This month I met a wonderful and impressive couple: Dr Ahmed Ali
and his wife Elizabeth. Ahmed is on his way to Berega, for a two-month stint as
Obstetrician in Residence – the first of what we hope will be many journeys. On
the next visit, Elizabeth also hopes to go, and her midwifery talents will be
greatly valued. Inspiringly, they have chosen to close the door on very
successful UK careers, and to spend the next phase of their lives making a
difference where it is sorely needed.
(When I was young, I might have referred
to this as the ‘twilight’ of their careers. However, now that I myself am not
just at twilight but hurtling towards the setting of Venus in Capricorn, this
couple’s careers seem positively early afternoon by comparison.)
Of course when we met, Ahmed’s mind was full of the last-minute
preparations. These are all the more important when the trappings of
developed-world comfort and convenience are not likely to be available in the
place to which you are headed. For instance, this is what a shopping mall looks
like in Berega:
It would be fine for buying sacksful of the more indigestible
parts of the faba bean plant, but expect a puzzled silence if you ask for a
cappuccino-frother plug-in for your iPad.
When going through the list of things to ensure to take, (phone;
charger; kindle; iPad; Sanatogen; etc), it transpired that Ahmed, (in his
words), needed to “join to the present to go to the past”. He had, it seems,
been living in the late twentieth century, when books were made of paper,
phones were designed for speaking to people, and GPS was a Gammon and Pineapple
Sandwich. Suddenly, he now had to equip himself with the electronic accoutrements
of 2014, in order to spend a couple of months in what for most of the rural
Tanzanian population, (for health purposes at least), is the eighteenth
century. Ironic.
When I think of it, though, I am not so sure that the analogy is
a perfect one. They had blankets in the 18th century, but Berega has no
blankets, nor good food, nor comfortable beds. Equally, three hundred years
ago, they had no anti-malarials, no vaccines, and no antibiotics; but the presence
of these modern miracles in Berega has not compensated for the dismal
conditions in which many children are raised. With an under-five mortality of
10%, and maternal mortality approaching 1%, Berega’s territory has not moved on
far from Walpole’s England. In the villages, the reason is clear: little has
happened in the intervening three centuries to make a difference.
In the hospital itself, however, we might have hoped for better.
Meagrely equipped though it is, it should nevertheless be ready deal at
least tolerably well with the majority of life-threatening situations for
mothers and their children.
In the past, to be honest however, clinical standards have been simply
too unresponsive to the many fillips that they have received. (Thus my
reluctance to kick off the first year of ‘EMBRACE’, until we are sure that we
will be bringing women into somewhere safe and effective.) However, with the
arrival of Ahmed, a new champion, hopes are high. This is particularly so, as he is
in fact the latest in a whole bunch of champions. (Champions, it seems, are
like buses – you wait ages for one, and then three come at once. Or in Mexico,
seven.)
There are some interesting parallels, by the way, between the
burgeoning help in Berega, and the Magnificent Seven. The most obvious is that
both Yul Brynner and I prefer to leave our scalps open to the fresh air, rather
than choking them with cultivated keratin. Both of us recognise, however,
that baldness alone cannot help save a village. And for all the immense efforts
of Isaac; Stanley; Abdallah; Sion, Brad/Hands4Africa; John, Tony, and the Diocese of
Worcester / Mission Morogoro; Gary, David, Mike and the amazing worthies of
BREAD; my good self; and others too many to mention; the hospital has still
been struggling in many ways, not least in relation to clinical standards. Nevertheless,
each year the lives of many are saved – lives which, without relentless hard
work, would have been lost. Eclampsia and Haemorrhage and Malaria and
Malnutrition and the rest of their deadly crew still regularly raid and kill. They are mainly fought off, but more could be done to deter these bandits.
Now, suddenly, opportunistically, the Magnificent-Seven-effect
is beginning to kick in. (You may know that the story was based on a sixteenth
century Japanese samurai myth. The idea, however, is as old as story-telling
itself: that from an extremely beleaguered position, some
fickle-finger-of-fate-ing leads to a burgeoning wave of powerful help, and the
baddies are vanquished. I, for one, believe that the Finger of Fate is not in
fact that fickle, and that the extraordinary constellation of heroes gathering
around to help, are not here by chance alone.)
Nevertheless, it is about as unlikely a story as ever inspired
Hollywood. Even I do not know the full details. (For instance, I genuinely don’t
remember how I got involved with Berega. I remember making the vaguest of
enquiries in response to an ad about a short spell in Ethiopia. The next thing
I remember is buying peanut butter in Dar Es Salaam.) Anyway, to cut a long,
long story short, a year ago, Sion was headed for a job with MSF. By a hugely
unlikely life-upheaving coincidence, four months later he had begun a year’s job at
Berega. A veritable Steve McQueen of the stethoscope, he began knocking off
baddies on every side.Then came myself; Dan; Marjaan; Blanché; and the recurrent hero, David Curnock.
More recently, Ann Kang, who works in the hotel industry, met
Sion in a random bar in Zanzibar. Utterly incredibly, shortly afterwards she had
begun a three months' stint working in Berega. Her legacy includes not only the first ever
monitoring of clinical standards, (accomplished with the new Assistant Matron),
and too many other works to name, but also the gathering of tens of thousands
of dollars to sponsor village children through education – the single-most
determinant of health in the world.
Check out her amazing story at http://www.anninberega.blogspot.co.uk/
And Sion’s at: http://doctorwoctor.blogspot.co.uk/
The story keeps on expanding. The medical establishment had
recently been up to three: Olivia Vandecasteele a Belgian tropical medicine
expert, and Sander Wever, a Dutch head of an Emergency department, found
themselves drawn into the whirlwind. What a difference to have these experienced professionals dedicating themselves to the cause.
Most extraordinary of all has been the expansion of KOFIA. From
the modest hope to knit 50 hats to send a message of love from Guildford to
Tanzania via Basingstoke, Blanché Oguti and Debbie Donovan’s efforts have
blossomed to an impossible extent, where many people in many countries are now
knitting for Africa. With the arrival of the wonderful Nina Oakman offering
herself as KOFIA’s link in Dar, they are set to begin helping poor women
throughout Tanzania to tackle the deadly problem of neonatal hypothermia. (By
the way, although sending knitting across the world sounds a little old-fashioned,
and although it may seem wiser simply to send money and commission some local wool-taming,
success is not measured only in financial value. Thousands of people are
finding not just purpose but an outlet for their generosity and good will
towards the plight of the needy. KOFIA hats, blankets and clothes are a symbol of an increasing readiness to share responsibility, in this small world in which we cohabit.)
Meanwhile, as ever, Brad and Hands4Africa have been beavering
away, and working towards a community solution that will provide a platform on
which health services can build. Recently, Julie Angulo has worked tremendously
hard to put in a bid for a grant which will really help the EMBRACE project to pluck
some of the poorest communities in Africa from the eighteenth century into the
present. We have been holding off with the implementation of EMBRACE until we
were happy that Berega clinical standards were sufficiently good. Now, we are
close to being ready to plan the next steps.
And so to the future: In order to keep the rapidly expanding
story in a single place, I am going to give over this blog site to regular
guest bloggers – anyone with a story to tell as to how things in the territory are
progressing. Whenever a blog is posted, I will put it on the Berega wall, so
please like it, (and get others to), and you will be told this amazing tale as
it unfolds.
Additionally, using my Berega facebook identity, I might have
invited you as a friend, and will also use that, (once my grandchildren have
grown up enough to be able to teach me how), to keep you posted.
When I was about forty, my scalp hair began falling out, and, like
Samson and Yul Brynner, I was quite upset about it. Little did I realise then that the power also
flows through teachers’ chalk, random drinks in Zanzibar, and woollen hats.
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