690 Grams of Love

Are many children born in Tanzania?

Only in “our” hospital in Nyangao we have over 2.5 thousand births per year. On average, seven to ten children are born here a day. A lot, because practically every woman in Africa wants to have five children. This is the model of a traditional family. Just like our “two plus two”. I have discussed this with African women many times. Even those who are very poor dream of large families. And most of them are poor here because it is a very indigent region. This is the tradition and it is practical because it can be assumed that children will support you in old age. In Poland, if someone has a large family, it is very likely that all children will survive. In Africa, statistically, one of these five children will not live to adulthood, because ordinary diseases and minor infections can be fatal. There is no easy access to medicines and doctors. Therefore, mortality among children up to five years of age is very high.

Could you please tell me about your hospital?

Nyangao is a tiny village located near the border with Mozambique, far from the capital and the coast. The local Saint Walburg’s Hospital was built by German Catholics in the 1960s. They did a good job. It’s a 220-bed hospital with gynaecology and obstetrics, internal medicine, surgery and intensive care units, and an outpatient clinic for patients who need consultations. Now the buildings require renovation, the furniture needs replacement, but the medical equipment is the most obsolete. The truth is that hospitals in Tanzania lack medical specialists, modern equipment, and even gauze pads and gloves. The Polish Medical Mission has been in Nyangao since 2018. We took part in competitions of the Ministry of Foreign Affairs and received large grants to improve the infrastructure and buy equipment of the surgery and maternity wards. As a result, a completely new building was reared up within a year, with offices for surgical consultations and minor procedures. We also renovated the existing surgery ward and provided three operating rooms with professional equipment. Another important activity is the training of medical personnel. Every year, Polish specialists come here at the hospital’s request to train the local staff.

What is all this training for?

Because there is a drastic lack of medical specialists in Tanzania. For years, this country, inhabited by more than 50 million people, had only one medical university in Dar es Salaam, the largest city, which trained mainly primary care physicians. In 2003, three ENT specialists and three surgeons graduated from the medical school! The situation is improving, but slowly. Another medical university has recently opened in Dodoma, the capital of the country. Recent calculations show that every year, there are 30 more specialists in Tanzania. It’s nothing, taking into account the size of the country and the extent of neglect!

So where do specialists in hospitals come from?

Foreign medics who train the local staff play a very important role. And this makes it possible to save people who first seek help from local healers, and from a doctor only as a last resort. In August, I witnessed a family bring a man with gangrene above the knee. The man was in agonal coma. But intravenous antibiotics worked, and after two days the man woke up, regained consciousness, and soon his relatives could take him home. Without a leg, but alive. Miracles happen.

But you have to work a lot for them to happen.

In 2019, we finished renovation and equipping of the surgical rooms, and at the same time we started the reconstruction and renovation of the delivery suite and the maternity ward, we also started planning the construction of the neonatal intensive care unit. The Hospital in Nyangao is the only one within 200-300 km. Even patients from Mozambique come here for rescue, often after traffic accidents, because the local surgeons are widely known. As for sub-Saharan Africa conditions, this is a really decent hospital. But when I saw the conditions in which women give birth, I knew we would have a lot of work.

But there was a delivery suite in Nyangao.

Unfortunately, the hospital management have never considered women’s problems as key, and over the years, they have developed surgery and orthopaedics, which are of course much needed units too. The neonatal unit for sick children and those with congenital defects consisted of three beds in a dark corner, without diagnostic care. Women with newborns born prematurely or with developmental defects would be lying in primitive sacks, in very difficult hygienic conditions. And there are many births in Nyangao. There were days when there were 12-14 of them. Women would give birth on beds, and when all were occupied, also on the floor.

Neglect concerning “maternal health” is more and more often considered a form of discrimination against women and violation of human rights. And Tanzania ranks 27th in the world in terms of maternal perinatal mortality. The perinatal mortality of infants is 36 per one thousand. Why is it so high?

Because of lack of education and poverty. Births are free and so is hospital care. However, you have to take into account that if it is necessary to administer certain medications, e.g. antibiotics, the patient pays for them. You have to get to the hospital – usually on a motorbike on poor roads. Transport costs money. For the poor, it is no thin dime. There is no laundry or kitchen in the hospital in Nyangao. Women are naked during childbirth and only after do they wrap themselves in garments. Someone has to wash these clothes, and a woman also needs food. That’s why another woman goes to the hospital with her – it might be her mother, sister or daughter. And she is the one who does the washing and cooks food for her. Imagine how burdensome it is for the family. During this time, this woman could look after the house and the children instead of going to help her relative. Sending a woman to hospital requires a tremendous effort of the whole family in terms of energy and money. This is why the vast majority give birth at home – as much as 80 percent. Sometimes, if a woman is lucky, she will be assisted by trained midwives from rural health centres. But 60 percent are home births, in solitude, with no help. Women go to hospital for childbirth at the last moment. Only when they have to. The greatest risk is haemorrhage, which is the main cause of death among women in the perinatal period.

And what about newborns?

Newborns most often die when they are born prematurely, with very low birth weight, breathing problems and no sucking reflex. When such a child is born at home, there is no chance for rescue. Women in Tanzania are malnourished – they eat mainly cornmeal pulp and beans. Children of such mothers are born underweight – a full-term newborn often weighs about 2 kg. If they weigh 2.5 kg, by the local standards they are quite heavy. Often babies are very weak at birth.

Family help for hospital patients is fascinating. Where do relatives, these assistants, stay during this time?

There are concrete buildings with places to sleep built near the hospital for this purpose. A kind of a hospital hostel, but – like most things in Tanzania – these places are very modest. They have shared toilets and two showers for several dozen women. There is a laundry room and huge fireplaces where women cook food for their relatives. The hospital belfry bell rings three times a day. This is a sign that you can take your meal to the hospital – breakfast at 8 a.m., lunch at 1 p.m. and dinner at 6 p.m.

Can relatives help take care of the sick? Or a newborn baby?

No, they only come in to bring food and clean clothes and to pick up dishes and dirty clothes. Therefore, women try to leave hospital as quickly as possible. After a happy childbirth, they stay for two days at most and as soon as possible return to their homes, or rather huts, where their older children and work are waiting for them. When you have to walk for half an hour to get water from the well, maintaining hygiene is a huge challenge. This is one of the reasons why there are so few Caesarean sections in Tanzania, after which the wound has to be carefully looked after. They are performed only when the life of the child or mother is at risk.

And do patients in Nyangao complain about the difficult conditions in the hospital – lack of space in delivery rooms or a shortage of doctors?

No, they don’t. They don’t complain about anything. Africa is very calm, gentle, reconciled with fate. I have never heard any complaints or raised voices in the delivery room. Women patiently await childbirth. If it doesn’t go as it should, they agree to treatments and procedures. If a child dies, they also accept the death.

Has much changed in the neonatal unit since the representatives of the Polish Medical Mission came there?

We have built a neonatal intensive care unit from scratch. Instead of a dark corner, there is a separate building with all the medical equipment that is used to save the lives of children. This is not the European standard of single rooms with adjoining bathrooms. However, it is a huge change in the care provided to at-risk newborn babies. One room has four beds, the other has seven beds. Women have the beautiful habit of kangarooing premature and sick newborns. They take the babies to bed, warm them with their bodies and lie down with them, cuddled up, wrapped in shawls. Children are monitored, they are also placed in incubators, there is all the equipment to keep them alive. We are proud because the mortality of newborns decreased by 30% within a year. There are also very dedicated female and male nurses.

Male nurses?

The hospital has its own nursing school, educating several dozen people a year, including boys. Believe me, they make great nurses and midwives. I have two favourites. They are exceptionally talented and they treat patients with great tenderness and mindfulness, which is rare. This school is a hope not only for the hospital, where the best students stay, but also for the rest of the country. The remaining graduates go to rural health facilities.

Do you remember those who were saved thanks to your support?

In September, a boy was born prematurely, in 26-27th week of pregnancy. He weighed 690 grams. He was fed with a tube and given oxygen to keep him alive because the prognosis was bad. I remember how we were all scared when he did not gain weight, because the sucking itself consumed more energy than the food provided. He was in hospital for two months. He weighed over a kilogram when he was discharged, and it was still unclear if he would survive. I visited him in December. It was an extremely poor house with a torn roof. Inside, I found a kicking baby weighing more than three kilograms and his mother, laughing and happy as if she had won a lottery ticket. This is her only child. She lost her previous pregnancies. Without the hospital, the boy wouldn’t stand a chance.

What about Mwana, a 16-year-old girl for whom you collected money?

When I met her, my attention was drawn to her huge belly, as if she were in advanced pregnancy. In our hospital she was diagnosed with severely enlarged spleen and liver, which required expensive treatment. We raised the funds needed for diagnosis and a stay at the university hospital in Dar es Salaam. Unfortunately, there is an outbreak of COVID there and we have to wait. Mwana’s story shows how dramatically difficult life in Tanzania is. Her mother admitted that she had three dollars a week to support five children. She realised that something was wrong with her daughter’s health when Mwana was less than three years old. And in the next 13 years, the mother did not manage to raise enough money to transport the child to hospital for diagnosis. It is shocking.

It looks like you still have a lot to do in Nyangao.

And we’re not going to stop. Since January, we have been running a project financed by the Kulczyk Foundation to support pregnant women. We continue equipping the neonatal intensive care unit and the renovation of the outpatient clinic for pregnant women and children. A very important employee of the project is a lawyer who specialises in combating domestic violence against women. She rides in an ambulance with the hospital’s medical team and visits villages within several dozen kilometres from Nyangao. She teaches women how to oppose domestic violence and fight for their rights. The ambulance crew examines and vaccinates children and consults pregnant women. And the lawyer talks about violence. There are always several dozen women waiting for our ambulance under the mango tree, which gives the greatest shade.

And men?

There are usually several men. They also get help from a doctor. And they do not protest when we teach women how to take care of their health and how to fight violence.

Is violence a serious problem in Tanzania?

Violence against women and children in Africa is widespread. I studied this phenomenon in Tanzania and South Sudan – this is how people react to poverty, abandonment, displacement, conflicts and joblessness. They even sell whipping sticks on the market in South Sudan. And violence breeds violence. Beaten women beat their children with cords and ropes. Our Nyangao statistics show that in each village there are a dozen or so women who are raped, beaten, and kicked out of their homes. This is why we are taking the project a step further: a lawyer will train 45 female leaders who will travel to various parts of the region with an anti-violence message. They will teach women where to seek help.

The project also aims to combat period poverty. Is that a problem in Tanzania?

Menstruation is a huge taboo. It is not discussed at home. Sanitary pads, even when available, are too expensive for women. So they use coloured cotton cloths. They rarely wear pants, they gird themselves with a string with a strip of fabric on it. They wash it later and hide it in planks under the ceiling. Because menstruation is a shame. The fight against period poverty is also an important element of the project that is implemented together with the Kulczyk Foundation. Girls often miss school and do not take part in social life during their period. We want to reach out to women and make the subject of menstruation more friendly to them, which requires long-term activities. We are also pursuing the idea of emergency aid. We will invite local tailors and sew 2.5 thousand reusable, washable sanitary pads which we will give out – in packets of two – to young mothers leaving our hospital. Thanks to this, they will have comfort in the difficult postpartum period.

 

Agnieszka Urazińska interviews Małgorzata Olasińska-Chart, director of the humanitarian aid programme of the Polish Medical Mission

Photo: Tatiana Jachyra

The text was published in „Wysokie Obcasy" on 20 March 2021 

 

 

 

The Kulczyk Foundation supports the activities of the Polish Medical Mission in Nyangao, Tanzania. As part of the project, the hospital camp for women along with the clinic for pregnant women and children were renovated, and the neonatal intensive care unit was equipped. Additionally, every woman who gives birth to a child in the hospital in Nyangao receives two reusable sanitary pads that can be used for several years. Dominika Kulczyk’s foundation also financed training for local female leaders and women and girls in villages on the protection of pregnant women, counteracting domestic violence and supporting women’s social rights, as well as menstrual hygiene and family planning.

More about these projects on 21 March on TVN and on Player.pl as part of the eighth season of “The Domino Effect”.