H4A), in a fairly logical sequence. A to B, like a husband. I feel a little awkward about this, especially towards those who might have expected something a little more James-Joycey. Indeed it was in deference to such fans of the wandering nib, that my blog style to date has been to start on a thematic journey, meander seemingly unhingedly, but then, with an attempt at an elegant literary double backflip with pike, deftly to return to base camp at the end. This time, however, I do not think I have managed it.

For reference: ‘EMBRACE Mnafu’ Empowering Mothers & Babies to Receive Adequate Care & Equality

‘EMBRACE Mnafu’

Empowering Mothers & Babies to Receive Adequate Care & Equality

Community development plan for Tunguli & Mnafu

With emphasis on the care of mothers and babies

The Problem

Berega Hospital serves a vast and inaccessible territory of rural Tanzania with a population of 217,000. There are 8,500 births/year, of which only 1000 occur in a health facility. Nearly 1 in 100 women die in each childbirth, and up to 10% of children do not reach their fifth birthday.

The Vision

The vision is for trained Community Health Workers (CHWs) to reach out, initially to the isolated communities of Tunguli and Mnafu, working with the Traditional Birth Attendants, (TBAs), Village health Workers (VHWs) and village leaders, to develop a systems for managing  childbirth, family planning, immunisation, child nutrition, and chronic conditions (eg malaria, anaemia, diarrhoea, TB, infestations, & HIV). CHWs will also help improve collection of information – eg demography, birth rate, etc.

Partnership

This project would a partnership between the hospital, and the charities Ammalife, Hands4Africa, BREAD, Mission Morogoro, and KOFIA.

Phase 1: Solid Base

Trained CHWs will engage with community leaders, VHWs, TBAs, and mothers, to examine their problems, ideas, potential solutions, and priorities in relation to pregnancy and childbirth; nutrition; family planning; immunisation; and chronic disease.

Meanwhile, the charity Hands4Africa will be enhancing transport, agriculture, and the building of a health / community facility.

At the same time, the hospital will be working to implement a new Charter of Standards, to prepare it for the future influx of patients.

Phase 2: Making a difference

CHWs will work with TBAs on safe childbirth solutions, bringing selected women into Berega for birth. Thereafter, the CHWs would try to enhance breast feeding, family planning, immunisation, growth charting, under-5s nutrition, and prevention and treatment of diarrhoea, malaria, worms, and other chronic conditions. This would be centred at a purpose-built health and community facility.

Phase 3: Expanding capacity

Berega will expand its School of Nursing to train both front-line ‘medical’ staff, (‘Clinical Officers’) and nurses/midwives. COs can deal with childbirth, family planning, and treatment of disease.

Phase 4 – long term

The long-term vision is to learn transferrable lessons, whilst creating an economically viable community, with good health and educational facilities, and a lattice-work of COs, CHWs, VHWs and TBAs working within a well-oiled mechanism for early transport of the needy to high-tech facilities at Berega Hospital.

References

1http://data.worldbank.org/indicator/SH.STA.MMRT/countries

http://data.worldbank.org/indicator/SH.DYN.MOR
   http://www.nbs.go.tz/takwimu/references/Tanzania_in_figures2012.pdf
http://en.wikipedia.org/wiki/List_of_countries_by_percentage_of_population_living_in_poverty

12. Allegri miserere

12. Allegri Miserere
6th October 2013

What is 31 minus 13? Answer: The Sixteen.

We went to see them in Coventry Cathedral on Wednesday. There are thirty-one in the squad for each away fixture, but they select just sixteen - then throw in two extra sopranos to balance out the second basses, whose voices are richer and deeper than a sub-terranean Lindt 85% chocolate lake. That leaves thirteen on the bench, and eighteen on the pitch. Yet they call themselves The Sixteen. As there was no ref, they got away with it, and at 7.30 on the dot, they kicked off.

Unlike Sir Alex Ferguson, who seems to need the help of chewing what appears to be a squash ball in order for his players to obey his passionate gesticulations, (although I have to admit a grudging admiration for anyone who can, with a single get-those-chickens-off-the-road gesture, manage to tell the forwards to move ahead, and yet the goalie to stay where he is); anyway, unlike him, the conductor of The Sixteen, Harry Christophers, simply walked up to the hallowed Cathedral rostrum, neatly stuck his Wrigley's spearmint between the Bishop's and the Archdeacon's, and began waving.

I said that there were eighteen on the pitch, but 'on the pitch' does not begin to describe their precision, beauty and passion. I have been listening to (and singing) choral music since the 1960s, (with breaks for eating sausages and delivering babies), and this was quite simply the best.

The starter was Palestrina, which at first sounded no more than beautiful. Then, walking up the aisles like mediaeval monks, and filling the vast cathedral with their dark, rich sound, echoing from nave, nook and niche, came what you suddenly realised were the missing men; chanting a deep, yearning, haunting, mediaeval plainsong. The deepest, yearning-est, haunting-est, mediaeval-est ever heard.   I felt all the awe of a feudal serf walking past York Minster at vespers on a soggy Martinmas Eve. It was all I could do not to die of pleasure and /or bubonic plague on the spot. The fog-horn, mastodon low of the monks interlaced with the sparkling harmonies of the main group, like seams of praline in diamond, (which, for the purists, cannot be a mixed metaphor, as it is a simile). You get the idea, anyway, that their singing was indescribably beautiful. But the best was yet to come.

The second piece was Allegri's Miserere. If you have never heard it, listen to it now - it is, (or was, as I thought then), the most transcendently blissful piece of music ever written. So beautiful was it deemed in the past, that it was kept secret by the Vatican choir, and only sung once a year in the Sistine Chapel. Then Mozart heard it, wrote it down, and thereafter the souls of we ordinary citizens could immerse ourselves in it. The Sixteen's version, moving from the simplicity of the authentic article, to the modern embellished version, was indescribably sublime, but one feature in particular I wanted to mention.

When soldiers march across a bridge, they have to break the regular stomp-stomp of their relentlessly in-time bootbeats, or else the bridge might begin to resonate at that frequency. Were it to do so, the continued stomping would feed an amplifying effect, and within a minute the whole bridge could be undulating wildly - before spectacularly bursting. If you are a squaddie on leave and want to try this, but are separated from your fellow stompers, the same effect can be achieved by moving a wet finger lightly round a crystal wine glass at a constant speed. What should be a tiny noise self-amplifies, until it is an all-pervading note, and finally the wine glass shatters in joy. Amplification of human voices, to make a sound which gradually expands until it fills and vibrates the building, can only be achieved if every one of the voices is perfectly blended with the next; every mouth-shape the same; every vocal nuance mastered to the same high degree; and every pitch perfect.  I have been in the same Cathedral when five hundred voices did not make as much sound as those eighteen were capable of on Wednesday night. The magic was that they could expand from a whisper to a Cathedral-throbbing thrill in a heartbeat.

"Why", I hear you say, "is he drifting off on this musical odyssey?" "Aha!" I hear you answer yourself, oblivious to the seriousness of the potential psychiatric diagnoses typified by talking to yourself through someone else's blog, "He is going to draw parallels between The Sixteen, and saving mothers and babies in rural Tanzania." Perhaps you are imaging that I would pick up on the idea that plainsong is all very beautiful, but that when it creatively harmonises with the efforts of others it fulfils itself. Or maybe you think I might point to the self-amplification that occurs when harmony is perfect, whence seemingly impossible effects can be achieved. Even the old structures can come tumbling down, under the persistent vibrancy of simple, resonant harmony, you may be thinking I would note.

Certainly you would have a good point.  Development in rural Tanzania is an echoing, clashing, plaintive emptiness, ready and waiting to be filled with the music of harmonised effort.  Aligning the efforts of  Berega Hospital, the Diocese of Morogoro, the Tanzanian Health Agencies, BREAD, Hands4Africa, Ammalife, Mission Morogoro, Kofia, the Diocese of Worcester, and various universities, institutes, Quangos, and NGOs, will be worth all the effort put in. Three key meetings are approaching, and a fair amount of email traffic. By Christmas, we will all be on the same sheet.

However, if you were expecting that I was going to be so predictable as to make such comparisons, you underestimate me.  The actual story I was going to tell was this: Allegri Miserere was not the highlight of the show. After four centuries of prime time on Classic FM, move over Gregorio, and enter James Macmillan.

I had never been much of a fan of modern music. My unacceptably uncultured philosophy had been that if you wanted  to drop a piano from a tall building onto a barrel-organ player and his monkey; or if you wanted to put a tom-cat that keeps you awake at night in a food-blender with a duck-lure and some castanets; then by all means go ahead. But don't call it music.  By my simplistic and uneducated take, if it sounded like you had made the wrong note, then the reason was likely to have been that you had made the wrong note. I knew that many modern composers were geniuses. I knew that they could have written like Tallis, but chose not to.

Benjamin Britten, for instance, was perhaps the archetypal twentieth century genius. His tougher works, however, (unless you sang them as he planned, and that is quite an unlikely 'unless'), could have a tendency to sound like emptying a recycling bin onto the National Youth Orchestra when they were warming up. When I was in the Liverpool Philharmonic choir, thirty-five years ago, we once sang Britten's War Requiem and a modern Russian piece 'Poem to October', on the same programme. We had no time to rehearse both well, so the conductor, (looking at me, I think), told us: "Look!! I don't mind if you sing the wrong notes, but when you do, for God's sake don't cover your face with your hands and then mouth the word 'sorry'!" On the night, we pulled out the stops for the Britten, but the other we just winged. About three out of the two hundred of us were on the right page when it finished, and some I think had already left the podium. We got a standing ovation. (The strange thing is, I am not sure that the composer would have disapproved.)

Anyway, now the light has shone. Macmillan's modern Miserere was sublime, and even surpassed the genius of Allegri. It still had plainsong chanting. It still had blissful bursts of embellishment.  It also at times expanded to fill the Cathedral with thrilling perfection of resonance. But there was something new and bold and exhilarating, that, once heard, could not leave you in the same state in which it found you.

So here is my point. A new music is happening in Africa. Something new and bold and exhilarating, that, once heard, could not leave you in the same state in which it found you. Perhaps, I hope, you might even want to be part of it.