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I have to laugh at what, yesterday, I considered rural because today has totally changed my perception of the word. We visited health centers and dispensaries today that were down roads I initially thought were foot paths. There was nothing but wide open space, the sky went on forever and we could go for hours seeing only locals on foot or bicycle. Houses built of red brick made from the earth and thatched roofs were spotted along the side of the road and in the distance but the nearest thing we had to traffic was problems with cattle and goats crossing the road. No wonder some of these areas aren’t able to offer much in the way of health care, they are honestly in the middle of nowhere. The areas we travelled today are a far cry from what I saw yesterday. Yesterday we were stuck around the gold mine and the town of Geita but today we ventured further into the district and it was absolutely beautiful. The people we met were all very friendly and welcoming and the hundreds of kids waved at the car as we drove by, smiling at the strangers. An hour’s drive and an incredible difference.
We started out bright and early, stopping by Geita District Hospital and the reproductive clinic. Already by 8.30 there was a line-up reaching the door. In a single day the one doctor, one health officer and nine nurses will see three hundred women. Anywhere from 30 to 80 of those are attending for antenatal care and the remainder for post-natal check ups or under-five “emergency” visits. When the women first arrive there is a group orientation session, followed by registration which includes taking their weight, blood pressure, weeks gestation if known and if not, weeks since last menstrual cycle. From the crowded desk the three nurses in their pink uniforms and white aprons direct clinic attendees into a small room that bears little resemblance to our health facilities. There is a single examination table and a screen and the walls are filled with posters on malaria prophylaxis and HIV testing algorithms. There are boxes of medical supplies creating organized chaos in the space and it in no way smells like antiseptic. After being tested for HIV and syphilis, the women move down the production line and into a second room for a physical examination. Outside the covered waiting area for antenatal care is a second waiting area filled with women surrounded by young children. Toddlers and infants were everywhere and no matter where you turned, a boob was being pulled out and a baby attached. The scale used to weigh the under-fives hung from the ceiling like a grocer’s scale in a produce store. There was a large hook on the end and even though I didn’t see it happen, I like to imagine that the babies are hung by their knickers while their weight is read by a nurse.
From the district hospital we proceeded on to the first of our ten stops for the day. The dispensary was empty in comparison to the center we had just left and three women sat on wooden benches waiting to be seen by the nurse or health officer. Collecting the surveys seemed to take priority over the clinic attendees who continued to wait while we counted and tallied the completed forms. As we turned back to the vehicle, preparing to leave, the nurse called out to Christopher and a smiling young women stepped out and was motioned into the car. “She just produced a baby,” I was told as she neared us. I made a, hopefully, enthused sound and gave the women a welcoming smile. I should mention that nowhere did I see a baby so I thought it may have been a miscommunication, and this young women, who “just produced a baby” was smiling and conversing like it was your average Monday. Not the type of behavior I associate with a post-delivery new mother. And then, from under the shawl she was clutching to her chest, there was a tiny cry. Christopher again repeated, to my disbelief, “she just produced a baby boy” to which I smiled in shock and gave my congratulations (with instruction) in Swahili. Five minutes later we arrived at her village, or the cluster of five houses where she lived, and off she went, smiling and nodding at the warm welcome received from her family. I think I’m still in shock. I was under the impression that labour is something that is a little trying on the human body but this women looked like she had just gone for a walk to the market and was returning with her basket of goods. Child bearing is so ingrained in the way life here that it is not given the same ceremony and celebration. Judging by the number of children running around, it happens fairly often and I’m guessing it tends to loose its wonder.
The dispensaries are the most basic level of care and are usually only staffed by one doctor and one nurse, if even that. The health centers are the next level of referral and have a doctor or sometimes a health officer or sometimes neither, and depending no their size, one to many nurses. These were much more crowded and the waiting room of the Bukohli Health Center overflowed. Children were sprawled across the floor and women sat outside on the front steps with their babies casually tied against their back or sprawled on their outstretched legs. Even with so many people waiting for care, the surveys came first and a nurse sat with us to tally and count all the forms, ensuring they were correctly completed. At the Kharumwa Health Centre I had the chance to stick my head into the maternity ward. The only apparent differences between giving birth at the health center and at home was the presence of a trained health care worker (that’s a major one) and sharing a room with five other women in labour. The hospital beds looked like they were out of the 1950s and there must have been ten or twelve in ward without any screens to provide the women with privacy. There were a few men seated on the beds with their wives or girlfriends and a nurse travelled between the women curled on their sides in… anticipation? Fear? I’m not going to pretend to know what a women feels before giving birth in the absence of pain medication, it’s not like a child waiting to open gifts on Christmas morning.
By the time we finished collecting surveys from the health centers and dispensaries and delivering RPR reagents, the sun had set and we were left to drive back to Geita in the dark. And that’s when we saw the hyenas! It wasn’t really all that exciting, there were two or three of them dancing around the side of the road as we drove by and the two guys in the car laughed when I got excited about seeing some “wildlife.”
It’s now almost nine and it’s been the better part of a day since breakfast. Suzanne’s suggestion to take dried fruit and nuts was my savior today, and it made me popular with the guys, bonus. There’s not too many places to stop and grab a bite out there and I think my stomach may be eating itself so I’m calling it a day.
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ksollis
Kimberly Sollis
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I know it's a whole lot of boring writing but I'll put photos up as soon as there's a fast enough internet connection. It takes about ten minutes just to load a page right now!!!