Care for Africa Online Journal

Last Friday, Lisa, Jane & myself visited the Bisawari Community with Benson Thadeus and our usual community team.

We were confronted with the issue of female circumcision.

We were informed that 85% of the women in the Tarime District are circumcised, whereas only 18% of Tanzania’s women are circumcised.

Benson was wonderful in the way her drew out the facts and  concerns from the male community leaders in Bisawari. Benson is a young high school teacher, who is passionate about the empowerment of women in this patriachial society in the Tarime District.

Every December Female Genatile Mutilation (FGM) occurs in the communities with the girls aged between 13-15 years. A huge celebration happens during this period, the community dances all night. Circumcision is seen as the girl’s right of passage into womanhood and marriage. The circumsisor is a hugely respected female elder. Her hands are considered sacred. During the whole event she does not wash her hands, hence at the end of circumcision, her hands are covered in blood. Once the circumcisions are completed, her hands are covered in cow dung which cleanses her hands with the removal of the dung when it has dried.

The girls are encouraged to bring their own blades, so the practice of sharing a knife has almost gone, through education. The girls are held down, in broad daylight in the fields. There is no privacy for the girls. It is punishable if the girl pushes the circumcisor’s hands. The punishment is usually by way of payment of a cow.

I cannot give you any statistics on death rates due to infection and haemhorrage because there are not such statistics in these ruiral communities. However, death does occur with these young girls due to FGM.

There are 4 different forms of FGM. The clitoris is always removed. The most extreme cases the labia are removed and the vagina is sewen closed, with only a tiny opening left to urinate through.

Unfortunately, I will be back in Australia when the ceremonies start, but Lisa will attend at least one. I know it will be really confronting, but I question, “how can we help if we don’t know”!. I will hopefully be able to attend next year in December.

This morning I had a meeting with Bomani, who like Benson is trying to empower women in the Tarime district. Bomani runs seminars to enform the young girls about the dangers encounted with FGM, both short and long term dangers. He, like Benson are looking for support so they can educate and inform the young girls about FGM.  Bomani stated that FGM makes the women sexually disinterested, hence one of the main reasons for the men seeking extramaratial relationships.

There is no government funding in Tarime to empower the women, especially with issues of FGM.

Both men are willing to answer questions or correspondence if you wish to email them.

Bomani: elimikatarime@yahoo.com

Benson: thadeusmaison@yahoo.com

Love to all in Australia

Diana

Leanne, Jane & myself have finally hit the communities.

The ambulance is in perfect condition, Dr Winani looks after the ambulance like his own child.

It is good to see our workers agian, Gabrielle, Paulo and Lucas. we have a new driver, Abdulla, he is great and cares for our ambulance beautifully.

Yesterday, (Tues 24th) we visited the Kiterere community. a community of 1,000 people, situated 10 kms out of Tarime. This community is very poor. Their only income is through growing vegetables, and selling between each other. They have no cattle, due to local thieves.

However, the biggest need for this community is clean, safe drinking water. They have no well, only minimal muddy, nearly dried up river water. Currently, in Kitere there is a cholera outbreak, which is due to poor water. Leanne, Jane & myself are setting up a cholera clinic on Monday to help treat the cholera outbreak. We would love to do it earlier but we have already committed ourselves to other communities and needs.

Cholera is treated by rehydration, preferably oral. Antibiotic management is ineffective for cholera.

We see that lack of clean safe water is the major health problem in the rural communities in the Tarime district.

It is wonderful to see Lisa settled back into the Tarime Goodwill Hospital with such comfort and enthusiasm. Dr Winani and his team, as well as the patients have welcomed Lisa back with much appreciation.

Dr Joe has been warmly welcomed, and his work so appreciated.

So, Joe Tempone, Jane Burbury and I arrived in Mwanza, Tanzania, after many flights, too much bad airplane food, little sleep, 2 almost missed flights, and many time zone changes. Miraculously, all our luggage arrived safely in Mwanza. We were met at the airport with a very joyful reunion with Didee, Leanne, Dickson, Dickson’s cousin Daniel, and our new driver Abdallah. It was amazing to be back in Tanzania, everything was so familiar and I almost felt like I’d never been away.

It is so hot here, and in the afternoons we often have storms. My Swahili is coming flooding back and I am learning all I can from my little Swahili book and from everyone I meet. I am determined to be semi-fluent by the time I leave the country.

The hospital is much the same, although now we have running water, in a town where not even the richest have running water in their houses, and we have a back-up generator for when the power goes out, which is very frequently. My first day in the hospital we had a woman come in in shock, miscarrying and bleeding heavily and we had to do an urgent D and C on her, which Dr Winani got me to perform. It was all quite exciting, but I could see the shock on Joe and Jane’s faces about the way such a sick patient was treated – they didn’t even take her pulse or blood pressure.

Today I was involved with a woman in prolonged labour, who thankfully we managed to deliver vaginally after a long labour. There is no option for instrumental deliveries here, and it takes 45 minutes to get the theatre ready. So, we ruptured her membranes and I started an oxytocinon drip. Both her and the baby are doing surprisingly well.

Both Joe and I have been seeing patients in clinic and on ward rounds, and while I am slowly getting back to the swing of things Joe is on a steep learning curve but is amazing – Dr Winani is stoked to have him and is learning a lot from him.

We are staying in a house that Dr Winani built specially for us, which is a lovely big place with 5 bedrooms, 2 bathrooms, and a big living space. However, although it looks good, half the time there is no electricity and so we sit around by candlelight and have to wash in the dark. Also, there is no running water to the house, so our housekeeper Eliza carries buckets of water in for us each morning for us to use for cold water bucket showers and to flush the toilets and do the washing up. We have a great crew – Didee, Leanne, Joe, Jane and I. The house is full of laughter, cups of tea, African friends and conversation. We have a little stove, and last night Joe and I cooked our first African meal, attempting to replicate dishes we have tried. It worked very well, and we are going to have Dr Winani and his wife Miriam over for dinner one night to see what they think. We have also promised Omari and his wife Mama Asha that we will cook for them one night when we are there – we may even try to have an Italian night!!

Jane is going to run some education sessions with the nursing staff in the hospital about sanitation and basic patient care,  and Joe and I are  doing what we can to help Dr Winani but also to train the local health care staff and  make some improvement to the hospital.

Every day children come to us asking for sponsorship, and it is so difficult not to be able to help them all. There are so many tragic stories and so many people living in poverty and I really wish I could help them all but it is just not possible. We do what we can, supplying them with school uniforms, stationary and clothes.

This weekend we are hopefully going on safari to the Serengeti, which Dr Winani has kindly organised for us. It should be amazing.

As the locals say, ‘hakuna matata!’

Lisa Searle

Let me share a special, but sad story with you, about one of Allison Bassano’s students.

Marguretta is her name, a young 13 year old girl from Tarime. She was studying for her exams using a parrifin light. Marguretta tried to relight her lamp using petrol. The lamp exploded and Marguretta sustained extensive 1st, 2nd and 3rd degree burns to the anterior region of her whole chest, right side of her neck, as well as to her right arm and leg. An estimate of 30% burns. By the time Leanne and I saw her, her burns were 2 days old. Dr Winani admitted Marguretta to his hospital where she recieved oral antibiotics and pain relief with diclofenac and paracetamol. Maguretta had recieved no dressings or debridement for her burns.

I spoke with Dr Joe Tempone in Tasmania, requesting a pressure garment for the prevention of contractures and advice. Per Mr Garry Kode (Tasmania Plastic Surgeon) we were advised to give her as much protein as possible, 120mgs/kg body weight.

Allison bought Marguretta milk, eggs, degar ( tiny fish from Lake Victoria) for protein. Up to that time, Marguretta had only consumed 1x bannana a day.

Marguretta is doing surprisingly well, her wounds are healing well with no infection. However, her scarring and contractures will be extensive due to no wound management in the early days.

Burns are common in Tarime due to the parrafin burners and lights.

Burn management and education is a vital project I feel CfA can easily give to the community of Tarime through The Tarime Goodwill Hospital.

Diana

What a wonderful welcome Leanne & I received when we arrived back to Tarime. It is so wonderful to be back working and helping these impoverished but needy people. Dr Winani is well, and truly grateful for the work, time, money and energy the community of Tasmania with Care for Africa have given him and his people.

Our shipping container has arrived safely in Tarime. Allison Bassano’s students half decorated the container with their hand prints. We have paints eagerly awaiting to anoint the hands of students to create the joining of hands between Tasmania and Tarime.

Allison And Stephen have had the most enlightening experience with education in Tarime. These 2 wonderful teachers have already proved to be invaluable to the people of Tarime, especially the children. To see the children swarm around Allison, all hungry for education and knowledge of the outside world bought tears to my eyes but hope in their eyes. Stephen did his share of education, one day when we were visiting Kiterere Primary school, Stephen walked into a class room with no teacher but students sitting patiently for “whatever” was on offer. Their teacher left 6 sentences of English on the board and left the students for the day. Stephen had much pleasure in teaching the students their only bit of education for the day.

We saw many needy schools with no educational aids, no books, pens or pencils. Many schools had no water or electricity. Some children will walk to school up to 10 kms with no food. We saw some really poor children that could not even afford a piece of sugar cane for lunch. Often children would be squashed 4 to a desk like bananas.

It was really encouraging to hear the children and teachers say that they wanted education more than anything else because education is the only way for them to escape the cycle of poverty.

I must close now, I am just going to look at a hospital in Mwanza (4 hrs from Tarime)

Diana

I’m on my way ( in 2 mins actually) a big stretch before me. All’s Good!

Ciao`

Joe

So….  i’m currently in Perth, and in 4 days I will be returning to Tarime. I have already been receiving text messages from people who can’t wait for me to get there, and I am so excited to be going back and can’t wait to see everyone again. Dr Winani and his hospital, Abdallah the anaesthetist, Ronald my translator, Isaac, Dr Choma, Tatu….. these are very special people and our reunion will be very exciting.

I do, however, have reservations about returning to my beloved Africa. My return to Australia last year after the trip was traumatic, I suffered with reverse culture shock and returning to the Australian way of life was very difficult for me. I just hope that things are not as bad this time around. 

I have had to resign from my job to undertake this trip as well, so have no job waiting for me when I get home, and that is a little scary. The sense of freedom I felt at resigning, though, was phenomenal. I have been tied to the Launceston General Hospital for the past 2 years, and to medical school for the preceding 6 years, and this is the first time in my life I have been truly free.

I hope that our return is well-received, that we are making a difference over there, that we are able to fulfil our goals, that I do not let Dr Winani down – I know his expectations of me this time will be much greater than last year and I hope that I can live up to the challenge.

So, we will see how it goes, and I shall try to keep this updated with stories of our adventures in Africa.

Lisa Searle