Wednesday, January 5, 2011
the Last Chapter In Zanzibar
If you ever want to appreciate what you own, visit the poor. If you want to appreciate your health, visit the sick. If you want to appreciate your government and civil infrastructure, visit Zanzibar. I have just done all three for one month. I feel so incredibly grateful for what I have at home that appreciation is leaking from my pores. Just like sweet oil sprays from an orange peel as you squeeze it between your fingers. When I saw a washing machine upon arrival to Cape Town yesterday I all but kissed it. And at the same time, thinking now of dear bittersweet Zanzibar, I will most certainly miss it. It is strange to be bidding goodbye to a place that I may never in my life see again. It seems so final and a life-time feels so short when you divide it by the number of towns, villages, cities, countries and continents there are in this world.
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| Goodbye Mnazi Mmoja Hospital |
The final instalment to the Archipelago chapter is a trip to the small sister island of Unguga (the native name for the main Island of Zanzibar), called Uzi. This is one of the least developed regions of Zanzibar. There is no tourism on the island. It is green with wet tropical vegetation and red with bare earth. Its people live simply and innovatively. We were welcomed there a few days ago, along with our German friends, by the local community and chiefs of the island. It was quite the journey in a landcruiser over a rocky makeshift road of pruned mangroves on low tide. It was as though the sea had parted just for us, on all sides there was water and mud.
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| The Streets of Uzi |
Barely any whites go to Uzi, so for some young children we were the first Mzungus they had seen. This was evident when one startled two-year-old took one look at me walking by her and burst into tears. And further cemented by the lively entourage of child fans we accumulated upon our tour of the island. We were there to hear proposals of projects seeking funding from the NGO Go for Zanzibar(GoZa) and to take donation goods from GoZa to the local pre-school. The projects set to launch there through GoZa include a new building for the pre-school, an upgrade of the secondary school library, a community vegetable garden for the school, and the introduction of medical outreach camps to the island.
There were some legitimate projects proposed and heart warming moments of connection to the people of the island. There were also ludicrous requests by people who heard that there were Mzungus throwing away money nearby, and thought they’d take a crack at the cash. It was possible that we were confused with a larger more powerful body such as UNICEF or possibly the UN. One highlight was the local fisherman proposing that the illegal fishing on the island was quite a problem and they would like us to provide them with round the clock surveillance and law enforcement. I don’t think they quite understood our mission statement.
The second most ludicrous request came from one of the local members of parliament of the Revolutionary Government of Zanzibar. Beware a government with the word revolutionary in the title. At about two hours past the point that we were all hypoglycaemic, without lunch, we sat down to a meeting with “the big man”. The “big man” was dressed all in black, a short-sleeved cotton business shirt, smart pants and leather shoes, with a leather bound case, sitting on a red plastic chair in the red earth of Uzi. It was a meeting organised by one of the island’s chiefs, and we had absolutely no idea of the agenda, and apparently neither did he. Whilst we stated our business in Uzi, and gave a detailed history of the projects of interest there, the big man carefully curved English script onto his pristine white paper pad. He did not look up once. There was a pregnant pause of three minutes. He was obviously deeply reflecting. Then be began “Ladies and Gentlemen. Thank you for coming to Uzi. I am a member of parliament here and the surrounding regions. We have many problems here…” He was reciting the speech that he had so carefully written during the time that we were evidently pouring our hearts into the ether. He had not listened to a single word. Instead he requested that GoZa supply running water to the island because the government had no budget for such things. He stated that if GoZa did not, then he might have to dip into his own salary. I don’t feel so bad about that knowing that on an island where most people live below the poverty line politicians earn around US$100, 000/ year. I also don’t think he will ever in fact dip into his own pocket at all.
No breakfast, no lunch, 5am to 5pm. Despite that it was one of the best days of my life. I was able to hear the stories of the people of Uzi, see their homes and lives, hear their issues, dance with them, see their landscape, share their air, meet a “big man” and feel so privileged to be one of the only Mzungus to ever see this island.
Saturday, January 1, 2011
New Years Interlude
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| The lone water walker Jambiani Beach, sunrise New Years Day 2011 |
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| Jambiani Beach, Zanzibar, New Years Day |
Tuesday, December 28, 2010
More on the ENT Department-Mnazi Mmoja Hospital
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| Dr. Naufal |
It was the smell of burning rubbish that wafted through the ENT department this morning as I stood beside Dr Naufal in his Tuesday clinic. It is hard to believe the scene. Dr Naufal sits in his white coat, suit pants and smart shirt decorated by a headband. Attached to the band is a round mirrored disc missing it’s centre which reflects the light from a lamp onto the patient and the orifices that comprise his profession; ears, nose, throat. Beside him I stand glued onto a tiny space of wall beside a door that frequently opens and closes, allowing traffic through, often battering me in the process if I become lax and mindless of it. This happens every five minutes. It is my meditation for the day.
I am enthralled by the cases that stream into the room at a rate 100 times that of home. As one patient sits on a stool in front of him for an average of three minutes he takes a short history, examines the lump or relevant body part, makes a diagnosis or management plan, writes a medical or surgical prescription and as one patient is waving goodbye he is onto step three with the next patient. The room is full of the next patients to be seen so as to save overlap time, with no complaints of lack of privacy from anyone. They are just glad to be seen. There are three nurses in the room and manning the doors, purely on crowd control, taking tickets and calling numbers like a deli lady in Woolworths. The next room is full of nurses and patients being triaged who intermittently are sent across to Dr. Naufal for a quick inspection whilst he is concurrently looking at another patient in front of him. At the same time he has visiting doctors coming to say hello, his wife may pop in, multiple people phone in and he juggles the otoscope and the telephone whilst barking at me playfully to examine the next woman’s neck lump and give my diagnosis. The meaning of multi-tasking is taken to a new level. As far as modern medical conduct by Australian standards he breaks every rule in the book. What he achieves however is mammoth.
For example this morning in a three -hour clinic we diagnosed approximately fifteen cases of goitre, fifteen cases of gastro-oesophageal reflux disease, booked ten surgeries for anything from adenoidectomy to skin tag excision, booked a biopsy of unfortunate looking lesions of an Albino African man, worked up a woman who most likely has nasopharyngeal cancer, and diagnosed one potential case of leprosy. As if that wasn’t enough Dr Naufal’s face said it all after he proudly dug into a two year olds’ left nostril for a long minute to finally produce a well-cooked, fully plump, month old, mischievous lima bean.
It sounds comical but this morning was also filled with the stuff that brings you to tears, the clichéd tragedies that put your woes into perspective.
Tragic case number one: A man aged forty five, I imagine with a decent sized family at home, lays on the operating table of the minor procedures theatre on the ground floor of the ENT building. He has cancer of the throat causing him to gasp for every breath because the tumour has narrowed his windpipe. Soon he will not be able to breath at all and he will die. That is unless a hole is made in his throat below the tumour and a tube put in place to act as a windpipe. The tube will buy him some time while the tumour is treated but significantly impact his ability to speak. He needs the tube, called a tracheostomy, today.
Unfortunately there is only power available in the operating theatre on Mondays now, because of the unreliable power supply to the hospital. This means that this man cannot have the procedure done with proper anaesthesia, sedation and monitoring. He must have this hole cut in his throat under local anaesthetic (a numbing needle). This means he perceives every cut and turn of the surgeons instruments, is completely conscious of every word of the theatre staff and cannot move a muscle in the process. I’ll spare you the gruesome details but when the procedure is done the grown man has tears rolling down the sides of his face, stands up off the operating table and walks out of theatre.
Apparently his case is not uncommon; there are extremely high rates of head and neck cancer here, almost exclusively among smokers. Apparently smoking here is much cheaper here than at home, and although the poorest cannot afford it there are still many that are addicted. There is little education about the health effects of smoking in Zanzibar and there are no restrictions to advertising. I would be surprised if you could watch the procedure I saw this Tuesday morning, a tracheostomy under local anaesthetic bringing a grown man to tears, and say that the marketing of cigarettes is ethical. I’m sure he was never warned that it could end up this way.
To be continued….
An aside
On speaking to my mum today I found out that my memory of my tonsillectomy, which was at four years of age, was less than perfect. The truth-seeking journalist within me feels the need to add a disclaimer here. The hospital I attended was not Westmead Children’s. It was a smaller private hospital that may have had a better average standard of care than its public counterpart. And, drumroll, the pink pony was actually a rabbit.
Mum also added that the cartoon of brave Nancy and the needle was somewhat imperfect at preparing me for my blood tests, albeit excellent at preparing me for my anaesthetic. It turns out that I was explained that the needle went in and came out, but nobody mentioned that to take blood it would remain in my arm for a while as the nurse collected it into different tubes. Apparently the needle went in and I was stoic, but when it didn’t come out immediately there was hell to pay. Cartoon Nancy didn’t turn me into Kassima the Brave African girl after all. So in terms of bravery demonstrated during tonsillectomy the score is Africa one, Australia zero.
Monday, December 13, 2010
Zanzibar
The Beginning
When the child is born they are handled like a piece of meat by delicatessen, gripped and transported firmly by the ankles, slapped to cry, and plonked into a plastic bucket on scales to be weighed. The newborn is left there while the mother is tended to. Only a half hour later the child is transported from the scales to the mother, who places the child at the foot of their bed in the post-natal ward, and speaks with the other women on the ward or tries to sleep. There is no “googoogahgah” babytalk that we hear at home, barely any initial interaction. But there are also no loud children here in Zanzibar, and I have not seen one tantrum. I have a feeling that this cultural behaviour is related to the high maternal mortality rate, that the child is not seen as important until the mother is cared for. With such a massive population and resources so scarce, fetal mortality no doubt reduces financial and resource strain on the family. Also to be considered is that contraception is fairly primitive and most likely majority of conception is unplanned. I suspect the concept of IVF would appear ludicrous to these women. However I may be completely misunderstood. I will let you know more when I do.
There is something very daunting about beginnings; The beginning of a big trip, a big idea… and for me sitting here in Zanzibar there is something daunting about beginning this journal. It is almost impossible to describe this place, the rich cultural fabric of Africa, the deep waves of emotion that I feel each day.
Transit
So it turns out that the physical journey to sitting on the balcony of the Africa House Hotel, unknown street name, via Kenyatta Road, Shangani, Stonetown, Zanzibar, Republic of Tanzania, East Africa, wasn’t so straightforward. One look at the address could have predicted that.
After an overnight stopover in Joberg Raffi (fellow med student) and I were met by the longest airport line in history. Not so serendipitously South African Air had decided to test out some new check in software on this particular day. All passengers for all international flights of South African Air were lined up over 500m down the terminal waiting to be rushed to the front of the line as their flights were closing. As we were told flight SA186 to Dar Es Salaam was closing we rushed to the counter. The check-in operator just shook her head. The flight was closed. It’s a long story but we did manage to get on the flight by sprinting the distance to the gate, but not surprisingly our luggage did not.
We arrived in Dar Es Salaam airport with cards only, no cash, parched and no ATM in sight. Quite humorously the “rich” kids felt quite “poor” here in Africa on day 2. The pity of a kind woman in the airport store afforded us a bottle of water. This was the first speck of the mass of African warmth we would discover on the trip. And we planned to repay her in a month on the way back through. What would change by then? What would we have seen?
The Dar Es Salaam airport leaked the pungent smells of sweat, body odour, and mould mixed with stale crackers. Everywhere the Muslim women wore full veil and long dress in the stinking 40 degree heat. The transition from first to third world, from secular to religious society, was so evident. The escalators were suddenly missing their stairs, and had become hollow skeletal relics of something that once worked, the air-conditioning had been sucked from existence, and live electrical wires decorated the walls and ceiling like Christmas decorations on a festive tree.
There were a few vital things that the people of Africa made very clear to Raf and I on our journey. The first was a note on the safety of air travel on the continent. Apparently if oil is leaking from any plane “don’t worry… only worry if it stops leaking.” This came in handy when catching “precision Air” to Zanzibar. The word precision flanking an airplane was like telling someone “don’t think of a purple elephant.” An imminent crash was all we were thinking about.
The second jewel of wisdom imparted to us came from the check-in lady at Dar Airport. She clarified that our bags were not “lost” they had just “not arrived”. This didn’t come in so handy when still days later I was in the same tracksuit pants and underwear in 40 degree centigrade Zanzibar.
Accommodation
We did eventually get our “not arrived” luggage, a few things stolen from my bag. However, more concerning than the “not arrived” items in my bag was the fully prepaid accommodation that we discovered on our arrival. The accommodation was organised by our supervisor, Dr. Omar Suleiman Medical Superintendent of the Mnazi Mmoja Hospital.
So picture this, it was dusk at “Mr Habib’s Place”, an the enormous antique, dust covered, Arabic style building swarming with mosquitoes, inhabited by numerous Muslim teenage boys filtering up and down the stairs yelling Swahili phrases back and forth. Not a woman in sight. We were shown to our rooms that reeked of must and were coated in filth. The mosquito nets were moth-eaten and havens for dust. The facts that the toilet didn’t flush and you got bedbugs and malaria from just looking at the place were deal breakers.
I won’t bore you with the steps in between but Raf and I found a small basic shared room with two single four poster beds that we now call home at The Zanzibar Hotel, The first purpose built hotel in Zanzibar. It is open and light, decorated to colourful eclectic Zanzibari taste. There are three resident orphaned monkeys rescued from abusive homes, and a baby deer that live in the garden.
Our first night sleeping at The Zanzibar Hotel was saturated in relief from images of us dying of malaria, febrile, in the dusty polyester sheets or Mr. Habib’s halfway house. Since then the mystique of our new home has been broken only a little by Harry the water Heater who groans like a dying animal for thirty seconds every minute on the minute through the ceiling of our room. And by Raf’s once lying on his bed only to find the bed collapse in a heap and he end up on the floor, breaking a lamp but no bones in the process.
There is a wooden staircase winding up to our room, with blatantly uneven steps. One in particular we have named “The step of mindfulness” because if you don’t think you will most certainly trip. And worst case scenario end up with a broken leg in Mnazi Mmoja Hospital, not such a great place to be if you need orthopedic surgery.
That leads me to…
The Hospital
Walking through the crowded paths between the buildings of the Mnazi Mmoja Hospital one can see glimpses of the Indian Ocean. First thought: This can’t be so bad. Walking into the Maternity Ward of Mnazi Mmoja hospital one sees the statistics board for the unit. First thought: Heartbreak.
Deliveries: up to 10, 000 per year
Maternal deaths since we arrived: approx 1-3 per week
Fetal deaths since we arrived: approx 1-3 per day
To give you some perspective I remember a lecture in third year medicine where the lecturer described similar statistics in Australia before the advent of modern obstetric medicine. He then went on to compare that with the year 2001 when only 4 woman in NSW had died directly related to childbirth. There were no deaths that year due to the preventable causes we see here in Africa everyday such as eclampsia and post-partum haemorrhage.
On the ward the women lay wrapped in a simple cloth, sometimes two or three to a bed on black or brown plastic sheets that they supply themselves. The women bring a basket to the hospital containing this primitive plastic sheet, 2 packets of sterile gloves, vials of the drug oxytocin, several cloth wraps called “kanga”, a thermos of homemade porridge and other personal items. There is no complaint about the “hospital food”, because there is none. If you leave the Maternity building alive you are lucky, and leaving with a living child is not taken for granted.
The maternity ward is one room lined with rusty bed frames. The sound of women with labour pains punctuates the hum of flies, the soft song of the solitary ceiling fan and the harsh voices of the nurses as they sound as if they are disciplining the patients. The bare concrete floor often has pools of liquor and blood, which are intermittently mopped up by a cleaner. This is the only place in Zanzibar where I have seen women’s bare hair, shoulders, and legs, let alone every other bodily part. It’s quite a shock in such a modest society to see male hospital personnel walking through the ward carrying boxes and mops. It is accepted that women be seen naked by these men, but no husbands allowed in the building, and no visitors. Sometimes women deliver on these beds, if the delivery suite is occupied.
When a woman is fully dilated she is moved to the delivery room. This consists of three concrete cubicles each with a steel table, stirrups, and a plastic bucket to catch the products of delivery. The midwives here, to a Western eye, are fierce, probably out of necessity. If a woman fails to progress in labour she will most likely die, worse for her child who will almost certainly die. It is literally a matter of life and death. It is perfectly acceptable as a midwife to slap the mothers or scream at them, to tell them in Swahili that they are not trying hard enough and they will die if they don’t push harder. All the women involved do such an incredibly difficult job that I really do not judge, I am just describing the scene to you.
There is no pain relief. Not for labour, not for birth, not for an episiotomy (cutting the woman’s external genitalia to avoid tearing), and not for stitching tears. This as a westerner is hard to watch or be involved in, but again, all of these things are a matter of life and death.
The real heartbreak is to be found in the nursery. There are currently 14 babies in a room the size of an Australian disabled toilet cubicle, two to three babies per crib wrapped in kanga. The smallest baby in the nursery has no name. She was born at 30 weeks by an unplanned cesarean section. 10 weeks early. Her mother died because of eclampsia, a condition that affects Australian women but is so vigilantly monitored and treated that it is rarely fatal. The father is unknown and the mother was known to be mentally ill. This baby is an orphan. We have named her “roo” because she is wrapped in a kanga and when I lay her on my chest after I feed her some milk formula she resembles a joey kangaroo.
They do have an operating theatre opposite delivery suite, it is filthy and very basic, comes complete with flies and a resident gecko, windows that open to the outside air, and there are no high-tech monitoring machines for the anaesthetised patient. Despite this there are rules. Even though the equipment is sterilised in the most basic way they do their best to preserve the aseptic technique wearing scrubs, gloves and gowns. Maybe only fellow medics will find this funny but I was shocked to be informed in disgruntled Swahili multiple times that my regular hospital shoes were not suitable for the operating theatre. They were brand new and spotless, cleaner than the walls in the theatre. One of the heavy Zanzibari nurses points to her feet and says in Swahili “next time you must bring like this”, I look down to see regular K-mart style open toe thongs. These are a cheap, washable, form of footwear. Occupational health and safety is not a major concern. You can understand why. So alas, I must bring thongs if I wish to go to theatre.
I really had hoped I could write home a story of Mnazi Mmoja hospital that was very different to this. Everyday I feel helpless, the disorder and filth breaks my heart. The only consolation is knowing that less women die within the walls of the Mnazi Mmoja Hospital maternity block than in their homes doing this on their own.
The language
For the first two weeks I was ignorant as to why the faces of the locals were so puzzled when I introduced myself. Resembling one who has just bitten a sour lemon, most ask for clarification. Usually my last name causes some confusion but my duo-syllabic first-name is so simple that usually toddlers can manage it. It would appear that my name in Kiswahili means “yesterday”. This is a strange concept to the Zanzibari people who find me to be quite physically tangible standing in front of them claiming I am a vision of the past.
This has become less of an issue though as I now have a pseudonym here on the island- “Mzungo.” This along with “asante” is the most important and ubiquitous word we have come across in Kiswahili. Asante means thank you and that is self explanatory. Mzungo however means “not from around here/ foreigner/ white person”. It is apparently a compliment or at least not derogatory, although first thing in the morning hearing “Hey hey Mzungo, morning, have a look my shop, want a taxi, hey hey Mzungo,” it’s hard to feel complemented by the sentiment.
The second Swahili lesson you learn on the street involves the numerous greetings you are required to engage in to begin talking about anything else.
They say “hu Jambo”, you say “si jambo”
anything from here for a few minutes of salutations you just reply “mzuri” or “poa.” Finally, they say “karibu” which means “welcome” and you say “asante,” “Thankyou.”
On the telephone this can become quite expensive and also getting down the street without sounding rude can be quite time consuming. You grow to love it very quickly and no doubt I will accidently “jambo” people on the streets of Bondi when I arrive home.
To give you some idea of the depth of this ceremony a direct translation of these greetings into English would be:
Person A: Any problem?
Person B: No problem
Person A: Stuff
Person B: cool
Person A: How’s your condition?
Person B: good
Person A: How is the kids’ condition?
Person B: Good
Person A: how is your husband’s condition?
Person B: Good
Person A: How is the dog’s condition?
Person B: Good
Person A: How is (insert anything relevant for many more repetitions) condition?
Person B: Good.
Person A: You are welcome
Person B: Thank you
What you should know about Stone Town & greater Zanzibar
The winding cobblestone back streets of Stone Town make finding the same place twice near impossible. If you find a café or shop you like, enjoy it that very moment because it is likely to take you all day to find it again in the absence of street signs. If you talk to the local expats or Zanzibari people nobody is au fait with street names. That’s the exclusive domain of the map-reading tourists (such as Raffi who has also memorised all the local bus routes) who soon realise that it’s less than helpful. Landmarks are key.
Shops line my Shangani and Baghani neighbourhoods. I walk through Hamamni and Mchambawima to the Darajani market most days. These foreign sounding words have become a part of my lexicon. Let me offer you an example of navigating Stonetown. To find the best breakfast food I turn right off the main road into what I call bachelor lane. I am drowned by a sea of “jambo”, “Hey Mzungo, my future wife, I like your hairstyle…ooh nice long hair. I like your style.” “You married?” The answer is always “yes, married and my husband is a big tough man. I’ll bring him to meet you tomorrow.”
I follow this market road down until I pass my favourite humble fruit seller with his cart, peddling mangoes, tomatoes, and ladyfinger bananas in small carefully arranged pyramids which are different prices. A handful of bananas cost 30 cents. I turn right at the shop with the unusual looking pants, left by the church, right at the mosque, left at the Lebanon Brothers poster. And here I am twenty minutes later covered in a film of perspiration. Voila, Zanzibar Coffee House.
Stonetown is practically metropolitan in comparison to the greater, more rural areas of Zanzibar, known as the shambas or “farms”. You quickly see the decrease in average income as you increase your distance from town. But this does not seem to be proportional to average level of happiness. Perhaps even the inverse is true. Those of the Shambas are known for their contentment with less, living by the ethos that one who does not covet another’s happiness will be happy himself.
Shanty-towns are cluttered with a variety of Bess block, thatch, and mud brick huts in the orange dirt. Speckled amongst them are small eateries, shops and rarely some vegetation. I just imagine the women giving birth in these huts and I feel eternally grateful for the luxuries of the first world.
The alternatives to walking in Stonetown or greater Zanzibar are bicycle, scooter, taxi, dalla dalla (local open bus) or car rental. All at your own risk. I have never seen more dangerous roads. The negotiable road rules are:
1. The biggest vehicle has right of way.
2. Every man, child, chicken and cow is responsible for himself.
3. Honk your horn to absolve you of all responsibility for what you’re about to hit.
4. Any vehicle is allowed anywhere
5. One way streets are actually two-way if there are no police nearby
6. Generally drive on the left side of the road (suggestion rather than rule).
7. The person behind you is responsible to notify you with a honk/ no honk system if it is safe to turn onto a busy road at an intersection, you don’t have to look yourself.
On the topic of rules, there are no smoking or alcohol laws whatsoever because common law is based on the Quran. You can drink and drive because apparently there’s nothing in the book against that. You can smoke next to someone who is eating. However most locals cannot afford to smoke. It’s mainly expats who do.
On the topic of rules, there are no smoking or alcohol laws whatsoever because common law is based on the Quran. You can drink and drive because apparently there’s nothing in the book against that. You can smoke next to someone who is eating. However most locals cannot afford to smoke. It’s mainly expats who do.
Women should dress modestly. Absolutely no bare shoulders or knees. If you wear less you get extra “jambo”s from the boys. Women don’t swim here even though it’s stinking hot.
There are no rules against venturing out without deodorant, unfortunately. The local fragrance is what my newest ex-pat friend Sam calls ‘Eau de fundi’. Let me put this in context. Fundis are “Mr. Fix its”. There are electrical fundis, wood fundis, phone fundis etc. These men are the sweatiest of the island. They are often strongly built men with a degree of body odour to match. It is this scent that perfumes the land. It is worst in Taxis and other confined spaces.
There are no rules regarding queuing, good luck lining up for anything.Similarly the hours in which one should be available to be contacted by mobile phone have no restriction. The local phone provider Zantel loves to send Swahili text messages during the hours of sleep, every night, most of them offering deals to win millions of Tanzanian shillings. Just imagine the amount of disgruntled calls to the ombudsman if Telstra decided to do this at home.
The last and most important feature of my guidebook to Zanzibar is a note on the cuisine. It is a mixture of Indian, particularly gujrati food, and local Swahili fare. Spices are abundant, owing to the deep history of Zanzibar in the spice trade. It features chapatti flat bread, fruit, fish, meat, poultry, rice, curry, sodas, tea and coffee. It is for the most part incredible although I have seldom braved the street food outlets and generally stuck to the “mzungu-friendly” places.
The ENT Department & The Zanzibar Outreach Project (ZOP)
The name of the man who may quite possibly save my sanity in Zanzibar is known affectionately as Doctor Naufal, Doctor Naufal Kassim Mohammed in full. He is a charismatic, seemingly duracel charged local hero who is one of the most genuine and selfless people that I have met in my travels, and on top of that he is a great teacher.
It is exhausting here at times being seen as a walking dollar sign. You can’t blame the poor who see you as the means to their next meal. The residents that speak English and haunt the tourist areas are largely immigrants from mainland Tanzania and Kenya who have come specifically for the tourist dollar. Or they are locals who have become involved with the drug-trade, and need the tourist dollar to support their addiction. This means that you rarely actually talk human to human, heart to heart with the local people here unless you walk the back streets and find your way in to the heart of Zanzibar. Mostly it has felt that I am talking as a prospective client to a salesperson. It is therefore infinitely refreshing to come across generosity here. Doctor Naufal is walking generosity of spirit.
The ENT department in Mnazi Mmoja is virtually run by this man and he has been instrumental in attaining funding to develop the facilities. In addition to this he directs a local volunteer-run project, The Zanzibar Outreach Program, which takes medical screening and treatment to the people of the shamba (villages) in Zanzibar. ZOP also donates equipment the ENT department and operating theatres. It is this department that I will work in for the next two weeks. To stay in maternity any longer I fear I would have died of the well-known condition, a broken heart.
Last weekend Raf and I were introduced to a warm and welcoming authentic Zanzibar. We travelled to the village of Uzini to set up a temporary camp of medical stations to service the 14 surrounding villages. Ears, nose and throat (ENT), opthalmology (eyes), diabetes and hypertension (high blood pressure) were the available stations for residents to visit. Local volunteer doctors, nurses other allied health workers and we bushy-tailed Aussies gave up our time to do anything from take blood pressure to perform minor eye surgery on location.
The volunteers that most warmed my heart were 11 year old Ali and 14 year old Mohammed, nephews of doctor Naufal who on their school holidays work on the camps making tea and assisting in the pharmacy or whatever needs doing. In the 40 degree heat these boyswq did not complain once. Not even when we had an hour-long meeting to close the camp and democratically discuss points for improvement of the service and how to use the budget. The service allowed 249 people to access free health care and medicines. It is the most efficient and effective service I have seen in Zanzibar. This is why I have chosen to donate much of the money I have collected from home to this organisation. It is important here where corruption is rife within the government and hospital systems that any aid be distributed directly to the people and not line official’s pockets. This is an earnest and growing organisation that I would like to support on behalf of our community.
In addition to meeting Dr. Naufal we were fortunate enough to meet some other soldiers of justice and generosity. The founders of the German NGO Go For Zanzibar, Mario and Antje, spend their holidays from work in Germany scoping the areas of need on the island and funding projects such as ZOP on the island. They hosted Raf and I for afternoon tea on the roof of their hotel in Stonetown, introduced us to their local friends, eateries and world. The dirty streets of Baghani glow with charm when you know where to walk, are willing to try your best Kiswahili and order the street food. Mario and Antje and the local people have been able to elucidate the depth of the corruption here that makes it very difficult to effectively distribute aid money. It is apparent that many charities that claim to fund improvements in Zanzibar do not actually do so at all, or only a small part of what is promised actually reaches the people. The story is the same throughout Africa so I hear on the street. I am so glad that I have the opportunity to be on the ground here and that I have met people who can guide our donated funds to the people.
Dr. Naufal, Mario and Antje have welcomed me to work with them these coming weeks. I am set to visit some of the local NGOs and see their work, to travel to the small island of Uzi to see the bush clinics there, to visit the local elderly people of Zanzibar and view their apparently squalid living conditions (in an aim to eventually improve them), and generally to be a part of the team in the ENT department when there are clinics and surgeries running in the theatre. Dr. Naufal is also interested in collaborating to improve the medical student doctor program between Australia and Zanzibar so that in future students have a better experience, and the hospital would like a written report and a formal meeting to discuss improvements that can be made within the hospital as I see it. I suddenly have gone from feeling somewhat lost and unable to contribute much, to feeling much more useful. This is a relief. I will let you know how things go.
In an effort to better understand the needs of the Mnazi Mmoja Hospital we requested a tour through many of the departments and a formal meeting with the Nurse in charge. This was so much harder to arrange than it sounds. We looked at the facilities and were able to ask what equipment and medicines were necessary in each department. It was shocking to see the dilapidated paediatric wards, the lack of modern facilities, and the absence of hand hygiene supplies or even running water and soap. This is consistent throughout the hospital but no matter how many times I see it it’s still makes my insides quiver like watching a cat be run over.
To formally donate supplies to the hospital you have to go through a very convoluted process that is apparently punctuated by roadblocks where you must pay officials to allow you past. Everybody wants a piece of the pie. The donations that do get to the hospital can still be embezzled by hospital staff and be sold on the street. An alternate route is to donate to a local NGO, many of which have off-shore Swiss bank accounts and don’t allow photos of their facilities or the results of your donations. There is little transparency.
To work as a volunteer medical student you pay a fee, or rather a “suggested” donation to the hospital. I would have thought the same amount would be “suggested” to all students. When looking through the book of donations that medical students have paid over the past months (don’t ask how I got to see this), it appears that the “suggested” donation to the hospital varies. I wonder if this could depend on whether the in-charge had a fight with his wife last night, or if in deed there is more method to this madness.
For the most part the Nurses in charge were good-humoured, amiable and warm, eager to help us write a list of what is needed. However I must make a mention of one heavily overweight, wide-eyed, slow moving sister who saw this as her chance to get a new computer, some nicer work uniforms and an extension to the ward including a larger tea-room facility. At that very moment, an obtunded 11 year-old boy entered the ward. With blood oozing from a bandage around a severe head injury he was carried supine by six men. There are evidently no stretchers. For boys like this; oxygen therapy, mannitol or dexamethasone (to decrease pressure around the brain), are much more useful than a new computer. I hope this puts the nurse’s request into perspective.
On the whole, the ENT department, including its’ ‘Seaview’ theatre that overlooks the Indian Ocean, is far superior in terms of organisation and resources than any other department of MMH. I have no doubt this is largely due to one man. Despite this, the department is still at the mercy of the hospital’s unreliable water and power supply. Let me paint the picture for you of the theatre this morning.
Five year old Kassima says goodbye “quaheri” to her Mama (no doubt under strict instruction to behave). She lies on the operating table ready for her tonsillectomy, to relieve the pain of recurrent, unresponsive tonsillitis.
I was in the same boat many moons ago, but at Westmead Children’s Hospital, Sydney, Australia. I remember attending the hospital a week before surgery in preparation for the event. I had been read colourful cartoon literature about brave Nancy and the needle that would put her to sleep. I had a friendly anaesthetist who softly put me to slumber. I awoke to adequate pain relief, a colourful hospital with more videogames than I had at home, a dream diet of ice cream and was surrounded by family whom showered me with gifts, among which was a pink pony princess with a secret compartment inside full of treasure. For me a tonsillectomy was a strike of luck, an ingenious means to attain attention, toys and the bonus was an end to tonsillitis.
In contrast, I doubt Kassima has cartoon Nancy as her hero. She lays perfectly still, eyes closed, like a meditating yogi on the table with no baby talk to calm her. She scrunches her face only a little as the cannula is inserted into her delicate arm, but does not move a finger. Can I remind you once again that she is five. Her bravery is the kind you hear about in tribal stories of initiation into woman or manhood. Like the teenage boys of the Massai tribes here who must be circumcised without flinching, to prove their strength of character.
Just before Kassima is put to sleep, the lights go out. No power in the operating theatre. She lies without saying a word or moving an eyelash for half an hour as the theatre staff discuss if we should hang in there or call off the days operating list. Kassima does not ask what is happening. Just as we call it quits, the lights, as if the heavens’ are claiming a sense of humour, switch back on. We precede but the power cuts out again soon after and the whole list must be cancelled. If we had have been further into the operation and Kassima had have been bleeding excessively, without the power to the equipment she could have died- Safer to try again on Monday.
At the same time as ‘Kassima The Brave’ was enduring the power outage, in the adult operating theatre across a few buildings, one surgeon was apparently asking Raffi and the other Aussie students how to treat a particular condition based on what they could ascertain from Wikipedia. The surgeon was probing them for the particular details of which surgical approach Wikipedia, via their iphone, would recommend in this case. Luckily Wikipedia was lacking the particulars because it was as if he would have happily picked up the scalpel if the steps were written there on the world wide web. At home we do entire courses on how to research scientific literature that could basically be summarised as “Don’t use Wikipedia”. So to us the situation was as humorous as it was ludicrous.
During one conversation with Dr. Naufal earlier that morning, surrounded by the busy theatre staff, when everything he said made sense to me, I had a moment of feeling at home. Things in my peripheral vision were seemingly organised, scrubs, gowns, gloves, check. At that moment I had almost forgotten that the previous day our room flooded because of a broken pipe, leaked across the entire third floor and created what could only be described as heavy rainfall in the centre of the hotel at the stairwell. Similarly I had overlooked that the day before that there was no running water in our building, that a week back Raf had fallen through his bed, and that two weeks ago there was no water in maternity to wash our hands or the babies. I had almost forgotten all the way back to Mr. Habib’s place, the organised accommodation where nothing worked at all. But then the power went out in the ENT Theatre this morning and I was reminded of it all.
And as if that isn’t enough evidence that everything breaks in Zanzibar, a monkey just literally broke the glass hookah pipe on the table where I am blogging to you. True story.
This is Zanzibar. You either laugh or you cry.
