It has been an incredible month of new discoveries, comings and goings of friends and family and visitors. A month of settling into the life here in Muheza. This past week we have hosted “the Anglicans” as they came to be known in our family (10 visitors from a church in Sunningdale, UK with a long history of significant donation to the workings of Hospitali Teule) who were here for less than a week and had a whirlwind exposure to Muheza, the hospital, the Diana Centre (Muheza Hospice Care and HIV Care) and even the boys’ school. It was strange to suddenly be the hosts and be the ones who “knew” and to be showing others about life in Muheza! In a curious way I think it helped us to realize we are settling in and becoming more confident and comfortable in life here and especially for the boys to receive such interest in their school and commending words of support for their adventures in Africa.
The boys are a joy to watch. Griff is back to his pre-mefloquin self and we are so grateful for that. Took about 2 -3 weeks for his confidence and poise to return, and now he is chief market bargainer and probably has the best Swahili of the family. He is super bored in school, but takes his home-schooling math book we brought with us and is working through his own math. During their Swahili, he works on “teach yourself Swahili”. He came forward with the scary experience of seeing his classmates hit (hard with a yardstick to the point of tears) and managed this with remarkable emotion and maturity. Fortunately, Sister Gwynneth has total intolerance of corporal punishment and for the moment the situation has been ’managed’. However, it will likely rear its ugly head again for him or for Simon as it is apparently the norm amongst Tanzanian teachers, despite there being a recent law forbidding corporal punishment in schools.
Simon has been a wonder, especially when I think of how far he has come from his initial huge fears of being the only white kid at school, and of missing out on everything at home. He is making friends, and making thoughtful comments about what he is seeing around him. For a couple of weeks it was really hard for him to go to school, but he seems over the hump of the early days of unbelievable adaptation to everything different. He is with kids a year or 2 older and the math work is actually about where he left off. My sense is that he is thriving with the family time and is pacing himself for the months and adventures ahead. No easy feat for a 10 year old. He has such a keen eye and appreciation for all the birds and insects and reptilious creatures here. We look forward to taking him on a nocturnal ‘camelion walk’ up at Amani Park on one of the upcoming weekends (and of course a safari at some point !)
They are both learning important life lessons such as how to navigate on a gearless bike at top speed the deep unpredictable ruts of the trails to school (especially after a rain when the slippery mud congeals between your tire and your fender), how to win at marbles on the playground (several different complex games) , how to take enough showers and drink enough water to stay alive in 35 degrees, how to sleep through the call to prayer at 4 am and the moaning cow across the road, how to avoid ugali and macheecha (Tanzanian staples) and squat toilets.
Graham ‘dropped’ in for a couple of weeks, in the middle of his university term. He got a good taste of life here although I am sure overwhelming for him and far too short. I am glad that he can now picture where we are and imagine the stories from afar. It was an epic journey for him to pull it off and we are grateful for the effort !
Our bodies feel in a state of suspended animation waiting for the damp cold and rain of a fall in Victoria to begin. Instead it gets hotter and hotter and hotter. Muggy days too with intense humidity that lifts only briefly after short unbelievable deluges of tropical rains. The other day I borrowed Rose’s little thermometer and attached it to the back of my bike as I rode up to the school for the afternoon pickup. We stopped on the way home at the hottest open patch and it read 40 degrees. Yikes! It is good that the kids are off school Dec and first half of January through the “hot season” !!!! It is all very survivable as long as the power is on, and the fans are working. Otherwise (recent outage for 3.5 days) the nights are long sweat-fests. We are all shedding pounds, just from the new rhythm of life, gratefully not from any serious illness.
Tonight we are entertaining Alex and Emily (2 young volunteering docs from UK) and the menu includes chicken on veggies, mashed potatoes, mango/avocado/tomato/red onion salad (your recipe Deb !) all well within the 100 mile diet. We are certainly eating well and enjoying fruit salads of mangoes and pineapple from our backyard, cooking with modified recipes from home.
One of my hopes for this trip was that time would slow down, and balance of life would improve and certainly I am loving the hours we have together, and all the reading aloud and games and discussions. The 6 of us (including Sally and Rose) are reading aloud “The story of the World: History for the Classical Child, Volume 4: the Modern Age”
(Thank you Eva for the suggestion) It is great to fill in our collective significant gaps in history especially around the colonial eras and how they have affected places like Africa.
The boys are becoming voracious readers and finding the joy in curling up with a good book.
On the work front it feels like we are making good progress. There was certainly a real low for a couple of weeks, where a feeling of futility and overwhelm would descend on a regular basis, but that seems to be getting better. We are engaged in a process now and feel significantly less ‘out of the loop’. We are doing consults on the wards pretty regularly and following a group of ever-changing patients, with cancers (always advanced and completely untreated) and HIV and end-stage this and that. We are building relationships with nurses and what are called AMOs and COs (assistant medical officers and clinical officers) and docs. Most of the time we are able to find someone who can translate for us so that we can have a decent exchange with patients and family, but not being able to speak Swahili remains a huge limiting force. The positive flip side of this is that translating for us actually places nurses and docs in the position of ‘role playing’ and practicing moments of information sharing, answering questions and ‘breaking bad news’ etc that are not typically part of care of the dying patient here (more often continued focus on inappropriate active care and/or general neglect of the patient). At the same we continue to be very aware of the different cultural context of illness and death and to tread very respectfully. My guide is the patient and family and try to let them show me what they need and want.
The politics of the ‘divide’ between the hospital and the Diana Centre are becoming clearer as we hear more and more snippets of the history of the last 8 years or so and the complex layers of government, NGOs, funders, egos and at times corruption that has shaped the delivery of first palliative care and then integrated active HIV care in Muheza. We are trying to keep neutral and focus on patients and certainly it is beyond us to maneuver. We have begun some formal teaching (with power point no less !) a series on palliative care that will provide a framework for what one can do in the face of incurable illness, and suffering. It feels like medicine at home, but 30 years ago. Ambrose recalls noticing on rounds as a medical student that the patients with incurable cancer were visited less often and for a shorter time, as death got closer. In fact, palliative care grew out of the gaps and lacking of acute care for these patients. Here palliative care is being born and growing up in response to a totally different context, the HIV epidemic. The definition of PC here is very broad, eg to “look after people with incurable illness, relieving their suffering and supporting them through difficult times”. So it is woven into active HIV care in a very different way than at home. We are learning, learning, learning.
Down the road in Tanga we are beginning the ‘roll-out’ of Palliative care and the use of morphine. We gave our first talk there last week at Bombo Hospital (big regional hospital) and took 20 handouts (based on the response in Muheza) and there was a HUGE audience of over 200 !! The questions were wonderful and the discussion after, more than we ever could have hoped for. They are keen, keen, keen and although the particulars of getting over the morphine access hurdles still need to be worked through, it feels very hopeful, and something we can really sink our teeth into. We will lecture, but more importantly attend ward rounds with the newly forming palliative care team, and teach at the bedside. We are feeling quite optimistic about this chapter….feels unencumbered by the unique history that burdens the development of palliative care in Muheza.
I am continually struck by how things here are both completely different and the same as at home. For example the politics of the hospital: the details are unique to Tanzania, but the heated human emotion feels very familiar. Also the patients: here they are in open wards, dressed differently, being cared for differently, different diseases and disease processes, but really in the end just the same. People are people it seems to me. Not to underestimate the huge importance of culture, language, history…but somehow a comfort to be finding common ground.
Religiosity: “at the same time both extremely important and not important at all” (Rose et al in conversation Oct 20, 2008). We are certainly the oddities here to be white and not Christian. But we are welcomed and not criticized it would appear. Perhaps it is because Christians and Muslims live side by side in complete harmony as do dozens of different tribal cultures. This is the legacy of Nyerere (the first post independence president) who set the tone of nationalism and one language of Swahili, insisting on peaceful co-existence that has been long-sustained.
That’s all for now. Thank to all for keeping in touch. Letters/snailmail very welcome !!
Love all around,
Leah
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment