Friday 26 February 2016

41. Expecting mothers …


When I first started going out with my lovely wife, we discovered unexpected things about each other. Once we got beyond the unbridled physical passion, (on my part anyway; hers was more an unbridled physical forbearance), we each realised that our new sweetheart had certain annoying attributes which needed fixing. As you might imagine, mine are still being fixed. Wives have an uncanny talent for fine-tuning the end-marital-product.

By contrast, I was almost completely happy with the product I was getting:    

   
           Mis 2015                                                  Mis 1973

… and indeed a short while into the relationship, I tore up the receipt.

There was one thing about my beautiful inamorata, however, that drove me potty: Patience.
“Patience? A worthy and desirable attribute in a person, surely?”, I hear you say.
And you would be right … up to a point.
“Up to a point?? A point where impatience is better than calm equipoise? Surely not?”,
I hear you add.
(I will be OK from here on in, by the way, if you want to take a break from interrupting people’s blogs.)

Yes, there is indeed a point where impatience is better than calm equipoise. And it is this: green traffic lights. Who in their right mind (other than my wife-to-be), slows down at green traffic lights, ‘in case they turn red’? What sort of mad sealing-of-one’s-own-fate is that? Of course they might turn red! That’s what they do! They are traffic lights, for Pity’s Sake!!! We are already being overtaken by octagenarians recovering from hip surgery, so yes, they will indeed be red by the time we get there!!! We cannot spend the rest of our lives together stopping at both red and green traffic lights!!!!

Anyway, you get the point. Miriam is a naturally patient person, and I am not, (although I am considerably better for the four decades of uxorial effort put into upgrading me).

(Before moving on, by the way, let me just point out that natural impatience is not, in itself, a vice. It has, occasionally, stood me in good stead – for instance in surgical crises, where the stop-at-green equivalent might be, “Hi everyone! How are things? And the family? Oh my! Bernie! Is that green you are wearing?! It’s funky, man!! It was great fun last Friday, wasn’t it? Do you know, sometimes we should just take deep breaths and suck in the pure joy of our friendship. But not now, because I just cut the aorta by mistake.” 
I freely admit that this is a wildly inappropriate stereotype of patient people, and that they are almost always right. And that patience even in surgery is a key attribute. I just needed to get it off my chest.)

Funnily enough, however, something within impatience does have another, positive, and somewhat more unlikely role. Unlikely, because I am referring to a role in Africa, where patience is traditionally measured on a different spectrum; (archetypally, where ‘never’ is only just above mid-point). To be impatient in an African project is to self-explode. Indeed, if you look carefully in the bush around where you intend your project to take place, you might well find the spleen of a predecessor who had a similar idea.

Why, then, am I feeling a bit sanguine at my choleric disposition? Well, it seems that when you strip away the negative aspects of impatience – the bad vibes; the intolerance; the jumping to conclusions; the making mistakes; etc – you are left with something actually pretty useful: Expectation. The expectation that, at the right time, the right thing will happen. (A bit like preparing a crab for the table: when you take off the bits that pinch you and the bits that poison you, there is something worth having inside.) (If you are fond of crab.)

This type of expectation is not vague or misty. It is an Expectation. It knows what it is after, knows it is coming, and is waiting, bright-eyed and alert, for it to arrive. It is not to be denied.

The setting up of Tushikamane took two-and-a-half years, and demanded not just patience, but a type of steadfast, quiet determination on behalf of many people, which I, for my part, was not very good at. But now, we have begun. The teams are trained; equipped; locally commissioned; accepted. They have now entered the small collections of mud-huts in distant Tunguli and Msamvu, and have begun to form women’s groups. These groups will be taken through a process whereby they explore the roots of the problems that kill them and their children. Thereafter, it will be the women themselves who lead the process of prioritizing which problems each hamlet is going to tackle.

Here is an excerpt from the February report of Wilbard Mrase, the Project Director:
Tushikamane project is progressing well; already three women’s groups are formed at Kwiboma in Tunguli and Dibabala and Kipera in Msamvu village.
Each group has a chairperson and a secretary.

Kwiboma has 18 women in the group and the group is called Amani, (which means ‘Peace’)
Dibabala has 30 women in the group and group is called Upendo. (which means ‘Love).
Kipera has 18 women in the group, name of the group not yet given.

These three hamlets Kwiboma, Dibabala and Kipera decided/agreed to meet every Saturday at 2Pm, Sunday at 2Pm and Friday at 9Am respectively every week.
… On 27th and 28th January we will be in Tunguli and Msamvu in order facilitate establishment of another four women groups (two groups in each village)”


     
                    Kwiboma Group



Upendo Group
  

Kipera Group

So. It’s happening. We have women’s groups in remote villages in Tanzania; where 10% of children die and maternal death is a frequent visitor. The expecting mothers for the first time will have an empowered and legitimate voice in determining what to what to do about these tragedies.

And we also have an Expectation; an Impatience: to consign these avoidable deaths to history.


Wednesday 3 February 2016

For reference: Revised guidelines for Meeting 1: the hamlet gets together to form the Tushikamane Group


MEETING1: THE HAMLET GETS TOGETHER TO FORM THE GROUP

What is the purpose of Meeting 1?
Before the Tushikamane process can begin to form groups within the hamlet, there needs to be a meeting within the hamlet of anyone who has any sort of potential involvement in the process.

However, with the leaders of the wider community having already met and given approval to the process, there is no need to repeat this high-level meeting at the hamlet.

The purpose of Meeting 1 in the hamlet will therefore be:
1.    To inform the local community about the project, and ask help and involvement, and
2.    To recruit the women who will form the core of the Tushikamane group.


Who should attend Meeting 1?
Even though the Tunguli and Msamvu Wards have given permission at high level, it is a good idea to get local leaders on board. Meeting 1 should therefore include:
          Any existing community group networks or any NGOs or other organisations working with that hamlet
          Traditional leaders and elected representatives in the hamlet
          Religious leaders
          Especially, key women in the hamlet – eg teachers, women in positions of leadership, as well as women who are natural leaders
Additionally, of course, meeting 1 needs to include all the hamlet women who will then form the Tushikamane group.

Who is in the Tushikamane Group?
The Tushikamane group begins as a ‘women’s group’ who will conduct meetings 2 to 7, in order for the women to explore the root-causes of death, and to come up with some ideas as to what to do about them.

This group will at first be almost all women, and should include:
          Young women, mothers and pregnant women – and especially those women who come from a family that has lost women in childbirth, or suffered the death of a baby
          Village Health Workers (even if male)
          Traditional birth attendants
          Traditional health practitioners (even if male)
          But specifically it will not include the normal male opinion leaders, husbands, mababu, etc. The idea is to get women to be thinking and talking about the causes of death.

These women therefore all need to be there at the first meeting, to find out what Tushikamane is all about.

What happens at the Hamlet first meeting?
Two (African!) hours should be allowed for the first meeting of the hamlet. The meeting should be held in a centrally located venue that has ample space for all participants.

The purpose of the meeting is to get commitment, collaboration and involvement from those present to the Tushikamane process.

This needs to begin with sharing what Tushikamane is all about: to give women – especially women of child-bearing age – a voice in discussing how to reduce deaths of mothers and their babies. This will lead, eventually, to planning with the whole hamlet what things they would like to tackle, and how.

The eventual plan is to come up with really good ideas and priorities to be tackled, that will get the whole community working together to reduce these tragic deaths. They should realise that in doing so, many other benefits will begin to materialise in the community.

Topics of discussion during the meeting should include:
·         How awful it is when a mother dies
·         How the people present are an amazing resource, but need a way of working together
·         That working together will bring in help from outside agencies
·         This will especially happen if the community can show sustainable progress, and can show that their plans are working to reduce death of mothers and babies.
·         Tushikamane meetings will not be a huge demand on their time.


Hamlet first meeting agenda
The recommended agenda is to conduct the meeting as follows:
1.    Welcome, introductions, and objectives of the meeting should be set out by the Project Supervisor, Alex Gongwe.

2.    There will be only one Project Facilitator present – the one who will be working with that hamlet.

3.    The Project Facilitator, with help from Alex, will then explain a rough outline of the way Tushikamane works:

Phase 1: Identifying problems together
Five meetings
2 – 6 months



Phase 2: Identifying solutions together
Three meetings
2 – 3 months
Phase 3: Implementing solutions together
Three meetings
6 - 12 months
Phase 4: Evaluating together
Three meetings
2 - 3 months
Total
12    – 24 months

4.    At some point, Alex should clarify in a bit more detail the types of practical solutions that Tushikamane groups may want to implement; of the type he has seen happen in Malawi: eg Transport; clean delivery kits; income generation; TBA training; improving health facilities; vegetable gardens; malaria prevention; better sanitation and or water; etc. (See annexe 1)

5.    Questions, comments and ideas from the audience. Give plenty of time for questions and answers. Encourage people to come up with ideas about how it could bring about good things – and about what part local people could play in making it happen.

6.    Finally, it would be good if a group of 2 or 3 hamlet people formed a committee to help the Facilitator run the Tushikamane process – eg help her set up meetings, help remind people to come, give her advice and support, etc.

7.    The Facilitator should make a register of all attendees, and take minutes of what was said. These need to be properly written up. An electronic summary needs to be later on agreed between the Facilitator and Alex, and this summary is then emailled to the Project Lead, Wilbard Mrase. (see Annexe 2)

8.    Closing remarks by Alex Gongwe.


Annexe 1

Establishing what Tushikamane will  - and will not - provide
Before the meeting finishes, and the Tushikamane process gets formally under way, there needs to be complete clarity in the community as to what will, and will not, be provided to the hamlet by Tushikamane:

What will be provided to each hamlet:
A trained Facilitator will form a Tushikamane Group and will lead meetings.
A Supervisor will help the Facilitator achieve success with the Group.

Once the process has reached the point that the Hamlet has examined the root-causes of death of mothers and babies, and has prioritised what it wants to do about them, Tushikamane will try to help provide the hamlet with links to those who can help – for instance links to other hamlets tackling the same problem; or to local organisations or initiatives which might be able to help; or to charities and NGOs who are looking to support the kind of thing being planned.

Examples
For example, the hamlet might prioritise the development of transport solutions to help get sick pregnant women to hospital. Perhaps other hamlets locally will have prioritised the same thing. Tushikamane might be able to put the communities in touch with a charity willing to provide a motorbike ambulance, once the charity is sure that the systems for maintenance, driving, etc are all in place.

The Tushikamane groups in the hamlets would then take responsibility for making sure that such systems are implemented.

Other examples might include:
·         Skills development – eg Setting up a programme of ongoing training for Traditional Birth Attendants
·         Health Services – eg Setting up accessible services for immunisation, checking blood pressure, treating anaemia, etc; or Helping the community to embrace appropriate family planning, and to provide services
·         Agriculture and food – eg Setting up feeding schemes for weaning babies
·         Education – eg Improving maternal education about health in pregnancy
·         Environmental health and sanitation – eg all working together to improve access to clean water


What will not be provided to communities:
·         Financial support or handouts of any kind from the Tushikamane team itself
·         Incentives or ‘Asantes’
·         Things being ‘done to them’ by others without their participation. Any help which comes will begin with community self-determination, and community participation. It will not be based on what outsiders think the community might need. It will not just be ‘dumped’ onto the hamlet.


Annexe 2

Key issues for your report on Meeting 1
·         The attendance register should be summarised: how many came, how many were women, how many were pregnant?
·         How did the meeting go – any particular achievements or problems?
·         Who are the local committee / steering group?
·         What are the rules for the way the meetings will be run?