Care for Africa Online Journal

A young man called Joseph came in to the hospital last week, with bowel obstruction and perforation. Winani opened him up and repaired the damage, but within days the wound was oozing faeces and a big hole that Winani had left in his abdomen was gushing frank pus. So after 2 days and some cajoling from me, Winani agreed to take him back to theatre. Leo and Winani did the operation,finding many adhesions, and an abdomen full of pus and faeces. In an operating theatre with no suction, trying to clean up the mess was no mean feat, and took hours. To try to increase his chances of surviving the operation, the staff had him only minimally sedated during the procedure. Joseph is 20 years old and staunchly committed to his political party, Chadema. On ward round yesterday he asked me to marry him, looking at me with hope and lust in his beautiful brown eyes, with faeces and pus oozing out through the massive wound in his stomach, running over his genitals and down his legs. I was overwhelmed, and lost for words. “Hapana, Joseph,” I said softly, holding his hand, “I can’t.”

Jared and Leo arrived here the weekend before Didee, Joe, Leanne and Jane left. Didee and Jane both came down with malaria a few days before they were due to leave, and on Leo’s first night here, Leo dealt with his first serious malaria case – Didee. She was delirious with fever and demanding more blankets even though her skin was scorching. We called Dr Winani and he and one of his medical assistants Dominique came late that night to start an intravenous quinine infusion and fluids. It was all quite scary, and we had no power that night either so all the medical treatment was carried out by candlelight. Luckily Didee was much better in the morning, although both her and Jane were still very weak for a few days and had to give up their planned few days in Zanzibar.

There was an election in Tarime a couple of weeks ago. The 2 opposing parties – CCM, who have been in power for many years; and Chadema, the opposition – have been campaigning crazily for the past couple of months. CCM especially has been roaming all over the Tarime district with their loudspeakers blaring, giving out free clothes – T-shirts, hats and kangas – to the people, playing music, and even giving them money to try to bribe the community to vote for them. There have been occasions where we had a community visit arranged, and turn up only to find that CCM have already taken over the whole community and our arrival is hardly even noticed. We would then have to either wait for them to finish or come back later. So, election day was interesting – Jared and Leo’s first day in Tarime. We woke to the sound of tear gas explosions and machine-gun fire. Standing on our front porch that morning Leo watched three people running away from a man wielding a machete. We were advised that we shouldn’t leave the house. However, boredom got the better of us and we drove over to the hospital. While Jared and I were cleaning up the storeroom, the sound of tear gas bombs got closer and closer and then all of a sudden the hospital was swarmed with people, and the staff locked the doors. Leo treated a young boy who had been thrown backwards by a bomb and was suffering the effects of tear gas– during treatment Leo himself felt the stinging in his eyes and burning throat typical of tear gas.

Jared and I have starting to research the water project – we are proposing to put groundwater wells into 5 rural communities that have major problems with clean water. When Paul Statham arrives next month he will take over and continue this project. I have learned a surprising amount in the past week about groundwater and the process of digging wells – it’s amazing the knowledge you accumulate here that you would never expect.

Jared has also been doing research into albinos –albino killing for body parts occurs widely in Tanzania, and more recently in the north-west region around Lake Victoria. An albino was killed in a town called Mwanza which we are going to tomorrow, and another killing occurred about 3 months ago only 10km from here, only to name a few. Jared and I met a young albino girl today and spoke with her parents. They did not understand why she had red, peeling skin and we explained to them the importance of covering her skin and keeping her out of the sun, and gave her a hat to wear

21 albinos killed in a single year out of a total of 300,000, which strikes me as being an awful lot. Other reports(below) give a figure of 8,000 registered albinos from a possible total of 150,000, others say 270,000 and some suggest the number of murders may be as high as 50.  It is something we may be able to have a direct effect on and are hoping to do some more research.

Lisa Searle and Jared Irwin

We have just completed 2 weeks working in our 6 communities: Kiterere, Biswari, Bugango, Mtana, Sombyosoko, and Surubu.

We were always warmly greeted by the Village Chairman, elders and the people.

We saw our normal abundance of eager patients. Mostly advice was given, mediation and treatment was also give to those that needed it. We were able to transport some of the sicker patients to the hospital to see either Dr Joe, Dr Lisa or Dr Winani. One of the major problems ithin the communities is lack of resources or money for access to the hospital. Like last year we saw a plethra of elderly patients with chronic arthritis, this is a continuing prolem due to our inability to provide a continuing supply of non steroidals and analgesia. We all find this simple problem personally confronting. We were able to supply some short term analgesia for these people. The usual numbers of people with cataracts returned to us again, hoping we had a doctor that could treat them. We need elbow crutches!!!! The need for them is huge!!!! Thank goodness for Bomani from Elimika, we have him makig some for the really desparate. Bomani is also making us 3 tricycles for our polio cripples we see.

We are developing a bee keeping project in the Surubu community for the men’s group. These men have tried to establish a honey making buisness to no avai due to lack of knowledge and equipment. We have set up a 2 week seminar on bee keeping with Rosaline Mussama at Mogabiri Agricultural College. Once this is completed we will provide the men with the necessary equipment. We are also setting up a brick making project with another men’s group in the Surubu community. We find that many have no jobs, and no income to even start any form of business. Once we set these people up we expect them to be self sustainable, therefore we give them no futher support, they will be able to support themselves.

The clothes in the container have gone to the women’s groups to give to the poor, orphans, widows and needy. We need more blankets, we never have enough. Almost every sinle person in these communities needs bankets. As for the knitted singlets for the children, tey are absolutely gorgeous, we see many children in need of them.Thanks everyone for giving us these valuable items for our communities, it really does make a difference.

Finally, there is a phenominal need to establish safe clean water to these communities. Unclean water is major cause of disease outside Malaria. Water is scarce. The young girls cart water for their families twice daily, often walking up to 5kms. They usually carry 20 L each time. The girls miss a lot of schooling because of the time it takes to carry water. They carry the water in drums on their heads. We also see the elderly women as well as the very  young girls carting water. There is no water harvesting any where. Wells are te best option to provide safe, reliable, clean water to these communities. The World Health Organisation states, every human being has the right to safe, clean drinking water. I see developing water in these communities as vital and our primary focus.

We had a meeting with Dr Winani and The Tarime Goodwill Foundation Board after our community work. They were most impressed with our work, and agree with us that the devlopment of safe water is the most pressing and most important part of our community work.

By Diana

What an incredible 3 weeks – and already coming to an end. I could be on another planet – both medically and from every viewpoint.

Jane and I took a trek out to the point of a high cliff overlooking the breathtaking 75km long great Rift Valley – the cradle of human creation. Although the rest of the world has moved rapidly through the epochs of Civilisation, much of the Tarime district remains in the period of family communal living in mud brick huts with thatched rooves, subsistence farming, no power or sanitation. It is quality not quantity of water that is a problem here – yet water harvesting is not a priority.

Food is ample, the rich red volcanic soil very fertile, so most eat well. But the cost of accessing medical services is prohibitive to many, and many services we take for granted – like CT and MRI scans, histopathology, and bacterial culture, are not readily available.

On drafting this blog with a freebie pen, advertising Symbicort – a standard asthma puffer – yet noone here has heard of it, and i have seen enough asthma to suggest it is not an uncommon condition.

Presentations of medical conditions here are usually extreme, yet the response to treatment can be equally impressive, which suits the patients who are generally very eager for discharge at the earliest possible time.

In my short time here, I have learnt that the safest path to tread is that well trodden! Winani uses treatments that are 40 years old, and with good results. He is understandably quite resistant to change.

Despite his great appreciation for the support I have been able to give, I feel that I am coming away with a lot more than i have been able to give. At 72 yo, his calm energy, enduring love and passion for his work, his patients and community, as well as his vision for creating a better future, are a great inspiration.

Kwaheri Tarime!

Dr Joe Tempone

Having spent a day absorbing the incredible sights, sounds and smells of Tarime, I had my first taste of hospital work watchin Dr Winani pefoming procedures which he has carried out for over 40 years, D&C’s, tubal insufflations-injection of steroids & antiobiotics into the tube to clear chronic infection & scarring, the most common cause of infertility.

The theatre is threadbare, sterilisation happens over a parrifin burner, there is an acute lack of awareness around  hygiene and sharps.

I learnt the ropes with Isaac, a medical assistant in training, interpreting for me both the Swahili language and the foreign medical tapestry – malaria, parasite infestations, gonorrhoea, HIV. “Common conditions are common” takes on a whole new meaning.

The reality of high infant mortality hits me with two stillborn babes due to obstructed labour beyond the help of caesarian section and no available ventouse or forceps extraction.

Due to their inability to pay for transport or services, many presentations are quite late. I assisted Winani with an emergency laparotomy for acute small bowel obstruction which was 3 days old. The kidneys had shut down and despite an amazing surgical effort to remove 2 metres of dead bowel, the patient’s kidneys did not recover and she died 6 days later.

I later assisted a visiting urologist to operate on a 2 year old child with bowel obstruction from paralysed bowel due to peritonitis, with no suction, diathermy, and instruments suitable for a hippo. He was able to achieve a good result and the child is making excellent progress.

Medications we take for granted such as codeine, morphine, up to date medication for diabetes, asthma, and arthritis are not available here. However, the most potent antibiotics and antimalarials are readily available on street corners.

The enormity of the task can be very discouraging, but when the husband of our laparotomy patient who died, embraced me the next day, I felt only the deepest appreciation and knew that every effort is worthwhile.

Dr Joe Tempone

So I have been spending some time in the hospital, but also some time working out in the communities with Diana, Leanne and Jane as I will be continuing with community work when the others leave. We are feeling very positively about the communities – we are becoming more focused and have worked out that the most important thing for these communities is water. So, we will start work on putting water wells into our 6 communities.

The hospital has been very busy. We have had a few very serious cases this past week – including a cerebral malaria, a 2 year old with abdominal compartment syndrome, an emergency caesarian for hand presentation this morning….. it is frustrating working in this environment with so few tools available to us. Minimal tests, minimal analgesia – the only things we have for pain are paracetamol and diclofenac. We are slowly working on some small changes in the hospital – like nursing staff recording when they have given medications and fluid balance charts.

I am working with Benson on running a seminar on female genital mutilation (FGM) in late November, just before the circumcison ceremonies start. Benson is a teacher at one of the local secondary schools, and has written a thesis on FGM. He is very passionate about women’s health and empowering women – something with is very refreshing in such a patriarchal society. Benson is also going to arrange for me to attend an FGM ceremony…. hopefully i cope ok with that and am able to watch. 

We decided to stay in Tarime for the weekend, and for Jane’s birthday last night we went to the CMG and had a party with some of our new friends here - Benson, Bomani, Abdallah, Nuru and Eliza. It was a great night – we turned the place into our very own disco!! 

On Monday, Diana and I are off to the Trans Mara in Kenya to spend the week researching the needs in this area, and checking on our projects like the brick making machine and how that is going. We will be staying with Omari’s sister Mama Anastacia in her little mud hut and living with the Masaai people for a week. The needs of the Trans Mara are huge, and we suspect that the area we can make the most difference in over there is also water. So we will spend time trekking around (there are no roads) looking at local water sources. 

I will go now so Joe can also write something. 

As Diana said, feedback of any kind on this blog would be awesome. 

Lisa Searle     

Thursday evening at 1700 hrs, Leanne, Dickson, Jane and myself left to deliver some food, clothing and bedding to Sara, as well as medication to some elderly people.

Last year Leanne, Ange Knight and myself met Sara, an elderly woman living in the Kiterere village.  Sara thought she  was about 80 years old.  Sara is the primary carer for  her 12 year old grandson. They were very poor, they slept in the same bed in their own mud hut.

This year when we visited the Kiterere community, Sara came to see us to let us kow her hut had burnt down, and she and her grandson had now where to live.

Our team has decided to build a hut for Sara and her grandson under the guidance of the local community.

When we visited Sara to tell her this wonderful news, plus delivering her  things from our container to help her, we discovered that we had a flat tyre. By this stage it was 6 at night, and we were in the outback of the community. It was dark. Jane and I needed to go to the loo. One of the local ladies took us to her to her place. We walked bare footed through pockets of squelching mud and  the freshly dug muddy fields. We felt perfectly safe with these beautiful people. The woman took us to her house. She had no food, no water, she slept on her hard mud floor with no pillow, mattress, she did not even have a blanket. There were 2 sheep huddled up next to where there were a few ashes, the remnants of the previous night’s fire. What a priviledge and honour to really see how some of these people live. I found it difficult to sleep that night, because I was nestled under a warm blanket, lying on the most comfortable mattress, with my head being cradled by a beautiful soft pillow. I went to bed after a huge bowl of pasta cooked by Joe. The thoughts of this woman sleeping with absolutely no comforts, let alone the bare essentials of life haunted me so much.

That is why we all do this work. There are so many people living like this, and we do and can help.

My next blog will inform you about some of the things were are doing to combat this in the communities.

I would love some input from people that read this blog.

Love to all

Diana