God Bless Soccer City

God Bless Soccer City

About 8km from the town of Kisarawe in rural Tanzania is a place called Soccer City. It is a motel with 4 sets of buildings with 4 rooms with ensuite bathrooms in each. It is also a pub with a small television set high above the chairs and tables on the balcony overlooking some lovely trees. There’s a well worn billiard table too. Thatched huts are scattered around where you can sit sipping milky tea at the end of a hard day. The motel is set at the top end of a valley. Above it is the local cement factory owned by the Indians. Apparently Soccer City is also owned by Indians.

The driveway to Soccer City from the dusty main road is steep and very bumpy. I imagine it’s tricky to traverse in the wet season. It is now the dry season and so there are no problems except for dealing with puffs of powdery dust.

I’d been intrigued by Soccer City ever since I’d been told by GHAWA that we’d be staying there while located on our rural placement. I can’t quite pinpoint the image I had in my head but it certainly did not match the reality! A silver building, multi-story perhaps, glistening high above the local homes and buildings? Not so…

Last week when we were here, so was the World Cup. The whole of Kisarawe I imagine, came to drink and enjoy the soccer. Each night we’d be woken by screams of delight. Drunken shouts echoed down the valley. Our rooms were close to the pub. The first time I heard it I was startled because I thought perhaps there was a riot! It took a few minutes as I woke properly to work out what was happening. This happened every night.

This week we were hoping that because the soccer was finished it would be quieter. Wishful thinking… Again each night the party cranks up. We have chosen rooms furthest from the pub this time and that has made a difference.

The other day I noticed that there was a lot more white paint than I remembered last week. Concrete walls now a crisp white colour. Then I saw the World Cup soccer fountain also painted white. I felt a little sad because it was a tarnished golden colour before. When I saw the fountain for the first time, the penny dropped. I now knew why it was called Soccer City! Anyway, yesterday we suddenly noticed two men spray painting the precious fountain – golden!! I have a photo but unfortunately there is not enough internet to load the picture but I promise I will when I get back to Perth. It’s worth a picture.

This morning when we arrived for breakfast (every morning we are served a boiled egg, 2 slices bread with butter and a cup of milky tea) nothing was ready on the tables. The place was a mess with dishes piled high. We’d heard quite a shindig last night including dogs fighting. All the pub staff looked a little worse for wear! Eventually at 7.45 we got some hot water to make a cup of tea (something we hang out for each morning). As the waitress returned to the kitchen she switched the thumping music on again. All three of us just about leapt out of our chairs shouting “no!!” And making the no signal with our hands. She quickly got the message and the thumping stopped. The birds began to sing again and it was music to our ears.

My room is quite spacious and I have a little routine now. Leave shoes at door so as not to bring dust and mud in. Spray with insect repellent before heading up for dinner. Have fan running until just before bed then switch off – there is only one speed although the dial says otherwise. Shower before bed. Don’t stand over the squat toilet because you’ll lose your soap (been there, done that!). Remember the shower is cold so ease in slowly.

Last week we ate dinner every night at the pub. It really was quite awful. Sadly the chicken was as tough as nails and a few times we just about broke teeth on grit in the greens. This week we are feeling rather smug because we have brought some supplements. Our routine is to order rice from the pub. Then we add a precooked/prepared meal. Monday was leftover Thai chicken curry and rice, last night was Alloo paneer from a packet and rice and tonight we had, you guessed it, rice with tinned tuna. It was delicious. The staff are intrigued by these three mzungu who are eating strange things. The kitchen staff have been very helpful in boiling water for us and heating up the meals.

When it’s time for sleep, I set out my mosquito net and snuggle down to sleep. The foam mattress sinks in after a while and so I find I have to dig myself out of the trench to get comfy again. Each morning I wake to the sounds of the many birds and sweeping. The sweeping starts at about 6am and hasn’t stopped by the time we leave which is about 8.15am. It reminds me of staying at my grandparents house in Scottburgh, South Africa…the sounds of sweeping the leaves every morning. p>

Despite all the noise and other discomforts, I’ll be sad to say goodbye to Soccer City. It has been a safe place to retreat to and we have felt well looked after. Every day we have gone for a brisk walk along the main road. It is busy at times and so we have to step off the side to let a heavy laden truck or bus pass. Of course we are intriguing to the locals. 3 white women walking along the road so we get lots of hoots and waves. We’ve got to know some of the women who sell oranges, coal, passion fruit on the side of the road. Today a couple of them greeted Mary and Beth by name! We’re feeling rather like locals here now!

We’ve seen some vervet monkeys, a bright green snake today, some interesting birds and of course some gorgeous children. It has been good to go for a walk and breathe in the fresh air (choose the timing carefully so as not to inhale a lungful of dust).

Soccer city , you have been good to us. Thank you God for a clean safe place to stay.

A Little Bit of Western

I’ve hooked my iPad mini to the speakers and am listening to Boy and Bear. It makes me feel a little less homesick for my family. I remember the journey from Perth to Albany that we took as a family to wish my Dad a Happy 70th birthday in April. The whole family humming along. That was a long trip but it was such fun being in the car together and chatting, singing and playing ‘I spy’. Funny how at the time I found ‘I spy’ so boring (again??!!) and yet they form fond memories for me now. I’ve coped well the first 2 weeks away, but this last week has been so hard. Most days I’ve shed a tear. The boys have written to me on Skype which has been great (me thinking, “that will help their writing skills”). Forever a mother!! Lovely to read their thoughts and feelings. I look forward to seeing them again.

It’s such a tightrope to walk. Being a mother, working. And not just down the road but in another country. I’ve had the conversation with my husband and children that they must tell me if I’m so busy helping mothers in developing nations, but I’m forgetting about their needs. They will always be my priority and I’m so thankful that I have a family that these open conversations can occur. I never want my boys to say to me that their mother was so busy helping others that their needs for love and time were not met. I think I’m reaching the limit of their tolerance. They’re having a wonderful time in South Africa: hiking in the drakensburg mountains, mountain biking, tree rope swinging, visiting places of cultural significance in Pretoria. Richard says they have been very good and all of them have had a wonderful time although missed me. It’s good to be missed.

Today I have focused on complete relaxation. I read in bed for a long while, then we went to the Hilton Hotel down the road for a leisurely breakfast. Funny how we always retreat to something Western to be comforted. Last night we treated ourselves to The Cape Town Fish Market for an absolutely delicious dinner. We caught a Bajaja for the short trip to the iconic expat (and anyone who wants to be seen) hang out. Beautiful view across the Oyster Bay, funky music playing in the background and a choice of mouthwatering dishes. I chose the surf and turf which was a melt in your mouth steak cooked to perfection and silky calamari that dissolved in my mouth. I will admit though, my tummy was a bit overwhelmed with so many flavours and richness of the food!

It’s Good to have a Laugh

Thank goodness it’s Friday!

I think we’ve all had enough of Soccer City. No water this morning. Mary didn’t get any sleep because the girls working at the place were fighting and shouting until 1am. She eventually played grumpy Mum and told them to go to bed. And bread with a touch of butter and a hard boiled egg for breakfast again is just not doing it for me anymore.

Last night we ended up in hysterical laughter – a sign that we’re slowly going mad perhaps? It all started when Mary took a mouthful of rice with green veggies and found it full of grit and sand. This had happened to us before, and we had continued eating, but this time Mary crossed her cutlery on her plate and pushed it away from her. She didn’t have to say anything, we just knew and so began to giggle. Next thing I heard a heavy thump behind me. I turned a round and there was a very drunk man staggering on the ground trying to get up. He was absolutely inebriated. No one was helping and we were stuck to our chairs. He crawled past our table and then a young man helped him up and he staggered to the side of the pub near the kitchen. Then he leant against a pole and had a pee. Next to the coal stove where our dinner was cooked. We lost it!! We laughed and laughed and laughed (we were mindful to be discreet and not cause disrespect). It was all too much for our senses. The pee seemed to go on for ever.

We finished our dinner and then departed to the safe sanctity of our rooms. It felt good to have had a good laugh! Some much needed endorphins had been released! As I had a shower, squatting over the toilet because that’s how the set up is, I dropped the soap down the drain. I laughed out loud because it was another thing to happen in a day full of a series of comedic errors.

Sewing Seeds

As the GHAWA car pulled up near the teaching class at Kisarawe, the two traditional birth attendants (TBAs) who have joined the class, came running out to warmly greet us. They smiled widely and grasped our hands to welcome us. It was very special and a lovely start to the day.

We had finally worked out why the data projector was not working, so with e few adjustments to the setting on the laptop we were able to set up the PowerPoint, using butchers paper as the backdrop. This was important for today because we had two short videos to show about quality care to women in labour and then how to check the placenta. It worked really well and obviously had a big impact because there was plenty of chatter and discussion about what they saw. A couple of times the power went out, but not for long.

This time Beth and Mary had everyone up and moving to show how important it is for women to be active and remain upright to assist with the progress of labour. Again, lots of laughter as hips were swinging.

Yesterday during a discussion about problems in pregnancy, a nurse had mentioned they do fundal pressure (apply pressure to the top of the uterus during labour) to assist the delivery of the baby ie. make it happen quicker. Today I spent time educating the class about the anatomy and physiology of the uterus and why it is so important not to apply pressure to the fundus during labour. I think we managed to get the message across and they understood the significance of the uterus and the danger of that action (over stimulation of the uterus can cause uterine rupture and fetal distress).

By lunchtime we were all three feeling rather tired. Last night we were kept awake by a very rowdy group of World Cup soccer spectators. At 1.30 am I was woken suddenly by loud shouting, whistling and the sound of the plastic chairs being thrown around the pub area. I felt a bit fearful at first but then remembered that the soccer was on so it was probably related to that. I tried to doze off again, but the revellers got louder. At about 2.30 I noticed that they were finally moving on, but I was so awake that it was difficult to fall asleep again. Then I noticed a buzzing mosquito and desperately tried to make sure it was outside my bed net! I think I finally managed to fall asleep after 3.

At the end of today we went for a short walk around the maternity unit. Currently there is a new labour room being built, so all the mothers are kept together , antenatal, labouring and postnatal all together in one ward. I think the saddest thing for all of us to see is a woman labouring on her own: no support, no encouragement, no touch or massage. Just lying on the bed, often on her side with a Kanga covering her. There is no sound, but you know she is in labour because her feet and toes are tense and move in circles as she deals with the pain of another contraction.

One of the things we’ve been teaching the nurses and midwives is the importance of quality care in labour and what that looks like: kindness, touch, water, regular toileting to empty the bladder, regular vital sins and observing the labour: strength of contractions and how often they are coming, descent of the baby’s head into the pelvis, cervical dilation, monitoring progress of labour and intervening if it is not progressing as expected. Although we know many times this does not happen in reality in the hospitals I do believe strongly that it is necessary to teach. If we sow seeds of kind quality care, eventually someone will act and influence the others. That reminds me, during one of the ice breaker moments today, a nurse midwife got everyone to sing a song which they later interpreted as, “we like our teachers and we want to be like them”. I found that quite significant. It is important to stick to the right path, teach the right way to do things, over and over again because eventually the seed will take root in fertile soil and grow into a plant that will produce good fruit, again and again. That’s how change for the better occurs. Through perseverance and sticking to the right way even when the right way is not always followed.

There is always good fruit from a plant which has been sewn in good fertile soil.

Perseverence

I’m sitting in a dusty classroom in the rural town of Kisarawe. Wasps fly in and out through the open slat windows. They need to be open to allow some breeze through otherwise the room becomes stifling. Beth is leading the next session of training which is a relief for me. It’s good to sit and listen rather than feel responsible for contributing. The class for the next fortnight consists of registered nurses, nurse midwives and traditional birth attendants from 3 clinical settings: Masanganya and Masaaki which are first aid posts, and Kisarawe District Hospital which is their referral centre.

There is a wide range of knowledge and abilities in the room which makes the training challenging. We don’t want the more experienced and knowledgeable health professionals to become bored and we also don’t want to lose the ones who need more knowledge. Another challenge has been that they are not used to speaking much English so a lot of time is spent having our questions or directions interpreted.

I’m starting to see that our experience with Kairuki and Amana nurse midwives was very special and a real blessing in terms of seeing the course put into practise for the first time. They understood us quite well and so the classes went smoothly. They were also a group of women only. This time we have 3 men who are very interested and active participants but they do tend to dominate (or rather the women are quiet with them around!).

Yesterday was a tough day. It’s always difficult to break into a new group especially after you’ve already done it once, achieved a level of comfort, trust and relationship. I miss the women in the previous group! At the end of yesterday I went home with a thumping headache and felt exhausted. I fell onto my bed and drifted off to sleep very quickly. I was woken by the music getting louder for the start of the evening pub and ‘watching soccer’ session. I forced myself up and went and got Beth and Mary. I told them we all needed a walk even though we didn’t feel like it. It was a good thing to do because we came across a group of very cute children who provided some funny entertainment. Breathing in the fresh air at sunset and looking across the hills was soothing for my soul.

Just before dinner I managed to connect with Richard via Skype. We haven’t been able to talk to one another because the Skype connection has not been good for over a week. This has been frustrating but at least we’ve been able to message one another. We had a great conversation for about 20 minutes. It was so good to hear his voice and have some encouragement.

After the call I had an unpalatable dinner which included a very tough chicken ( we saw the chicken delivered in the morning!), some green vegetables with grit in them and more rice. We were all feeling a little tired and deflated. I went to bed wishing the week away!

In the morning my mood was still low. I spent some time reading my bible and praying, trying to find some comfort. I told God how I was feeling and that I was finding it hard to be positive today. I also acknowledged that I knew He goes before me and that I must trust and obey His leading. I prayed for the group of participants and for Beth, Mary and I, that we’d find inspiration to engage the group and deepen our connection with them. I felt I just needed to persevere, push through this tough time.

We arrived at the hospital and most of the participants were already there. It was great to see them again and as I moved from one to the other greeting them and remembering their names, I could feel a new connection with them. They smiled warmly and laughed at my quirky Swahili accent. I even managed to get the men to laugh as I mentioned the soccer! I had been woken in the night by the roars of cheering when Germany scored their goals. I had a sense it was going to be a good day and it was.

We had some beautiful singing and dancing led by an elderly traditional birth attendant. Her voice was strong and very musical. She made up some songs for us all to join in with words related to what we’d been learning. She was very clever! One tune had the words to warn against birthing at home in the village with the TBA, rather go to the hospital to give birth. Beth then taught them a song which had some actions and echo singing. It was great fun and they really loved it.

We learned about the importance of antenatal care, the role of the midwife in providing care to women and preventing deaths of mothers and babies, problems in pregnancy and education about danger signs and birth planning. Lots to learn. I’m looking forward to tomorrow.

Part Two

I am now in a bed and breakfast called Soccer City on the outskirts of a small rural town called Kisarawe. It is about an hours drive from the Dar international airport. It is lovely to be in the rural area. Rolling hills, traditional houses made of mud and sticks, vegetable gardens, trees. No high rise buildings. It’s good.

I’ve had some dinner: a rather tough but tasty crispy kuku (chicken) with rice, greens and a lovely tomato relish. Satisfied. I’ve had an interesting shower balancing over the toilet and am now snug on my bed under the mozzie net.

I can hear sounds of a motorbike passing, crickets and men talking across at the Kibo Pub. The World Cup soccer is playing in the background too. The whir of my overhead fan is lulling me to sleep.

The second course begins tomorrow. There will be 12 participants from 3 different health facilities: one district hospital and two rural health centres. Apparently there will be 2 traditional birth attendants as well. I’m really excited about this mix of trainees. It will be interesting to compare their knowledge and skills with those of the city nurse-midwives. And it will be great to share the load with our third team member Beth who has joined us from Perth.

Today was a nice quiet day. We were expecting to travel to Kisarawe early this morning, but it is a public holiday and so late yesterday we were advised that our departure time will be 2pm. I was so relieved. After our relaxing time in Zanzibar we still had a lot of repacking and preparation to do before leaving. Knowing that we had the whole morning to pack was music to my ears.

After a leisurely sleep in and breakfast overlooking Oyster Bay we walked down to the Slipway, a shopping and food area catering for expats. We discovered a bakery and bought some rather delicious bread to make lunch with. It was yummy, so fresh and tasty. It was quite hot today and so I was tempted to have a swim in the pool at our apartment. Bliss.

The new GHAWA apartment is absolutely fantastic. It is on the ground floor of a high rise building, right next to the pool and borders the ocean. Our view is uninterrupted of the sea, yachts moored nearby. It is literally stunning. A welcome sight after a busy day at the hospital.

Last evening we met some of our neighbours as they rushed down to see that we were ok. You see, a new alarm system has been installed in the apartment. When we returned from Zanzibar we had to disarm it for the first time and literally within 3 seconds , before I’d finished typing in the code, the alarm was screaming. It shut down quite quickly and so we thought all was ok. Lo and behold, after about 15 minutes we discovered a man with an AK 47 standing at our door. He was from the armed response! We had to prove who we were and why the alarm had gone off.

Later we walked down to the waterfront for a nice meal at the restaurant. On our return we had to disarm the apartment again. The same thing happened. This time we rang the company to tell them it must be a wiring problem because the alarm is going off within 3 sec of opening the door and the guards are telling us it’s the panic button going off. Anyway, this time two armed guards arrived within 5 minutes of the alarm going off and 2 lots of neighbours as well.

So we’ve met the neighbours and they’re all very friendly, most are expats. Needless to say we’re not setting the alarm until it’s been checked by the technician!

It’s been difficult resetting my mind for the upcoming course. I’ve never been away from my children for more than 2 weeks. I knew I’d find this stage difficult and so have given myself permission to cry and feel a little sad before embracing the challenges ahead. I’ve had Skype contact with Richard and he and the boys are having a wonderful time in South Africa with his Dad. It’s comforting to know they are happy and occupied. So much to do over the next 2 weeks. Before I know it I’ll be on the plane back to Perth!

Small Steps, Giant Leaps

Small Steps

I’m lounging on a comfortable beach chair with the sounds of the gentle waves rolling up the beach, only metres away. Every now and again a dhow sails past with the brilliant white sail spread across the bow of the boat making a stunning picture against the backdrop of a blue blue ocean. Men paddle past in dugout canoes. Coconuts crash to the ground nearby as the hotel curators clear the palms of the dangerous missiles. Muffled Swahili voices are carried away by the gentle winds. Heaven. Bliss. I’m glued to my lounger, unable to move. Unable to think beyond the moment. My brain is tired, my head sore, my senses have been overloaded the last 2 weeks. It feels good to breathe in some fresh sea air and do nothing.

We are in Zanzibar. Beth, a midwife from Perth, has joined Mary and I. It is lovely to have her with us. We picked her up from the airport and have whisked her away to Zanzibar with us. We arrived after 7pm last night with fingers crossed that the hotel matches he pictures on the website. After our experience last weekend we were hesitant to expect anything. As soon as we came to the front entrance, my heart started to sing. All the lights of the front gate were working and the flags announcing the name of the hotel looked new. It looked clean and freshly painted. The hotel lobby was beautifully decorated and welcoming. I was starting to relax. Our family suite is a little small, but it overlooks the beach and stunning tropical gardens. Mary and I kept looking at each other with grins from ear to ear. We knew that after the week we’d had we needed a retreat like this to recharge, ready to face the next fortnight.

So why do I feel so tired? In need of some rest and quiet?

My senses have been assaulted. Dust, noise, blood, meconium, crowds, traffic, faeces, licquor, screaming, sobbing, wailing, mosquitoes, sickness, death, sorrow, joy, fear, laughter, smiles, gridlock, jammed, relief, delight…

So many feelings and emotions.

Yesterday was our last day with the group of 11 midwives that we have been teaching. I felt quite emotional. They were the first group to receive the course I had spent months writing. It was a joy to read through their completed journals and case studies. I had seen them all grow and develop as midwives. When A representative from the Tanzanian Ministry of Health asked them what they thought of the content of the course there was a resounding chorus of affirmation. It stirred me to the core. They said they felt inspired and more confident with their clinical skills and Mary and I have certainly seen that happen over the duration of the course.

From their feedback they seemed to feel empowered as midwives. I think we were able to encourage, support and assist them along a journey of quality midwifery care and continuing professional development. I feel excited because that was exactly what I’d put in the curriculum framework as objectives for this course.

One of the participating midwives, a very experienced clinical instructor, gave a speech of thanks at the end of the proceedings. She said she felt like a new excited midwife again, inspired to do simple things to prevent the deaths of mothers and babies. She shared her experience of a birth that I supervised her in. The woman was having her second baby but it had been a long difficult labour. She was now ready to push but it was taking a long time. She was flat on her back, exhausted and trying to push as best she could. There was little progress, the head kept rocking back inside again. I suggested to the midwife that we change the mothers position to be more upright and help the head move down with the assistance of gravity (I said this at the time when a few other local midwives were yelling at the woman to push harder). She was exhausted. So after another ineffective push, we managed to get the mother to move from her back onto her hands and knees. Her head dropped down onto the bed so she was head down, bottom up. She pushed again and this time the head progressed and next push it was out. The midwives were all amazed at how quickly the change of position had managed to assist the descent and birth of the head.

The midwife said that this experience had really inspired her that changes in position can make a big difference to outcomes for mothers and babies. I felt so pleased to hear this. In fact, understanding more about the mechanics of the pelvis and position changes had a huge impact – they all mentioned it as something new they had learned. Both Mary and I witnessed our midwives at different times getting all the labouring women up off the beds and benches and getting them to rock their pelvises during a contraction, shimmying and shaking their hips to help with the descent of the head and getting it into a good position for birth.

Another part of the course the midwives said had made a big difference to their practise was essential newborn care and resuscitation. And I could see there were major improvements over the 2 week period. From being a little slow to respond and unsure of what to do next, I was now seeing the midwives respond quicker, getting resuscitation equipment (what was available anyway!) ready prior to birth and not waiting too long before commencing ventilation of the newborn who was not breathing. There was plenty of practise on real life babies unfortunately. At one stage Mary did 3 full resuscitations on newborns with thick meconium, within 40 minutes! That includes cardiac compressions. I have never seen so many floppy, pale or blue babies covered in green meconium before.

We used the Mama Natalie simulator to reinforce the emergency responses we taught. It worked really well and the midwives commented that being able to practise the steps with the doll helped them retain the information.

Small steps…