So long, farewell ...

The last Day. All the clinic staff were in a festive mood as they were celebrating the New Year … on the 11^th of February? The clinic was virtually empty, so Anika, another volunteer Lise (from Brisbane of course) and I executed a mass cleaning of the delivery room, beds, equipment, walls, everything. After helping with a delivery in a car outside, we decided to take an early lunch. We’d just tucked into our delicious salads when Lise phoned Anika – “We’ve got 2 pushing and another 2 in labour – come back!”

We walked into madness. Two women occupied the delivery room both in second stage of labour however they kept getting up and swapping with another two women who were also on the verge of pushing. This tag team continued until one of the ladies (inconveniently not in the delivery room but in her bed) called for help and delivered her baby into Anika’s waiting hands. Meanwhile I was occupied coaching a woman who’s baby had stopped descending. The lovely Hawa was supervising and at my suggestion for a position change, we attempted pushing in another position OTHER THAN SUPPINE for the first time in 6 weeks! For a good half hour I attempted to deliver this baby, but maternal exhaustion was clear. I had just asked Hawa to give me a hand when Mama finally delivered without any need for fundal pressure J

Thank goodness for distinctive kangas !

Another woman who we assumed would deliver on her bed was then rushed in - here I observed the worst case of Female Genital Mutilation (FGM) I’ve seen. While traditional for many women here to have minor circumcision, this young mum of 2 had clearly visible scars. We’d managed to run out of delivery bundles so it was a race to see which Mama would deliver first and score the kidney dish, scissors and clamp. I asked to deliver the mama with FGM and I was concentrating so hard I tuned out the horrific screams that escaped her mouth – a true sign of pain considering birth is culturally silent. Over my shoulder I was vaguely aware that the baby next to me was being suctioned due to thick meconium but soon enough my Mama birthed a gorgeous little girl. To my absolute delight the midwife cheered what an excellent delivery it was as the mother was intact despite the non-elastic scar tissue.

The other newborn was healthy which is more than I can say for his mother. The poor thing had retained membranes which 4 different midwives could not deliver. After an hour of poking and prodding, elbow length gloves were donned and manual removal was attempted. Trying to distract the mama, I stood at the bedhead with her and cooed over her new arrival who had been left in a corner, forgotten with the complication.

Whilst this was happening, the first Mama who had experienced slow fetal decent called out from her bed – she was haemorrhaging. Post partum haemorrhage is treated simply with a saline drip (sometimes with oxytocin in the mix) and thankfully we were able to change her sheets.

Back in the delivery room I found a new baby swaddled on the table – a baby born before arrival. Before we’d had a chance to check the mother over, a girl who looked about 15 years old (but insisted she was 21) came in to birth. The poor thing looked very unkempt but she had a steely resolve. Anika conducted that delivery; a baby girl if I remember correctly?

After everyone was settled in bed, Anika and I said our final goodbyes. We handed out our scrubs and shoes between the midwives to their delight (most had been keen on the blue scrubs from day one) and ushered our favourite Hawa and Digna into the office for a warm farewell. They presented us with a kanga each reading “God is Kind.” Handshaking the doctors for the last time, we were told to bid our Australian families and friends Greetings from Tanzania and assured us we were welcome anytime. My heart was heavy with gratitude and emotion as we walked out the gates for the last time.

Coming home to our Tanzanian Mzungu family was definitely uplifting. Mama Liz’s daughter surprised everyone with a weekend visit from Nairobi, so good to say goodbye to her! We dressed and treated ourselves to dinner at Blue Heron, a fancy Italian dining in a peaceful garden. The loveliest part of the evening was returning back to Mamas dinner table for dessert. Sarah had bought a beautifully decorated cake with ICING, and we gorged on mars bars, cake, double choc ice-cream and mint biscuits – delicacies here where fruit is considered dessert. Everyone then squeezed into our bedroom while Anika and I packed.

Unable to sleep – sleep brought leaving much too close – I watched the White Massai until I nodded off.

Final breakfast of cold toast and honey. Final cold shower. Final jump from top bunk. As the whole household stood at Mama’s front gate, Pam and I entertained with songs from Annie. Singing “For Good” from Wicked however was a poor song choice – I started the waterworks. When the shuttle bus finally arrived, I hugged Mama, Monica, Hlin, Molly, Pam, Sarah and even got a hug outta Jess J The shuttle bus passengers were a little bewildered at the sobbing from Anika and I!

We spent a fantastic afternoon in Nairobi visiting the Giraffe Sanctuary… their antiseptic saliva was an added bonus in our many smooches! For Dinner we enjoyed a smorgasbord of meat at “Carnivore,” rated in the top 50 restaurants in the world twice in the last decade. After a month of only chicken and fish, I sampled beef, pork, lamb, ox balls, crocodile, ostrich meatballs but I drew the line at chicken gizzards. Nairobi, despite being 5 hours away from Arusha is a different world – so much more westernised, organised and clean… nevertheless I’d stay in Arusha in a hearbeat.

I’ve been so blessed to have such an enriching and eye-opening experience these past six weeks with the most beautiful people and I look forward to the day when I can come back to Africa a qualified midwife and lend a hand again. Asante sana!

Hi-5s in the Delivery Room

During handover at the clinic the next morning, I’d popped my head into the delivery room to be told “breech baby!” The Mama had known about the malpresentation however had waited until delivery was imminent to come to the clinic so there was no time to refer her to Mt Meru Hospital for a possible c-section. The head doctor kept insisting we say a few words about our time at the clinic during the education session, however when the staff saw our excitement for the breech delivery they laughed at our eagerness and waved us off to observe. This delivery followed Australian practice of “hands off” moreso than the previous breech (footling again meaning feet first). Bub was a tiny 2.8kg and came into the world bright and healthy. 2 more bubs were delivered within the hour and Anika and I were content to watch the midwives in their element.

One of the trip highlights has been the rapport we’ve developed with the midwives here. Compared to our first day where everyone was a little stand-offish and we had to ask lots of questions to be acknowledged in the room, we were now laughing and joking with the midwives in broken English and Swahili – not to mention lots of hi-5s and hugs (and I’m talking about inside the delivery room!)

The Beautiful Hawa 

As a huge thankyou to the midwives and doctors for their hospitality, Anika and I served up a spread of soft drink, cookies, popcorn, fruit, chocolate and (biggest cheer) samosas as a departing lunch. Crowed into a tiny waiting room, the head midwife, doctor and clinic supervisor all made touching speeches thanking us for our time, generosity and cheerful attitudes. Anika and I were dressed in vibrant kangas and we danced to the hearty singing, whistling and clapping of the staff. After the food was inhaled, the midwives individually came up to hug us, ask for a photo and our email addresses before a card signed by all the staff was presented to us. Best of all, the doctor and midwife we upset in our second week gave each of us a hug and thanked us for our time - it's such a fantastic feeling to leave on a good note!

The Staff

Thoroughly enjoyed our last Volunteer Dinner at the house – especially the last chapati. Back at mamas we lazed around watching Bride Wars until I snuggled into top bunk crossing fingers and toes for a memorable last day at the clinic.

Nursie!

After days of a quiet labour ward, all those women holding out finally popped. We had a full ward with 9 labouring mamas, and the other volunteers humbly swapped shifts so we had the delivery room all to ourselves. During the mornings lecture on suctioning (babies should cough so we know we’re in the trachea and not the oesophagus what?!) I snuck into the delivery room in time to see a bub fly out. Three midwives were in the room, yet no oxytocin was drawn up and no kangas were ready for the baby, Tanzanian time prevails. The repair of the mamas second degree tear was scarily warped, plus they don’t believe in top ups of local anaesthetic.

2 more babies were born in quick succession: one a tiny 2.5kg girl who caused a huge tear and the other a 4kg sumo girl whose mum was perfectly intact. If I’ve learned anything in my time here, it’s identifying signs of neonatal resus and acting quickly. When the 4kg bub came out stunned, I had already assembled the equipment and Anika was suctioning before the midwife even considered the need to stimulate the baby. She perked up beautifully by the way ☺

Mum and Bub in bed of delivery :)

We scrubbed the delivery down, changed dirty sheets and received such satisfaction from wrapping delivery packs using the new scissors and sterile drapes Anika’s aunt donated. We were sitting down when we heard the familiar “Nursie!” and midwife Hawa waved us over to one of the 15 patient beds. “Deliver” she said smiling, and toddled off to bring a flimsy privacy screen. Grabbing a delivery bundle and snapping on some gloves, I delivered her baby onto her bed in front of the entire ward. Anika and I made the perfect team and without even instructing each other we pulled out all the stops for the healthy baby girls arrival. So proud of us!

On such a high, Anika noticed the lady in the bed next door was in fact Glory, the school teacher from Errat who we had taken to the Snake Park the day before! We had just been discussing maternity gifts for her and there she was cradling her tiny 2.5kg baby girl. Unfortunate that when she complained of a stomach ache the day before the 3 midwifery students didn’t connect the dots, but she did go over a month and a half early! We sneakily bought her baby a pink beanie in celebration, so lovely to finally share a personal connection with a patient. We bypassed the usual tourist lunch spot to eat locally today before collecting gas for the new stove which took 5 people to figure out how to connect!

In the afternoon we were kindly invited to one of our favourite midwife’s house for afternoon tea. On numerous occasions she had warned us that her house required “improvements," but she wore gold jewellery every day and I envisioned a modest cottage. A motorbike carried us through the barren dessert clustered with the cinderblock boxes they call home until we reached Digna’s. She proudly took our bags inside and settled us in the loungeroom before bringing out a feast of fruit, beef stew, chips, fried bananas and rice. The house consisted of a kitchen, lounge and bedroom, a few pieces of furniture and no running water or electricity. Out the back she showed us her prized chicken coup – “we have chicken once a month!” 

We had our last meal at Mamas tonight – Wednesday Night fish heads and cabbage which we washed down with drinks at Sakina Bar. The waitress who is also our new maid during the day mocked me for ordering soda instead of beer. Good night.

Sssssnake Park

 I fulfilled a goal today – school excursion! Roomie Sarah, plus Pip and Nyssa all work at Errat, a deeply impoverished school for kids aged 3-10 years. Most of them had never left their suburb, so a day in the Snake Park was a special occasion. Dressed in their Sunday best, we loaded 51 children into 2 dala dalas and waved goodbye to their parents. We may as well have just driven the kids around for the day – the novelty of their first car ride had us volunteers busy making sure all limbs were in the vehicle at all times!

While I wouldn’t recommend the Snake Park for tourists, the kids were beside themselves at the range of animals. Some of the girls cried at first glimpse of snakes double their size, but the baboon was an enormous hit with even the 3 year olds. The biggest challenge was to stop the kids from trying to stimulate the animals too much. Rocks and spit went flying (and some brave fingers in cages!) trying to provoke action, leading to a minor stand off with a particularly nasty eagle. We exclaimed over crocodiles, lizards and had only one child escapee into the turtle enclosure. The kids faces lit up when the park staff brought out a snake to drape around their necks, we even coaxed teacher Glory to have a hold.

Just as exciting as the snake was the lunch we packed – PB&J sandwiches thanks to the Canadians, bananas, muffins and juice boxes! We thought maybe the kids would enjoy the neighbouring Massai museum, but we probably should have factored in the scary factor of a dark enclosed warehouse filled with frightening clay statues of warriors with masks and spears. A handful actually wet themselves with fear … Pole! (Sorry!). Luckily the camels outside the museum for tourist rides lifted spirits again. We also awkwardly ran into a World Vision team filming using the decorative but fake Massai huts as a backdrop. The dala home was much calmer due to sheer exhaustion; all in all the day was a huge success. I love how such a simple outing was a massive highlight, their shining eyes = priceless.

Final Weekend, Shopping, Singing and Shiftwork.

Our last weekend in Tanzania. Wise advice for market shopping is to browse, barter and finally buy, and boy did my wallet take a beating. Serious stamina is needed as each shop keeper lures you into their pokey stalls and corners you inside with “support me sister” – all with puppy eyes. Every single store sells the same wooden masks, beaded jewelry and ornamental hippos… it gets old very quickly. A group of volunteers gathered at Africafe for lunch before we headed back to the markets. Saturday night = Chapati Night! Mama’s chapati compares to eating warm pastry and will be one of my most missed dinners. Pam had been feeling ill for days and decided to pay the clinic recommended by TVE a visit. Despite many Western clients, it was unnerving to watch the nurse attempt cannulation 3 times. The next night the nurse read the wrong file (confusing Pam with 62 year old John) –the mistake was realised after the John’s meds were already administered but luckily John was on the same antibiotics!

Amazing Pam/Grace

Sunday morning I hand-washed my entire wardrobe before heading to Mama’s church service. After our last visit Pam was inspired to sing to the congregation, and blessed us with the most beautiful rendition of Amazing Grace accompanied by myself on the keyboard. When we finished, Pam received heartwarming applause. When it came time for the 30minute homily in Swahili, the priest called for English speakers to sit amongst us and translate. Today I felt the least like a mzungu since being here as we were welcomed into the church community. The after church auction of food to raise money for parish funds saw item after item be purchased for the “beautiful musicians.”   

We celebrated with chips mayai (an omlette with hot chips) at Sakina Bar and toasted to Pam’s fulfillment of a dream. To indulge ourselves we bought 3 litres of ice-cream from Sakina supermarket and after chicken sandwiches for dinner the 10 of us polished off the most convincing dairy I’ve tasted here.

I went to a night shift Sunday night and was delighted when I saw 23 year old male midwife Gasto was working, however the night was quiet with only 1 delivery of a chubby baby girl. A woman also came in around 1am complaining of ruptured membranes for longer than 24 hours. Due to the increasing chance of infection the longer membranes are ruptured without delivery, the midwives demanded the woman go to the Mt Meru hospital. I’ve learnt that women are hesitant to go the larger hospitals as they often are money hungry. Even in the case of emergency caesarean sections, women are required to pay the 400 000tsh ($250USD equivalent) for surgery.  The woman was sent away, but at 4am she returned with her son delivered at home – women are prepared to risk delivery without sufficient assistance and equipment for fear of crippling medical bills.

Later on in the morning, her baby experienced hypoxia and was referred to Mt Meru anyway. After handover, Anika and Hannah arrived with a van full of all the equipment we’d purchased. One by one we unveiled each new gift, the stove however got the most enthusiastic applause. No doubt the midwives are looking forward to making “chai” (tea) for themselves as well as the mamas.

Doctors + Baby Heater and Sterile Drapes

Spent my arvo sleeping, shopping, and preparing for tomorrow’s Snake Park adventure. 

Clinic craziness.

It must have been last week that I returned to the vaccination clinic for an early shift only to find that we were no longer permitted to do injections. One of the high school leavers who’d never used a syringe had made a baby bleed thus all mzungus were banned from pricking babies. We weighed and gave oral polio vaccines like champions though, never a shift wasted J

Wednesday Night shift – I arrived to find Fatuma and Philippina on duty. Both midwives have a very, shall we say laid back, attitude towards birth. Women would stumble into the delivery room in preparation and the midwives would call from their beds not to push yet in accordance with Vaginal Examinations performed over an hour previous. The first baby of the night delivered himself onto the delivery table after the midwives kept insisting the mother was not ready to push despite her calling out.

Another woman had retained membranes after birth, and the midwives called the doctor to assist. Unable to contact him, another male nurse showed up, and managed to gradually poke the uterus enough for the membranes to deliver.

2 babies were delivered through mec stained liquor, both of which had me on edge since our suction machine had broken. Each boy came out crying to my relief, one after some heavy fundal pressure. The night was a production line of 6 births in total, and I found my niche in giving oxytocin, taking the baby to wrap and preparing the bed for the mama. Midwife Fatuma said to me “You very sharp and fast, you make a good nurse.” Not sure how I feel about being a “good nurse” by Tanzanian standards but I’ll take this as a compliment anyway.

When I turned up at the clinic the next night I found favourite midwife Hawa on duty. The biggest compliment I can possibly give is to say that I’d happily allow her to deliver my baby, not something I would say for most of the staff. I won the other midwife over for the night by sharing cookies with her, bribery works wonders. The night was slow, personal highlight was when a woman was catheterized using a wide bore suction tube, which was then returned to the suction tray after use (which I may have sneakily sterilized with chlorine when nobody was looking). After her baby boy was born, I slept until morning when 2 women inevitably delivered at once. Beautiful Hawa pointed at one lady and said “conduct!” so she and I stood side by side chanting Hemma (Breathe), Sukuma (Push) Safi Sana! (Very Good!) until we each caught our bubs.

Today I learned that both of Mama’s maids had taken their pay checks and neglected to return. Both about my age, I’d really started to bond with them, learning practical Swahili from them and watching them cook … shame I never got to take them out to dinner to thank them. After a short nap I met up with Anika at the clinic with the intention of doing an evening shift, but the labour ward was empty. Dr Japhet had shared a list of equipment the clinic would appreciate, so we set off to suss out equipment prices.

We purchased 2 wall heaters (serving as baby incubators), a set of baby scales as the previous set died days ago, 1000 syringes, 200 neonatal suction catheters and a gas stove. All up this cost equivalent of $350USD. Excited beyond words to present the clinic with the goodies next week. A huge group of volunteers went out to Njiro for dinner to farewell Sophie who arrived with us – where did those 5 weeks go?! The best chicken fajita burrito around accompanied by the horrible live band and sips of wine/rum and coke made for a great Friday night.

We Love You So So So Teacher Monica!

I had previously planned to spend 3 weeks volunteering at Golgotha School before we knew how accommodating the clinic would be, so I was keen to meet the kids roomie Monica is so fond of.

Monica has been at Golgotha for the past 3 months and led me into a desolate area of Arusha where the school consisted of 2 cinderblock classrooms and a small dirt yard. I felt so welcome when I entered the staffroom, any friend of Monica’s must be a rafiki. Monica usually floats between Class 1, 2 and 3, sometimes helping out in the 2 baby classes. All the kids dress in smart blue shirts, brown pants and brown jumpers, and upon entering each classroom they all stood in their seats to chant “Good Morning Teacher, How are You?” Your response prompts a chorus of “We are very fine thank-you teacher.”

We were first directed into Class 1 of kids aged 6-8. Golgotha is quite well off and each classroom has a blackboard, chalk and textbooks; the kids have exercise pads and stationary. We practiced simple math, body parts in English (in details such as eyelashes!) and reading basic English sentences – The cat can kill the mouse. The classes are taught in English, and I was surprised to find out that the kids get hit across the hands as punishment for speaking Swahili in class. I’m not an advocate for corporal punishment however it’s clear to see that the children behave impeccably for their teachers as a result. Monica briefly took me on a tour of the baby class – their singing of English songs were the epitome of cuteness. My favourite:

“We love you so so so teacher Monica, oh!

Teacher Monica what a wonder you are”

We found our way into Class 2 of 8&9 year olds where the kids completed exercises in English like sorting animals. I’m so impressed with their conversational English - “Sit next to me teacher!” “Write your name on my book teacher!” “Teacher, let me braid your hair!”For a break, the kids all began to sing and dance around. Influenced so heavily by all the music film clips around, the kids rap convincingly and shake their booties seductively, it’s hilarious.

Golgotha has one of the longest school days I know of (until 4pm), so Monica and I helped dish out lunch of beans and rice. The system is so organized that the kids neatly line up and collect their bowls, no desperate scrabbling here. I sat with the kids and was swarmed when I brought my camera out. They were all gasping when I showed them photos from safari - it’s so bizarre that these kids live only hours from the Serengeti and have never seen an elephant before.

Right out of the science textbook.

Last class of the day was science with Class 2. Teacher Eliza left the classroom and I took the lesson “how to bath and clean your teeth.” In science class.

Safe to say I laid the textbook on the floor and taught what I perceived practical tips on health education that I taught last year in Cambodia. The kids loved hand-washing and each wanted to demonstrate their newfound skills to the class. We walked home entangled with kids, such a sweet day and a sharp contrast to the poverty of Faraja school.