Reports from the Field
World Lung Foundation staff, grantees, partners and supporters share quick updates about their work in lung health around the world.Each posting has a comments section that you can use by setting up a WLF user account. We welcome your thoughts!
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Sunday in Tanzania
Two women visiting family members in the maternity ward, coming to cook and provide emotional support.
On Sunday at 7 AM, our World Lung Foundation team of Peter Baldini, Jack Salvo, Carl Mercer, Dismass Masumbukoo, our driver Filbert Kalilameso, and I climbed into a jeep provided by our grantee IFAKARA and headed south to visit one of our maternal health clinics in Rufiji district. The rural district, just two hours south of Dar Es Salaam, is named after the Rufiji River, which sweeps through Tanzania for 375 miles and into its delta at the Indian Ocean, the largest mangrove forest in the world.
As we left the outskirts of Dar, we were struck by the sight of groups of young people, banded together, running along the main road as though getting ready for a team competition. Some were even singing as they moved in unison along the busy street in the early morning cool before the sun gained strength. We asked Dismass whether the youth were in training for a competition of some sort. He told us that young Tanzanians run together simply for the companionship and the exercise. Impressed by this dedication, we mused that we couldn’t imagine children back home even being up at 7:15 on a Sunday morning.
As we moved farther and farther away from Dar, the urban landscape gave way to lush countryside, with vast fields of coconut and banana trees and fields of rice. We arrived in Rufiji at 9:15 AM, on schedule thanks to our able driver and a mercifully traffic-free Sunday morning.
The infrastructure of the rural village seemed typical for many poor areas: While electricity lines ran through the streets and powered some dwellings, others were without power, and the further inland, the less likely it was that people would be on the grid. With the river as a natural resource, most people could get clean water from wells by hand-pumping it into their buckets. Sanitation also seemed intact, reducing the likelihood of related health problems, at least outside of the harsh rainy season.
But poverty was obvious. Apart from the verdant fruit trees that surround the village and some scattered farming, the dusty village was lined with dilapidated buildings and under-nourished children. Health services are also in short supply in the region.
Sign outlining the project, the donor, grantee and what is being carried out.
As we turned off the main road toward the Kibiti Health Center, I wasn’t sure what to expect. Jack, a WLF consultant overseeing the project; Dismass, our Project Administrator on-the-ground; and Carl, the Project Manager for this initiative, have already been here. They have also driven WLF’s efforts to build and support these health centers at 12 other sites in rural regions. For Peter, our Executive Director, and me, this was a new experience.
WLF consultant Jack Salvo and WLF Executive Director Peter Baldini discuss the health center with Assistant Medical Officer Dr. Mahendeka.
We were greeted by Dr. Mahendeka, one of the Assistant Medical Officers (AMOs), who escorted us to the buildings that had been built with WLF support. The infrastructure includes a maternity ward and an operating room for surgical deliveries. These new buildings were on the same compound as the existing medical clinic and its dispensary, much older buildings, crumbling by all looks. AMO Mahendeka told us that the medical clinic was needed to serve the village and the surrounding area of 10,000 people, but the key problem was a major shortage of personnel, drugs, supplies and infrastructure. And the roof was in sore need of repair; one could only imagine the flooding when the rains came.
Local women who have come to deliver their babies at the health center.
Access to obstetrics and maternal health care is even more daunting in the area—and this is where we are helping. Working with the IFAKARA Tanzania Medical Center, WLF supports the building of operating theatres, maternity wards, staff housing, and training of AMOs to improve the safe delivery of babies, thus averting maternal and infant deaths.
AMO Mahendeka told us that the maternity ward and operating theatre at Kibiti are the closest to approximately 100,000 women in the surrounding area, many of whom travel miles by foot to give birth. Before this center was built, there was no dedicated service of this sort. Now there are two AMOs and two midwives, all of whom were recruited by the government into the facilities. AMO Mahendeka proceeded to proudly show us what they had accomplished, even with the challenges and huge demand placed on them and these vital services.
Patients at the health center.
He escorted us into the maternity ward. We walked into a long, modest room built on an east-west access to shield occupants from the heat of the direct sun and to accommodate as many beds as possible. Nearly every one of the 18 beds—12 dedicated to normal deliveries, the other six to C-section patients—was filled with women who had just given birth or were about to deliver.
In one room labored Hawa, a 27-year-old woman who was about to give birth to her fifth child. Nurse midwife Asia Minje, who was solely in charge of seeing to all the women, comforting them, and changing their bedpans, was alert and stayed close by, ready to help with the delivery.
We walked through the ward, not wanting to scare the women or to violate their privacy. We smiled at them to offer comfort, offering greetings in Swahili, assuring them we were there to help. The center’s other AMO, Chagi, arrived then. Though it was a rare “day off,” he came to the center on a Sunday to meet us and was just as eager to tell us what they had accomplished and the challenges they still faced. He also told us a little about each woman. He pointed to Nasra, a young girl who had just gone through a C-section. She was recorded as 17-years-old but looked more like 14 or 15. In the past couple of days, she had given birth to a stillborn baby. AMO Chagi said that because the baby was stillborn and did not die as a result of delivery, they were running lab work to determine if the girl had syphilis or malaria or some other ailment, demonstrating the center’s thoroughness with diagnostics. And they were keeping her in the ward until they knew more, so that they could give her any needed medicine.
I noticed that Nasra was the only woman without a baby next to her. I wondered what she might be feeling after carrying her child for nine months, only to see it die. She showed very little emotion. AMO Chagi, who was far more used to these tragedies than I, said that Nasra is less sad when she is with her family. It was heartbreaking. I also knew that for many of these women, childbearing is not just a joyful experience; it is one fraught with anxiety as the fate of their children is uncertain. In Tanzania, poverty, hunger, acute respiratory infections, malaria, and diseases for which medicines are scarce contribute to 10 out of 100 babies dying in their first year of life.
As we walked past the mothers who had given birth with babies against their breasts, I asked my Tanzanian colleagues to express to them that their children were beautiful.
We continued our tour on to the operating theatre and the rest of the compound. Though the compound was minimal in terms of equipment and infrastructure, there was a clear commitment to hygiene and infection control. Shoes had to be taken off before we walked in, to protect the theatre from dust. Scrubs, masks and clean water were at the ready, as was sterilizing equipment.
In the midst of our tour, Nurse Minje quietly came to speak to AMO Chagi. Exchanging a few words with her, he made us aware that he had to go back to the maternity ward. Hawa had just given birth, but her placenta was still inside her and had to be removed.
I accompanied AMO Chagi and Nurse Minje back to the ward. Hawa’s baby girl was already placed on a cot and wrapped carefully in a blanket. She couldn’t have been more than five pounds, a low birth weight not uncommon for babies born to poor women. Hawa was still lying in the delivery room. AMO Chagi washed his hands, asked Nurse Minje for a pair of gloves, and proceeded to get to work to pull out the placenta. It took him less than five minutes. Though close by, none of us heard any expected delivery screams from Hawa. She was also silent as AMO Chagi removed her placenta.
WLF has clearly done so much to create this safe haven for these women and their children, but as expected, the more that is done, the more it seems needs to be done. Our AMO colleagues told us about their own hardships of being on virtually 24-hour call, as more and more women come and the beds are almost always full. We spoke to them about the need to also do more to promote family planning. We discussed the need to build staff housing, as we have at other centers, to enable staff to live closer to the clinic. We also offered to provide the AMOs with motorcycles, as they have no transportation to go to and from their homes to the clinic each day.
We got back in the jeep to return to Dar. One couldn’t help wonder whether any of those new babies will someday be running along the streets with their friends on a Sunday morning.
Sandra Mullin
Senior Vice President, Communications
World Lung Foundation -
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