#16 Pursuing God's Standard

Being married to a doctor serving a small rural African hospital affords me the questionable privilege of hearing first-hand accounts of stories which too often have sad endings. Yesterday’s was only the latest of many. Juma, a six-year old boy, was brought in sent from a small village clinic staffed by clinical officers (health workers with a 3 year diploma). He had dangerously low blood sugar levels and was vomiting blood. He had been on quinine treatment for suspected malaria at the village clinic, but the treatment had had no effect and the child’s condition had instead deteriorated rapidly. It seemed that the clinical officer in the village had not had access to any malaria testing kits and so had treated the patient with quinine anyway. In this distressing case, as in so many, perhaps the majority of such cases, the poverty we are witnessing is a poverty of education as well as resources. Juma’s inability to access an adequate level of healthcare was not due to a shortage of money to pay for treatment but a lack of access to a health centre with testing facilities and adequately trained staff. Parents often don't know what signs of serious illness to look out for and this results in them coming to seek help with it is too late. Juma was given a drug he did not need, and no provision was made to deal -effect of low blood sugar. 

On the same day that Juma was brought into Ifisi hospital, I had been sweating over a series of knotty problems relating to the publication of the Nyakyusa Bible – how to format footnotes correctly, how to arrange book introductions, how to capitalise names consistently…. not to mention a hundred other imponderables which, when I arrived home to hear Juma’s story, faded considerably in the importance that seemed to attach to them earlier in the day. This is the privilege I mentioned earlier of living with a doctor – that I am ever having my own day’s work put into perspective!

But there is a reason why we worry about every detail of publishing a Bible in one of the local languages (which will usually be the only book ever written in that language). It’s not my pedantry nor just the Western luxury of having time and space to worry about footnote formatting rather my children’s daily survival – though perhaps there’s a bit of that. The reason is that we do not believe that Africans deserve only second best. If we would sweat over footnote formatting when publishing books at home (and believe me – UK publishers can get more pedantic than you can ever imagine!), then why do Tanzanians not deserve the same level of consideration? When we say that our clothes are no longer good enough for our own bodies, do we send them off to the clothes bank because they are good enough for poverty-stricken Africans? When we translate and publish a Bible in the developing world, is it ok to make do with lower standards than we would use at home? Should a Tanzanian community be happy with whatever crumbs fall from the rich man’s table…if the dogs don’t get there first? And should Juma’s parents be satisfied that there was at least some sort of clinic in their village, while Britons continue to issue furious letters daily to the authorities over every blip in the NHS?

I was at home one evening recently when my wife called from the hospital to ask if I could pop over to help her bring some filing home. When I arrived at her office I was handed a large stack of files, each with sheafs of paper wildly stuck in at all angles. A nonchalant question from myself about the content of the files drew the response that these were the patient files of all the newborn babies who had died in the hospital, that month. As I bore my burden back to the house, it became heavier with every step. The weight of the files became the weight of the children. Those sheafs of low grade paper were crying out for justice; but I wasn’t sure that I had an answer. They stared back at me in just the way that well-filed documents do – not at all; they don’t have a voice of their own. Will the children whose names are still written on them be forgotten as quickly as I could forget the weight of the files after carrying them such a short way? Was that the white man’s burden? If it was, what have I done to lighten the load?

Juma was brought into our hospital too late. He died soon after arrival. A lack of knowledge, a lack of education, killed him. As it has surely killed many others before him, as it will go on killing many more. Twenty thousand copies of the Nyakyusa New Testament will be printed later this year. I don’t know whether there is any connection between these facts. I can only pray that there might be.

 

 

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#12 Reflections on Beauty

This weekend we returned to Lubwe village in Nyakyusa country and visited our friend, Pastor Mwangoka. It was lovely to see him and his family again. On Saturday we enjoyed walking with him to the neighboring village. The following day we drove 50km of dirt road to one of the churches under his care, a tiny village called Mbigili. The setting was beautiful, high up in the hills, surrounded by volcanic mountains and lush vegetation. A tiny mud built church with dirt floor and tin roof lay surrounded by wild flowers and banana plants. Butterflies of many colours and shapes were fluttering all around, hornbills and sunbirds flying overhead. There were fields of neatly planted tea plants; potatoes, coffee and yams also flourish there.

I was thinking how wonderful it would be to live in such a place. As soon as that thought came to me, I began musing on the problems of healthcare and education. I thought about the 2-3+ hours it would take to access a basic hospital and all the worry that would bring with our own children to care for.

I really enjoyed speaking to the children we met on the way and watching them play with Lydia and Aaron. Meeting little ones in remote, or even not so remote, villages often makes me wonder about aspirations. With little exposure to the outside world what do they dream of? What do they long for in life? What will they get? Is any of it fair?

These beautiful and lively children, who give such thoughtful answers and who are keen to talk about many things. What will they get and where will they go in life? Working in the health service here I know how the story can end. No matter how many times I see a little one, or a young woman, or a 24 year old man, whose life has been broken by a preventable illness such as HIV, or by a treatable illness that only came to get help when it was already too late, I hope that it never stops hurting. I hope that I never loose the ability to feel and to cry for them.

Great beauty has enormous capacity to move us greatly, even to tears; it might be in a poem, in nature, or in the faces of people, in their eyes, or else the stories that lie behind the eyes. There is abundant beauty here in Tanzania. Beautiful places, and animals and flowers of course, but mainly people and their beautiful acts of love. I see it in a patient sharing what little food she has with her neighbour in the next bed who has even less. I see it in the eyes of family as they search my face for  news of their loved one’s progress.

I hope that seeing daily all this beauty gives us the motivation and energy to confront all that seeks to tear it down and to break it. Sadly, too often that is not enough. Complacency easily creeps in when we reflect on the enormity of the task before us, when we see the sheer cliff-face of poverty and disease and step back from the attempt to scale it. We need to ward off that complacency, to squash it and dare to hope.
 


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#10 People working

Ibada - patients praying
Ibada - patients praying

There are often wonderful moments of closeness to colleagues and patients at Mbalizi hospital. I have recently been reflecting on the richness of these experiences, and wondering if the equivalent is available in larger hospitals such as those in the UK. 

 

Whenever a member of staff or one of their family members is sick, needs surgery, or is in labour, they usually come to my ward. This means that I am often treating colleagues (almost daily). It's a privilege, though not without its challenges. Inevitably, I am present when a colleague’s relative dies. I cared for the terminally-ill mother of a nurse; the warmth and tenderness I sense from her now, after her mother's death, continues to surprise and challenge me.

 

When a colleague dies (sadly we have lost several nurses to road accidents) we are together in mourning. If the funeral takes place in the hospital chapel, we all go together, all of us pay our respects to the body, one by one in a long file. If it is further away we share cars and all pile in together.

 

Then there's the experience of being crammed into a small room for our 'ibada', a biweekly evening service in the chapel for our patients. There is always a guest choir, and so a great deal of dancing and loud music. If they can't walk, they simply come in wheelchairs or are carried in on stretchers. The smells of the African night air mingle with those of wounds and disinfectant. Seeing the raw expressions of despair, searching, hope, joy and pain in the faces of many sick of all ages is one of those experiences from which it is hard to detach oneself.

 

There are gifts too. I have recently received tomatoes, cucumbers, cabbages and a pumpkin from kind subsistence-farming patients. Even when out in the market shopping I have been given extra peppers by a patient whom I had cared for during her pregnancy. Their gratitude can be hard to take when one feels one has contributed so little. 

 

Tea break in the morning about 10am is really more like breakfast. Here in one room, nurses, admin staff, ground staff, our carpenter and electrician, and doctors all eat together. Chat is lively and everyone invests time in keeping work relationships alive and flourishing. If anyone sees me drinking tea but not eating they often insist on buying me a samosa or cooked banana from the tea lady....just to make sure I don't fade away!

 

Yet another way people are brought together is trade! Most hospital staff have some other business interest or other. The physiotherapist makes mosquito nets, one of the junior doctor sells chickens, another nurse sells soap, another fabric. If you want avocados pharmacy is the place to go and so on.

 

So many ways our lives can touch. I am still a total outsider in many ways, but there are moments I am brought in and each of these is special.

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