Diocese of South West Tanganyika

The Anglican dioceses of St Asaph in North Wales and South West Tanganyika are linked. Consequently the parishes of Bala in St Asaph and Milo in SWT have also become linked. The purpose of our first visit to Milo in April was fact finding and establishing contact, building relationship and communication, and exploring how the link might be developed to the mutual benefit of the two communities.

This second visit was opportunistic, like the first, because of being in the country for the LSTM Life Saving Skills courses, and has unexpectedly widened our connection and influence. Bala is part of a Deanery with 5 parishes and so is Milo, we discovered. Our deanery in North Wales wants to be part of the link with Milo and as our visit coincided with a conference in the village attended by the priests and members of all 5 parishes we were able to extend the idea of the link to the DSWT deanery also. The idea of 5 white digits interlinked with 5 black digits in a gesture of friendship and cooperation is a beautiful concept but it needs to have a practical, relevant expression for both partners to be of any real value. That is the current challenge – to convey the vision to all of the partners.

They would keep giving us clothes and chickens (and eggs, of course)!

They would keep giving us clothes and chickens (and eggs, of course)!

The needs of the 5 parishes, as expressed by the priests and parishioners are much the same, and their perceived priorities remarkably similar. We discussed these needs in Swahili and English, glad to have several capable translators.

Their economy depends on cultivation and livestock, very similar to the farming communities in North Wales. Chickens, pigs and cows are desirable but the latter are rather costly. Hand tools are mostly used in the fields, and donkey power as the tracks between fields and villages are mostly unsuitable for vehicles and machines although Milo does have a communal tractor, trailer and plough. The region is too hilly for the ox carts which are commonly seen in the lower, flatter areas of this country but ox drawn ploughs are feasible.

There are many orphans, usually HIV related, generally cared for by extended family but with no prospects for inheriting the family home and fields as those are absorbed by the extended family in payment for bringing up the orphaned children. Training programmes and equipment for practical skills such as carpentry, tailoring, knitting, weaving and shoe-making improve their prospects for independent living.

Sewing machines are not expensive to us, and give independence to them.

Sewing machines are not expensive to us, and give independence to them.

Water supply is unreliable outside the usual rainy season (which has also become less predictable) particularly for villages on the higher hills and ridges, since there are no streams or reservoirs high enough to provide a supply. Some villages have wells and others with streams providing drinking water cannot abstract water for irrigation because it is needed for a new hydro-electric scheme lower down the valley.

Exploring one of the village water intakes.

Exploring one of the village water intakes.

Sunflower and pumpkin oils are used for cooking but extraction requires an oil press, usually diesel-powered  although electricity is now coming to the district.

Many of the church buildings need repairs especially to the roof and that is beyond the means of poor rural communities although they have been saving towards some of these bigger projects. It is interesting to watch the offerings during a church service, as much maize, eggs, potatoes, etc. is given in lieu of money. Bricks for new or extended buildings are very cheap as they can be made by hand from mud and water in wooden moulds and fired outdoors. The mortar is made from the same raw material. Door and window frames cost a bit more, as do timbers for roofing before the tiles go on. Tin sheets are more practical for roofing (if less attractive) and cover quickly and more cheaply, as well as being more durable.

Some of the requests for help are less obvious to our way of thinking. The lack of a church bell is very important to them although they did accept the challenge that most people now have a mobile phone and know the time, so should be able to attend church without a bell to remind them. Maybe they should consider a loudspeaker instead, and so be on a par with the local mosque, and the crowing cocks. Musical instruments including keyboard, electric guitars and amplifier/speakers are also very much desired despite the fact that we love to hear and see the unaccompanied voices, rhythms, dances, drums and clapping of the choirs here. Their perception is that young people (anyone under age 40) love these instruments and will continue to attend the choir and church because of the music and dancing. Maybe that is an important consideration.

Blessing some new guitars ... not a blessing to our ears, but happy for them.

Blessing some new guitars … not a blessing to our ears, but happy for them.

It is a challenge to understand the needs in the local context, to find ways of meeting the needs which involve local initiative and sustainable sources of materials and funds, and to inspire two very different communities to find ways of working together which will enrich and develop the lives of both.

The next phase is to convey something of this back home, in Welsh and English, and to translate the information we have gained into concrete plans and actions. That’s the challenge…

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Southern Highlands

We are happily back in UK this morning and thankful for safe travelling especially on the Tanzanian trunk roads. Once again we saw plenty of accidents – cars, trucks and buses most of which will not drive again without substantial repair. These are the write-offs of our western world but they provide the basis for rebuilding new vehicles in theirs. Most seem to be due to speed, blind overtaking and overloading and are therefore avoidable. They are constant reminders of the dangers of travel on African roads. Thankfully the single track routes in and around the villages, and between rural centres do not allow for such dangerous driving even though they are very exciting to travel along.

Off-road - the safest place to drive

Off-road – the safest place to drive

The primary school welcomed us again like royalty and was delighted with a laptop,  printer/copier/scanner and footballs donated by St Asaph Diocese and Bala FC. In return we received two baskets of eggs, each egg individually donated by one of the school children and inscribed with the child’s name and form. We asked what other needs they may have and learned they need a copier for exam papers … we then explained the multiple functions of the machine we brought – something they have no experience of. Thankfully Paul, the Peace Corps volunteer in Milo, will teach them how to use the equipment in the coming weeks and months. It was good to see some of the school buildings being renovated and brought back into use as kindergarten classrooms.

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Autographed eggs

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The goalkeeper’s right leg…

Boma FC was excited to receive footballs too, and a full kit from Bala FC from a previous season. We watched them play a local village whose team had walked for 2 hours to play and walked home again in the dark. The outcome was a score draw, 1-1, but could have been better for Milo had they not lost the goalkeeper who has recently fallen in the fire during an epileptic fit. He has full thickness burns of his legs, particularly the right, and needs skin grafting for which he will need to be transferred elsewhere at significant cost relative to their level of income, though it would be small beer to us. Incidentally Boma FC was established as a tool to teach young men about HIV and safe sex, and as a useful safe recreation.

Boma FC Milo play in Bala FC shirts

Boma FC Milo play in Bala FC shirts

The hospital is quiet at the moment because there is no doctor. Some of the outpatient clinics are still doing well, especially the HIV clinic – the incidence in the population in this region is 15%. There has been a gradual decline in maternities too, over the past 5 years particularly from the more distant villages, partly because of effective family planning locally but perhaps also because the lack of a regular doctor means some are travelling elsewhere.

Milo maternities

In common with most of the hospitals and clinics in these rural areas, very few vacuum assisted vaginal deliveries are done which contributes to the high rate of caesarean births. With good obstetric practice the caesar rate (CS) would be somewhere in the range 5-15% but it is more than double this in most places.

Caesarean Section rate, St Luke's, Milo

Caesarean Section rate, St Luke’s, Milo (blue line) with upper and lower limits for target CS rate

We gave two plastic obstetric calculators – merely a circular plastic device for quick calculation of duration of pregnancy and expected delivery date – and the midwives were thrilled (and needed instructing in their use). Such simple things we take for granted. Stethoscopes and an audible fetal heart rate detector were equally well received. It is heart breaking to see the poor level of equipping of the laboratory too. There are no tests for urinary protein – such a fundamental test in antenatal care – no reagents for haemoglobin or blood sugar, no CD4 tests for the HIV patients, no bacteriology (only a microscope for urine infection, malaria parasites and faecal examination in gastroenteritis) and so on.

We were able to do clinical teaching several mornings based on the current inpatients, in outpatient clinic and more structured training on severe pre-eclampsia and eclampsia (which we had not covered last time we came). Even this small input was much appreciated. We had a medical student this time from a local village, on break from university and spending time gaining experience. He is very bright and soaked up information like a sponge. He has a heart for his own community in this area was delighted to be given copies of the books ‘Where There is No Doctor’ and ‘Setting up Community Health Care Programmes.’

There is so much more to be done here to re-energise this hospital where the staff are doing so well with so little, but could achieve so much more with a little more investment. Regular wages would help – it’s hardly surprising that most people have more than one means of support when they often wait for 2-3 months to be paid. Fortunately most people have their own small field or shamba and are self-sufficient. The climate and soil in the Southern Highlands is particularly suitable for growing crops and well as being pleasant to visitors from cooler places, like North Wales, for example…

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From the dark side of the moon

A whole moonth of activity and adventure has passed since last I was able to post from Bukoba on the shore of Lake Victoria. We now emerge from radio-silence like the orbiting command module during the Apollo missions in the 1960s. They had no internet then of course, and we had none for the past 4 weeks, thanks to rogue SIM cards, poor networks, slow and dropped connections and large areas without good signal. Actually it has been rather peaceful and I recommend it now and then, but today we are reconnected, having arrived in Dubai on the way back to Britain, and it is good to have news of family and friends.

‘Habari’ is the usual greeting in East Africa – ‘What news?’ – news of the day, of work, of family, whatever, and the initial response is always ‘good’ – ‘nzuri’.  The news of the course in Ndolage is good.

Pre-course assessment - Neonatal Resuscitation

Pre-course assessment – Neonatal Resuscitation

We trained another group of 69 nurses, midwives and doctors in two courses over 8 days with a ‘rest day’ sandwiched in the middle during which we retreated to Bukoba by car but failed to gain satisfactory internet access  yet again. Ndolage sits atop an escarpment and boasts a good little hospital and an excellent nursing school and we were greatly entertained in the last few evenings by the students of the school celebrating with wonderful songs of joy in the chapel accompanied by drums and whoops and ululations as only Africa can produce. The view of the villages scattered over the extensive plain below the escarpment is spectacular as far as the tea plantations on the distant hills and the edge of Victoria and some of the islands. It was too tempting not to climb down the cliff one evening by the rickety fixed wooden ladders placed to gain access to the generating house below where water diverted from the top of the falls blasts via a large pipe through two turbines which keep the hospital site supplied with power.

Somewhere down here is the turbine house ...

Somewhere down here is the turbine house …

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All too soon we were saying goodbye to another new group of friends and heading back to Dar for the next leg of the journey to Iringa, Njombe and eventually the village of Milo. And I must say goodbye to you all too because I’m writing this episode in Dubai and my flight has been called so I leave you in suspense while I head off into radio silence once more.

This time on the Airbus but well below the moon…

 

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Back to Bukoba

It had been raining not long before we landed in Mwanza on the south-eastern shore of Lake Victoria after the 1.5 hour flight from Dar.  We sat in a small open-air café across the road from the airport before our onward flight and the wind coming across the lake brought myriads of small flies.  People battled through them seeking the refuge of cars and buildings, trying to shield their faces, until the rain started again and cleared the air.  Our flight was a little delayed until the weather was clear for a landing in Bukoba 45 minutes away on the west side of the lake.

There were only 4 passengers in the single engine prop plane and we three UK visitors (one from Scotland, one from Iraq, and I) were met by Mselenge and a vehicle which drove us 200 yards to our lodging place.  Since I was here last November, the airstrip in Bukoba has been upgraded to tarmac from red dirt that would not support the larger planes in the wet season.  The commemorative pillar and plaque euphemistically called the foundation stone had been unveiled on my birthday less than a month ago and on reading it I felt rather special!

It was nice to return to familiar ground, to the place where we held our courses in November last year.  Some of the local health workers are here in the hostelry having 2 days of training on febrile illness in children.  In the last 2 months there has been an outbreak of malaria at Muleba just 2 hours drive south of here, and 200 children died.  Just at the end of the small rains is a time when such outbreaks may occur but it has not happened on this scale for very many years.

Mselenge, Adrian, Carol and Zach checking in

Mselenge, Adrian, Carol and Zach checking in with the RMO

A local football match was staged in the afternoon where the local side, made up from one representative from each of the wards in Kagera district, playing in Argentinian strip, was beaten by Kagera Sugar, a more experienced visiting team in red shirts. The curious method of taking gate money involved purchasing a ticket through a hole in the fence, handing it over to a man on the gate who then returned the tickets to the man at the fence hole to be sold over and over again.  In this way a few old tickets from the 2004 and 2005 seasons served their purpose very well.  We jokingly suggested that these are no longer acceptable since US dollars are also rejected if the date is before 2006 as there are so many forgeries from that period in circulation.

We ate well in the evening to the usual accompaniment in this outdoor restaurant of British Premier League football on TV. We turned down fish in favour of beef and chicken with plantain banana, potato chips and chili tomatoes and I completed my collection of 15 bottle tops in five varieties ready to challenge all comers at the ancient game of Nim!  If you haven’t heard of it you need to meet my eldest grandson who is rapidly becoming an expert at the age of 10.

Tomorrow we transfer by road to our training venue, somewhere in the direction of Rwanda, to prepare for the first 4-day course and to settle in.  No doubt we shall have the repetitive pleasure of eating fish in the coming days as the economy and diet of this region is very much influenced by the proximity of Africa’s biggest lake…

Bukoba Monday 19th

The shock and reluctance of emerging from sleep in the dark at the wrong time of one’s natural diurnal cortisol cycle is rapidly replaced by the onslaught of sound from the local pre-dawn bird chorus.  The sheer exuberance and variety of calls, of squawks and tweets, the chuckles, whoops and booms of the monkey-frog-bird*, overlaying the more tuneful songs of these creatures of earth and the sky as they celebrate the arrival of the new day, the survival of another night, the sheer joy of being alive, the social contact with birds of their kind, the wonder of it all, for whose sake?

Aside from their own world, their swelling sound overflows to the pleasure of the Creator and the eavesdropping of other creatures, like me, bathed in their song as I enter the world of the wakeful. It washes over me in waves of freshness and generosity and welcomes me to join the worship, quietly reflecting their thankfulness of life.

The concerto gradually fades to take its place in the soundscape of daily life – the gunning of a turbo-prop as the first flight of the day prepares to leave Bukoba airstrip, the passing of the occasional car, the sound of mop and bucket along the corridor, the squeak of bed springs as someone else leaves dreamland, a distant radio, the rattle of a chain and padlock freed from a tin-sheet door.

Only the dogs and cats are silent. Exhausted after their tuneless communion in the thick of the night, challenging each other and every strange sound, and with no alarm clock to disturb and no duty to call them from sleep, they rest oblivious to the feathered orchestra overhead.

*This little known local ventriloquist confuses newcomers with its brilliant scope of vocalizations. Rarely seen, it hides by day in the swamps and trees bordering Lake Victoria composing itself and its music for the following night.

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Mafia and Milo memories

It’s ages since I blogged and I apologise. Wifi in Tanzania was unreliable and emails were often clogged up and unsatisfactory.  Blogging proved impossible. The Mafia trip actually went very well. We did the usual two week course with a hospital tour in the middle. Interestingly we found some of the hospital wards were sponsored by families from Sicily in memory of deceased loved ones. Now what would be the connection I wonder?

Sunset over Kilindono Harbour, Mafia, while drinking coffee outdoors with the locals.

Sunset over Kilindono Harbour, Mafia, while drinking coffee outdoors with the locals.

The highlights of Mafia for me were the night we ran out of fuel in the dark returning to our hotel across the island. It was utterly dark as we stood on the dirt road gazing at myriads of stars waiting for the local ambulance to bring us a jerry can of diesel (what it is to have friends in high places). On that road in the dark we were entertained by a passing hotelier in the back of a tuk tuk, seriously inebriated, with his lady friends, inviting us to stay with him or to call if we didn’t have any luck with the fuel. The bizarre conversation was hugely amusing and we could have talked all night had it not been rather annoying after a while and we wished they would drive on. Then there was the evening we watched the sun set over the harbour while drinking coffee sitting on logs in a circle of local menfolk. And the rest day when we took a boat to a neighbouring island to visit the fishing villages and ruins of some old arab trading colonies.

Two punctures on the Milo road but thankfully two spare wheels...

Two punctures on the Milo road but thankfully two spare wheels…

Milo was something else. The hospital there is tragically run down despite many decades of international aid – financial, donations of equipment and expertise and so on. The staff were lovely and received us royally. We had our own house where Hilary cooked over the charcoal brazier on the kitchen floor. We had a log fire in the evenings as it was cold after dark. At the Primary School the marching band turned out in force and sang a song in praise of good education to welcome us! The Chairman of the village gave us his blessing to visit wherever we wished for as long as we liked, and we carried a letter of invitation from him to the Mayor of Bala to come see Milo firsthand. The Bible School wanted an address from Adrian and the Mother’s Union a talk from Hilary, thankfully with interpretation, and the church welcomed us as the long-awaited visitors from their twinned town in North Wales. That all seems so long ago and now I sit in the Business Lounge of Emirates Airways in Manchester enjoying a champagne dinner before boarding business class on another visit to Tanzania – I have been upgraded for the overnight leg to Dubai so I might sleep better than I imagined. There was a moment of concern at the check-in when I was informed that printer ink cannot be carried on board since I am taking a printer/copier/scanner for the school in Milo (and “how can they possibly use it without ink?” I pleaded!) and a swift phone call later cleared up the problem.

Gangnam style leap of faith into the Tryweryn!

Gangnam style leap of faith into the Tryweryn!

So it was once again ‘goodbye’ to Bala and Brechdan this afternoon and ‘goodbye but see you soon, God willing’ to Hilary this evening before off into the setting sun for some destination way in the north west beyond Bukoba and Lake Victoria for another two weeks of training and then down to Milo for two weeks of je ne sais quoi. Always exciting and never disappointing, except perhaps for poor Pakistan. Sadly, that was not the best…

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Mafia

The memories of Pakistan and Gujranwala are fading slowly. That was not the trip of a lifetime. Nevertheless, despite the lack of freedom, the ill-health, the problems with accommodation and the food; the training courses went very well, which is what we were there for, and the team members both visiting (us) and national were excellent (not just us). A short time after, one of the participants communicated her gratitude saying that she had obtained some equipment and drugs as used and recommended on the course and was having good results with them. She appreciated the efforts of all in helping her save lives.

Mafia island

Mafia island

That was 6 weeks ago and fortunately the Tanzania course was delayed for a month allowing sufficient time for recovery, family, work and refuelling before flying off again. Mafia is an island off the Tanzanian coast of 400 square km with 40,000 inhabitants relying mostly on fishing, and some scuba diving tourists. No prizes for guessing what the main meals will be.

I’m looking forward to seeing some old friends (Ahmed Ahmed alias Bob, and Madam Malingumu amongst others) and some new vistas, and to a little adventure/relaxation if we can squeeze some in around the usual busy course schedule. Hopefully the natives will prove friendly and will not be competing with Sicily for reputation.

We fly into the dirt airstrip of the principal town, Kilindoni, on Wednesday. The small hospital is situated here and I guess the training venue will be too. The hotel on the other hand is in the Marine Park area of the island, one of two suitable hotels intended for tourists and providing all the usual holiday facilities. That’s the only accommodation that could be found. None of us are complaining.

After two courses with one rest day we fly back to the mainland where I hope to meet up with Hilary to travel to South West Tanganyika to visit the parish of Milo in Ludewa District which has recently been twinned with Bala.

If there is a decent WiFi then there should be news from time to time, and who knows? Perhaps the odd photo.

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The Revenge of Jack Sparrow

If I say it was the sparrow, you will think me paranoid. All the same we have all been smitten by the same affliction, after we went to the same BBQ.

Gujuranwala has a reputation for meat eating and I guess mixed beef and horse burger would not be sniffed at here as long as it comprised halal meat.

Sparrow Hawk

Sparrow Hawk

After a busy day we set out under cover of darkness in a ‘high top’ – the local name for a minibus with curtains providing privacy – heading for the restaurant zone of town and after driving around for the best part of an hour we found a suitable establishment where we could enter covertly by a side door, and use a private basement banquet room fit for visiting dignitaries. We did our best to appear dignified as we awaited the local delicacies – baby chicken, quail and sparrow.  Apparently only cock sparrows are eaten although I have it on good authority that we ate Jack Sparrow’s cousin rather than the house sparrow we all know and love, but whether that was Cousin Hedge, Cousin Tree or some other relative, I cannot tell.  Whichever variety, spare a thought for the BBQ widows of sparrow society, poor things.

It was that night that our lurking viral illness emerged in the faculty and within 24 hours all were ill. Coincidence really, as one member was already so unwell he stayed in the minibus and ate nothing. We thought he may have had malaria but the weather has been so cold here, all the mosquitos are hibernating. You may think our menu was the perfect recipe for bird flu and we did all have a severe respiratory infection with backache and muscle pain.

Secretly I know it wasn’t the sparrow’s fault. I knew I was incubating something when I boarded the plane for Lahore, but when I saw the questions on the landing card I decided to keep quiet as I had not travelled from an endemic area. So I ticked all the ‘no’ boxes and carried on. I later saw in the local press fatal swine flu cases in neighbouring India – one reason behind the precautions.

But there you are, never let the truth get in the way of a good story, eh?

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