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.
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.
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.
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.
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.
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…