As I sit here scoffing back an ice cream, recently bought from the local supermarket that I have only just discovered, thanks to Nobete, the 8yo boy that also lives in the house, I find it hard to believe that I am already into my second week in Arusha. And much like the first week, it has filled with a heap of new experiences, some more pleasant than others. And with a greater sense of familiarity for their way of life, I am beginning to truly appreciate the simplicity people in this stunning country enjoy. Opportunities are created by the most miniscule of material possession, and despite such hardship in my eyes, there is nothing but happiness and love. But the one thing I will NEVER get used to, despite how hard I try, is the concept of Tanzanian time. Everything is done so polepole (slowly), I find it near impossible to comprehend how people actually ever achieve anything in their day. From walking slower than a snail, to it taking at least 5 times longer than it really should to do anything, it’s no wonder nobody suffers from stress! Just walking down the street I am constantly finding myself stuck behind women, children and men going about their daily business, many pushing wheelbarrows far too large for the footpath to cope, oh and as well as the odd goat or cow. But of course attempting to pass them would require stepping onto the road, and that would be like taking your life into your own hands. With pikipiki and daladala speeding down the road and no sense of road rules whatsoever, I decide it’s better to just slow my pace and join them in their daily stroll no matter how slow.
So back to the ice cream. The best thing of course about the fact I am eating an ice cream, apart from the obvious, is that I have recovered from my Tanzanian tummy. The result nonetheless of my fragile stomach mixing with a lunchtime stop off at a street stall in Moshi (a neighbouring city). The street stall looked reputable, the smell was delicious and the food even better and having survived two weeks already I really thought my stomach would be up to the challenge. Clearly I was wrong. My trip to Moshi was somewhat last minute, but I’d heard it was worth visiting so decided I’d head there for a day out. First problem was not knowing how I even get myself to Moshi. With a bit of confusion about where exactly I was meant to get the bus, I set off at 8am on what became a mighty adventure, involving 3 daladala, two buses and a taxi. Getting the dadadala to the Moshi bus stop can’t be that hard, right? Haha. Try doing it when you’re amsungu (foreigner) and have no real idea of where exactly this bus stop is located. In an attempt to pronounce the right destination, the dadadala assistant nodded so I jumped on board. Assuming I was heading in the right direction, I sat there working out what I should do once I make it to Moshi. I’d heard the markets were great so that was to first on my itinerary. The rest of the day I’d work out once I actually got there and found my bearings. And that is about as far as my itinerary actually got, because I didn’t actually arrive in Moshi until 1:30pm, by which time I needed lunch, hence the quick stop off at the street stall. As I should have predicted, the dadadala I was currently sitting on wasn’t heading anywhere near the Moshi bus stop, but instead to some residential area on the other side of town. I’d never been to that part of town, and before long the dadadala stopped, kicked me off, the assistant promptly informing me that I needed to head in the other direction if I wanted to get back to Kilombero market (a place I did actually know). So, by this time it’s already gone 9am and I’ve not yet even found the bus stop. But I have been on a dadadala to the other side of town. I guess that’s a bonus as I doubt I would have seen that side of Arusha otherwise. At 10:45am, after yet another major detour on the daladala I make it somehow to the Moshi bus stop and find myself sitting on an extremely crowded bus. The smell was overly familiar. Much like the smell of the hospital, minus some of the bodily fluids. And this bus had windows, thank goodness. I really don’t think I would have survived otherwise. I was told it would take about an hour to get to Moshi, so that wasn’t too bad. I forgot to add on the Tanzanian time tax, meaning the trip actually took over 2 hours, but I arrived, albeit exhausted, hungry and completely over the day before it had even barely begun!
I did find the market and managed to barter my way to a pair of traditional African trousers, a necklace and a bracelet for the grand total of about NZD $15. I felt very proud of myself, especially when upon returning I showed mama my purchases and she was very impressed with the price I paid. The trip home was even more adventurous, and somewhat worse than my morning’s dramas on the dadadala and bus. I jumped on a bus back to Arusha at 4pm precisely. The bus didn’t actually leave Moshi until 4:50pm and it was 8pm when I finally got home. Don’t ask me what took so long because I couldn’t tell you. I’ll just put it down to Tanzanian time.
The rest of my weekend was spent laid up in bed resting and recovering from my dodgy stomach.
On Monday I returned to St Elizabeth hospital for more eye opening experiences and I most certainly wasn’t disappointed. I attached myself to Dr Quaker, the Romanian paediatrician, for her ward round. Many of the children were different to those I had seen the week before, with just a few familiar faces, including the dear wee 2 year old with extra pulmonary tuberculosis and AIDS. Her mother sat vigilant by her side, barely able to vocalise more than a few words, but her facial expressions spoke a thousand words. There were two children on the ward with tuberculosis. Fortunately for at least the second child, whose condition was far better, there is a fantastic anti-Tb programme in Tanzania that has been set up by the WHO. The programme has meant much earlier diagnosis, and therefore far more effective treatment of children with Tb. Treatment is intensive, and compliance is a big challenge, but with regular follow-ups in a Tb clinic, the prevalence of Tb will hopefully begin to decline. Much of the Tb is contracted from drinking unpasteurised cow’s milk. Mothers, in their endeavour to provide more adequate nutrition to their young children, supplement breast milk with porridge made with cow’s milk. Unfortunately, bovine tuberculosis is rife, and these children are innocently infected.
Most of the ward round comprised the usual diarrhoea, vomiting and pneumonia. Pneumonia, malaria and dehydration remain the biggest killers of children in Tanzania, yet can be so easily prevented and treated with some basic health education and accessible medication. Any child who presents to the hospital with a fever is automatically screened for malaria, because a missed diagnosis could kill a child in as little as 24 hours. Nearly every child is treated with a cocktail of antibiotics for a minimum of 5 days even if the clinical picture points to nothing more than a viral infection. I expect this is because of the extremely high incidence of secondary bacterial infections, but I dread the day that Tanzanian bacteria become multi-resistant to antibiotic treatment.
On Tuesday I had the opportunity to visit a small orphanage in the suburb of Usa, on the outskirts of Arusha. Just getting there took over an hour, involving a 40 minute daladala ride and a short hike into the wilderness through banana plantations, but at the top of a very long hill the Fruitful Orphanage awaited me. Children of all ages came flooding in my direction, with grins wider than their faces, each and every one of their little bodies wanting a hug. As if a day on the paediatric ward wasn’t hard enough, this experience was on a whole other level. Attempting to keep my emotions in check, I entered the orphanage with 2 or 3 children hanging from each arm and leg. For two hours each morning the children attend class, where they receive lessons in maths, English and geography. Lessons are given in Swahili to the younger children, and English to the older children. For the lucky ones, overseas sponsors eventually gift money allowing them to attend a proper school in the city. For the remainder, this is the only formal education they will ever likely receive. I was allocated the older children for morning class, of which there were only 4. I taught them maths and English and was overwhelmed by their politeness and willingness to learn. There were no complaints, only an eagerness for more. Had lunch time not been fast approaching I could have continued for many more hours. Lunch was porridge, served in either a large or small cup depending on the age of the child. I had already been made aware of the infamous porridge so commonly served to young children in Tanzania from Dr Quaker, who detests the stuff. She blames it for the increasing incidence of malnutrition and I can see why. The porridge was nothing more than water mixed with two other ingredients, neither of which offered any nutritional value to speak of. I can’t imagine it tasted of anything either. But, like a scene from Oliver Twist, each child lined up for more, politely waiting their turn for a refill of their cup. It was at this point I didn’t know whether to cry or scream. I found myself questioning why these children were not being fed a more varied diet. The orphanage was set in the middle of a banana plantation but I can almost guarantee you none of these children have ever tasted one. The name of the orphanage was even a misnomer! There was certainly nothing fruitful about the food they received. I spoke to the other volunteers about my concerns and made the suggestion that once a week a volunteer attend a local market and buy some fruit and vegetables. It would cost nothing more than $10 and provide these children with the much needed nutrition they were so desperately deprived of. And with that, Operation Fruit and Vegetables at Fruitful Orphanage had its induction. A small air tight and lockable container was obtained, and each week a different volunteer would provide the supplies. Here’s hoping it continues. After lunch, I helped build a small shed, to house a cow that will be bought with donated money in the coming weeks. The orphanage already owned about 20 chickens, although I’m really not too sure what the intention of the cow or the chickens was. The chickens didn’t lay eggs (that I could see) and the cow had better not have bovine tuberculosis. I intend to go back to the orphanage next week to see how my little operation is going and offer suggestions for further nutritional interventions, including the possibility of a vegetable garden. I will keep you updated!
So apart from my usual hospital days, the remainder of my week was taken up with a couple of walks around the city, one of which I stumbled across the High Court and Mt Meru hotel. It was a hot day, my walking buddy, Amelia (another volunteer from the UK) and I were feeling thirsty and tired so we decided to stop off for a drink in the hotel bar. It was there I discovered the swimming pool I will now be visiting at least once a week. The cider went down a treat too.
This coming week I’ll be doing general medicine and infectious diseases. I intend to spend this evening reading up on Malaria as I haven’t got much of a clue about it other than it’s a parasite transmitted by mosquitoes and the second biggest killer of children in Africa. I don’t think that knowledge will help me much somehow.
On Friday I’m heading to Dar es Salaam and Zanzibar for 5 days. I can’t wait to go swimming in the ocean again. In fact just seeing the ocean will be nice!
