Maasai Mzungu

Early rise, car packed, and off we went! Myself, Valerie, Fred, Tom driving and Harry our chef. A long journey through Arusha city with a stop off at the mzungu supermarket for a few bits and bobs, including a million more batteries that my camera kept chewing up! On we went along the highway - which to us mzungu is the equivalent of a motorway but only a single-carriageway with almost as many roadworks as we have, but countless police checks, I think on the journeys to and from Maasai we got stopped 9 times. And this may partly be due to the fact Valerie was sat in the front. You see Tanzania have very strict motor vehicle regulations, more so for the vehicles being used to ferry tourists around, so if the police spot a mzungu in the car then it's more likely to get stopped as they assume a white person is a tourist and the car needs to be checked. And there was nothing intimidating about these checks, well maybe there was during the first few, but generally they're just checking the car log book, the drivers license and insurance, that there's a first aid kit and fire extinguisher.
Anyhoo, after several police checks we went on and left the highway. Drove past the Military Academy and into the region of Monduli. We arrived in a town which was heavily populated with people in Maasai dress, we pulled up by a shop where several huge water bottles were loaded into the car and a Maasai man squeezed in with us. This was Alais, our guide and translator. I must admit, sitting next to him in the car at this point I felt a bit nervous. There was less awareness of personal space and boundaries which made me a little uncomfortable but this was definitely amplified by the foot long knife tied to his belt! We'd experienced an 'African Massage' driving around town (basically huge potholes on the tracks off the main road) but as we left the town and ventured into the rural area, the road became a dirt track....then we were introduced to 'Maasai Massage' where the "roads" made me think of those Red Letter Day off road driving experiences you can buy; in a 4x4 with extensive protection wear provided! But here we were in a typical people carrier on terrain that was never flat or straight and massive crevices within the millimeters of they tyres that the car could have slipped down!

one of the hundreds of ditches either side of the tyre track

And as Tom's skillful driving took us further into Maasai land, we caught glimpse of a Boma - a gathering of mudhuts where one family lives, usually with an enclosure for livestock made out of thorny shrubs and branches and sometimes with one of these fences surrounding the boma. We passed several of these, some weird and wonderful plants and trees and an ostrich - my first glimpse of wildlife that is mostly associated with Africa. We also passed lots of the locals; some herding their cattle, goats or donkeys carrying water and firewood, others carrying food and water on their head from wells and waterholes. Alais told us that some people will walk upto 40km for water, and often this was water from water holes/ponds rather than from a well of clean water. We passed a water hole and there were people washing, people filling huge water carriers (jerry cans), livestock drinking...it wasn't until a bit later on that I realised that what I'd just seen with my own eyes was what we'd often see on a charity TV advertisement. These people were travelling for miles to get water, and with all the livestock drinking from these pools then it was highly likely that their waste products was getting into this water too!

home sweet boma!

The Maasai Massage continued as we drove on and every now and then we had to rush to close the windows as big dust spouts and clouds formed and rushed towards us. We weren't always quick enough! We arrived at our boma and were given a quick tour of the four huts that we'd call home for the next few days.




There were two round mud huts. Valerie and I shared this one. Alais told us that Maasai women build the houses - quite literally the 'home makers' and the interior of the roof was twisted into an intricate spiral before the exterior thatched roof is woven into place. Two wooden beds with mattresses, a shelving unit and industrial strength mozzy nets. I was very glad of these, but this was more of a barrier between me and the spiders rather than defending off the mosquitoes. There were lots of spiders!

Directly in front of our front door was a fenced-in dining area where all our meals were served and we sat chatting the night away. Beyond this was the bathroom...well I think it's safe to say that term is used rather loosely! A thatched shed like building with a mud wall separating 2 tiny rooms. The first had a curtain across the doorway and was the 'shower' room. But as expected there was no shower, just a little hole in the floor for water to drain away if you used a basin to wash. But having seen how precious water is here, we just stuck to washing with baby wipes that we'd taken. The next door was the toilet...a long drop. And it wasn't too bad. The only downside was checking for spiders at night, if anything was to crawl on me during a night-time visit I think it's safe to say I would've jumped a mile and possibly ended up with one foot down the hole! Thankfully it never happened, phew! The view from the bathroom however was stunning. Especially so at sunrise just as the sun started beaming onto the landscape.

   

On the opposite side of the boma was another mudhut, and in between was the kitchen; the size of the mudhuts but just branches making the walls. Possibly the most basic of camping kitchens I've seen but the food was amazing! A trestle table for the kitchen counter, a small fire for the oven and a single hob gas stove. The feasts Harry made would be impressive if they were made in a regular kitchen, the fact they were made in this make-shift kitchen was just astounding! 

We were welcomed to the village by the warriors and women of the village...and a village here spans many miles. Each boma is only one family home, and from where we were staying only 2 other bomas were visible, so most of our welcome committee had walked a good distance to greet us. The warriors and women performed a celebratory song, the warriors danced and the women danced...and got us involved in the dance. It was a lot of fun but I dare say we were providing a great deal of amusement in our attempts to copy the moves. The warriors did some of their infamous jumping which was impressive to see the height they can reach. Then one of them ran towards me and nudged my shoulder. It was clear that this had taken me by surprise as everyone burst out laughing. The warriors continued to do this and Alais eventually explained that this is a dance about making friendships, some of the younger warriors who 'nudged' our shoulders were quite bashful afterwards.

Maasai sandles made from old tyres,
most durable shoes around!

In both of these videos you'll have to excuse the wind interfering with the singing, but trust me it was impressive. And I know I look a fool in the second video and provided some amusement, but the moves to get the necklaces to move properly were tricky enough before adding in the foot-work/hip movements/shoulder jerks! Then in the next dance we had to jump too, was tiring stuff but fun!

After the dancing, the children swarmed us trying out their English greetings, amazed when we responded in Swahili or a little in Maasai...but I caused more amusement for them because I was greeting all the girls with the male greeting and all the boys with the female greeting! Alais then gave us a tour of the whole boma, showing us his hut, we met his mother who welcomed us, we were shown into the cattle enclosure...the cattle didn't like us very much so we were then introduced to the goats...who didn't like us either but were less of a threat! Our first morning there we helped milk the goats before they went out to pasture. We weren't as efficient as the Maasai children but we were assured we were more of a help than a hindrance!

Children as young as 7 are responsible for a herd of goats, guiding them to water and herding them around the land to pasture. And as you can see there isn't much green grass this time of year so they do walk miles upon miles only returning to the boma just before nightfall.

On the second evening we were audience to a goat slaughter, but that's another story! Not as traumatising as I expected and I was surprised at how delicious the meat was. Another wonderful dinner as the sun set, then gathered together for some konyagi and talking into the late hours of the night in a place where the stars really did shine as bright as diamonds; I wished upon at least 10 shooting stars and for the first time in my life saw the milky way (or so I was told).

Yes, it did actually get cold enough to need layers - even for this northern lass!

One of the most awesome places in existence and despite the numerous challenges the Maasai people have to contend with day after day they are so unbelievably happy, warm and welcoming. And I'm  honored that I was told I could be a Maasai Mzungu if I wanted lol ;)

The Maasai Midwife!

So I spent 3 days living with a Maasai tribe in a mudhut, peeing in a long-drop that was dug specifically for us mzungu visitors, trekking 6km in blistering heat to the dispensary each day, then home again, learning some of the Maasai language, about their traditions, history and observing a goat slaughter - then eating some. I loved my time there so much I arranged to go back for another 3 days after all the other students had headed back to the UK. I will write another post about life at Maasai, and working at the isolated dispensary but first I want to share the experience I had meeting the Maasai midwife.
The basics that you need to know is our Maasai guide was a warrior named Alais, the day I met the midwife his brother Festo took over his duties. Their village has over 800 inhabitants but the village is spanned over 50+km. Each family lives at a Boma, a small collection of mudhuts and an enclosure or two for the livestock.
So after my last day at the dispensary, we went back to our Boma, had some food then trekked about 2km to a nearby Boma to see the midwife. As well as being a shorter walk, it was mostly flat and much more pleasant...also due to the fact it was a cooler day so I didn't feel as though I was melting!
When Festo, Fred and I arrived we were greeted and shown to some small 3 legged stools in the shade of one of the huts - they took a little concentration to keep balanced on them! Then a girl aged about 10 guided an elderly woman around to us with a pole and assisted her to her seat. This was the midwife; aged 72 and blind. Yes. Blind!

Me and the Maasai Midwife

When she sat down she spoke at some length to Festo, then he spoke at length to her. This was how Maasai greet one another, after saying hello one person would give an in depth update of how they and their family is, and then the second person would do the same. Shortly after, Fred then gave his update to the midwife. Then I was introduced and told to ask anything I wanted.
I started by asking how long she'd been a midwife, how she became a midwife and how many women she'd cared for. Fred translated my questions to Festo in Swahili, who then translated them to Maasai for the midwife, and her answers were translated back along this route to me. I was told that when she was in her late teens she began attending births with other women of her village, a relative of her's was midwife at the time and she began asking questions and developed an interest. This relative encouraged her to get involved; palpating the uterus, supporting women, observing what was done during a birth. She then had her first baby and said she now understood birth better. She continued to learn the knowledge and skills her relative shared and as time went on got more involved then began taking on the role herself. She told me she's delivered thousands of babies and has no idea of a specific number as it's been too long!
I asked how she copes without her eyesight, especially in situations where I for one would completely depend on my vision such as external signs of descent of the fetus, observing for signs of placental separation, and assessing blood loss for hemorrhage. Her response was that birth has little to do with sight, she uses touch and sound. I continued to ask how she deals with emergency situations without her sight, to which she replied she has never had a woman hemorrhage, a shoulder dystocia, a cord prolapse or abruption. I asked if with her experience she's able to identify signs of any of these emergency situations and transfer the women to the dispensary or district hospital before they advance, she told me no, there has never been an emergency situation and no woman or infant has died in her care!

Inside a hut, the little doorways are sleeping areas, which almost
completely prevent a woman from being cared for in bed

She talked me through a typical birth, that when a woman is in labour a warrior from her Boma will go to the midwife's Boma and escort her back, guiding her with the pole that was used earlier to guide her to us. She said that this could be up to a 30km walk in the dark. This means she has to put so much trust in the warrior leading her, with it being dark he may not see as many obstacles in her path as he may in daylight...add to that the added risk of lions and other predators and wildlife freely wandering about the Savannah! She told me that the hut will be kept extremely warm for when the baby arrives, there will be other women there supporting the labouring woman and offering assistance to the midwife.
She palpates to check the contractions and presentation and sometimes does vaginal examinations - but not always. The woman's body then leads the birth, the midwife gives no time limits to birth but her experience tells her that things are progressing. Sweet chai is given to the woman to give her energy and positions including kneeling and squatting are encouraged to help fetal descent. She told me how the head is delivered, she waits for the head to turn and with the next contraction the baby arrives. She told this all in 1 long explanation and I kind of felt for Festo and Fred for having to remember everything she was saying before translating. However, as she spoke, she gestured and used her hands and knees as props...as she was talking Fred spotted me nodding knowingly in agreement. He quietly asked if I understood her and I told him what I thought she was saying. When Festo translated to Fred he kept smiling at me and said I was right. He then told Festo and the midwife that I'd understood without the translation. She said that midwifery doesn't need words just like it doesn't need eyes.
I asked what she does once the baby is born, when does she cut the cord and what is done with the placenta? Again, from her movements I figured out most of her response :) The baby has immediate skin to skin and is encouraged to breastfeed ASAP. The cord is tied when it has stopped pulsating and cut. Then she waits until the mother has a contraction and the urge to push and deliver the placenta. In retrospect I wish I'd have asked what's the longest time she's waited for third stage to be completed. Then the placenta is buried near to the Boma. This made me a bit nervous as not too long before this meeting I was being told about the lions and other predators that wander around...and they're putting 'bait' near their homes...reallllly hope they're buried very deep lol! I told them how some people consume the placenta either by cooking it, having it made into a type of smoothie or reduced into capsules...Fred couldn't believe what I was telling him...Festo's face suggested shock and the midwife began spitting and waving in disgust. Her view is that the placenta was part of the baby and part of the mother, if someone can eat that then what's to stop them eating their baby! That topic didn't go much further.
Out of curiosity I later asked what were her reasons for waiting for the cord to cease pulsating, as I assumed her practice wasn't based on current evidence. I was told that it's how she was shown when she was younger, she's always done that, as did the midwife before her...and why would you cut the cord when it's still doing a job? If the cord has a pulse then it has life running through it. I must admit I adore the simplicity in her reasoning and I really love that for her and the midwife before her, they have complete faith in Mother Nature and the ability of a woman's body.
This midwife provides some antenatal care too, if women are unwell during pregnancy she will advise them on traditional Maasai herbal remedies. Still dubious about her saying she's never had a woman with any complications I asked what does she do in situations such as malpresentation or premature labour. With the latter I was told that labour happens but nothing further was discussed regarding the wellbeing of the infant. Again with gestures that I understood, she told me that she turns babies that are the wrong way - basically performing External Cephalic Version (ECV). I said that where I am training it's only obstetric consultants who perform this procedure while the mother has pain relief (entonox) and a ultrasound scanner is used throughout the procedure to ensure the fetus is well, and if the procedure is unsuccessful then most women opt for a cesarean section. "If it doesn't work? Why wouldn't it work? It's easy? Why don't midwives do it? It's basic. Just need hands and grease." Again, a very frank response which focused on the hands on skills surrounding childbirth.
The three of them told me about some of the tradition surrounding childbirth; when a woman is at approximately 12 weeks gestation a large bombfire is built outside the hut. This is basically the pregnancy announcement and a way of telling family and friends that they are welcome to come and give their well-wishes. I'm not sure at what stage the fire is lit though. From this gestation the woman and her husband will not have sex again until the baby is 3 years old - as her body has to continue growing the child and to then give the body time to heal.  When the woman is in labour her female relatives support her and assist the Maasai midwife and once the baby arrives the women sing for hours and the warriors slaughter a goat and the whole Boma celebrates. The woman is brewed a traditional Maasai medicine (like a herbal tea) to give her strength to recover and provide for her baby.

A bonfire in front of a hut to indicate the woman was pregnant. 

In all honesty the midwifery this Traditional Birth Attendant (TBA) spoke of was generally what I expected to be observing during my placement - more focus on normality and low risk, women uniting to support each other, keeping birth a natural physiological process surrounded in practice that's based on cultural traditions.
Now in the dispensary clinic I'd met several women who had lost babies in the past while delivering at home and the doctor had told me of situations where Maasai women had died in childbirth that could have been prevented if they had a trained professional present rather than a traditional birth attendant, so I don't completely believe that she has never had an emergency but can understand that she wouldn't want to openly advertise any fatalities she's had to an outsider like myself.
The doctor at the clinic told me about outreach programmes that are being launched in more remote areas of Tanzania, where nurses and midwives use motorbikes as the quickest form of transport over rough and changeable terrain. In Tanzania 57% of women give birth without a healthcare professional in attendance (in the UK it's <1%) (White Ribbon Alliance, 2012) and this is mostly due to the remoteness that some families live in. Logistics and costs of improving this and increasing the number of formally trained midwives undoubtedly lie in the government's hands...another issue we have in common.
There is discussion surrounding TBAs and providing them with training to help deal with emergency situations. But after meeting this TBA, I personally wonder whether they would be receptive and engage with this...or take offense, declaring they don't need to be trained in such matters because their traditional practice has served them well. And from what I was told, why would a TBA want/need training when she claims to have never had an emergency situation? Speculation on my part of corse!
This woman was an absolute inspiration. Her ethos pretty much covered the Promoting Normal Birth campaign by the RCM here in the UK and I would have loved to have had the opportunity to attend a birth with her - to see a home birth, Maasai style! I adored my time at Maasai for various reasons and would go back in a heart beat, but meeting the Maasai midwife was really the icing on the cake!

a new song 'it must be love (love, love)'

Day off!
And this day is better shared in pictures - enjoy!
Beverley and I were due to be collected at 8.30, but we'd already learnt that punctuality isn't exactly a priority here! However, our guide arriving at the house at 12.30 was much later than expected, Neil was extremely apologetic and had brought us each a little gift as an apology - a weaved bracelet saying 'HAKUNA MATATA' and for those of you that aren't familiar with the phrase from Disney's Lion King, it means 'no worries' and is a mantra that many people here live by!
Anyway we set off towards the main road as Neil continued apologising and explaining what held him up. We got to the main road where he was planning on getting a taxi to our destination to make up some time, while we weaved through the dala-dalas and taxis we spotted Tom, our driver, and he offered to take us. In we climbed and off we drove.

(the dala-dala/taxi stop)

We came off the main road (the highway was the only tarmac-ed road around), onto a dirt track, past the hospital where we had our placement and up a hill. Up a very steep hill, the further we drove the more grateful I became that Neil was late and Tom was driving us lol. Tom pulled in by a house to drop us off, the road ahead was a bit too steep-time to continue on foot. 

(onwards and upwards)

(looking back down the hill - really doesn't represent how steep the hill was! lined with banana trees and in the distance towards the horizon is where Tanzanite is mined)

We were surrounded by gorgeous, lush, green vegetation - most I could identify as banana trees...but it wasn't until later into our trek that I discovered there are so many different types of banana and how every part of the banana tree is used for something from food to gift wrapping to building material to cattle feed.

(two different types of banana)

We got to the top of the hill, through a village, over a bridge then off the track, under a branch and over a boulder. To the left was a ravine - we could see the opposite side, we could see the tops of the trees growing from below but we couldn't see the bottom. Neil said the waterfall we were heading to was at the bottom and this was where we started our descent. I laughed - he'd been very humorous along our walk so far so I figured this was a joke...how wrong was I! 

(you can't quite make out the sudden drop at the bottom of this picture, but trust me it's there! And that's the far side of the gorge)

(some very steep parts of the climb down - no helmets, safety ropes or padding (other than what I already have) just hands, feet and branches)

As we were descending we were joking 'Indiana Jones, eat your heart out' and sang the theme tune. Then we finally made it down alive and were next to a river. We ventured upstream clambering over rocks and crawling under massive boulders until we came to a pretty fast flowing part of the river which was where we needed to cross. 

 Trousers rolled up, socks and shoes off and tied to my bag and tentatively finding my footing across some slippy rocks.

Made it across, had a brief break where we put our footwear back on, then as we went to move on I lost my footing and my foot slipped into the river! It was very refreshing! Again lol

We moved on a bit further and stepped between another two large boulders and that's where we found the waterfall.

It was beautiful and not a single photo I have does it justice. Well worth the scrapes with death we'd just faced! Neil pulled out some cakes - a mix between a taste of yorkshire puddings and donuts - sticky, sweet and delicious. 

Then it was time to go back up the opposite side of the gorge. That was much trickier but much quicker. At times the only thing we had for stability were bamboo stems and vines - Tarzan eat your heart out! We even did a couple of Tarzan calls to help disguise our fear of tumbling back down. But we made it to the top and were met by a bull, I got the impression he didn't like company but at least he was tied to a tree while we left his field and before I knew it we were back on the bridge we'd crossed. Neil pointed down towards where the waterfall was...again we couldn't see it!

We ventured back through the village, across a football pitch which was being trimmed by cattle and goats, past a cemetery which was covered in wild flowers in full bloom, under an avacado tree, through some maize fields and under more banana trees which were providing shade for the Arabica coffee plants. Neil told us about the perfume of the white coffee flowers, the coffee berries which were mostly green at the moment but were beginning to ripen to red; how the berries are picked by hand and the beans inside.

(a large guava berry, smaller green coffee berry, 2 red ripe coffee berries and the white coffee beans)

We ventured on and met lots of locals along the walk, having short conversations with them;

'Jambo' (Hello)

'Poa' (Hi)

'Habari?' (How are you?)

'Mzuri sana' (very good)
'Safi' (cool)
'Karibu' (welcome)
'Ah, asante sana' (thank you very much)

At this point they were impressed we knew Swahili and talked on, but unfortunately this was the limit of our vocabulary...we amused most people! Neil then introduced us to someone who was making a local brew and offered us a sample of his banana beer. It looked like porridge, smelt like a whiskey brewery, had a gritty texture and tasted incredibly strong and not of bananas!

To the brewers amusement neither of us could handle much more than the sip we tried, despite pouring us a huge beaker full. We thanked him 'asante' and bid him farewell 'kwa heri' and after some time we arrived at Neil's mama's house. She'd made us tea - homegrown (and brewed) lemon and ginger tea, with homegrown (and roasted) peanuts and fresh popcorn (also homegrown and popped). After a chat she served lunch - an amazing and very generous buffet of spiced-beef stew, chapatis, fresh veg, salad and masses of fresh fruit. I wanted to gobble up the whole table it was all so tasty and we were sat in such a beautiful garden in the middle of a jungle of banana trees! Neil then told us how the the beans are sun-dried, then need shelling, which we did in a big pestel and mortar. 

 We then had to sieve the beans from the shells by tossing them in the air with the hope that the wind would catch the shells while we caught the beans...however this is quite an artform which Neil made look effortless!

 Beverley and I accidentally created our own little coffee plot in the garden...we had to pick up all the beans we'd dropped!

The beans were then roasted for quite some time and then back into the pestel and mortar where they were ground into the fresh coffee we're familiar with.

Tom had come and joined us on this side of the hill, started grinding the beans but then decided to leave the grinding to the professionals - Neil and his Mama.

 This couldn't get any fresher! Added to a pan of boiling water, heated and ready for sampling! So delicious and almost as strong as the banana beer! We were given a little bag each of the coffee we had made, then purchased some more ground coffee and coffee beans (my bag still smells divine).

We were then given some fresh sugar cane to munch on - home brew, freshest coffee ever, sugar...I was beginning to buzz on our drive to the finale of our day.

We arrived next to a lake which reflected the far side as clear as a mirror, so serene. We were helped into a canoe where plastic patio chairs had their legs cut off for seating, then our oarsmen pushed off from the shore. Gently paddling around a gorgeous lake, singing 'row, row, row your boat...' it was sunset and it was beautiful. Neil and our other paddler pointed out wildlife to us - lizards, eagles, herons, snakes, vultures, kingfishers...

 It was so so beautiful and such an amazing day. I was beginning to fall in love with Tanzania and the smile couldn't be swiped off my face as we floated along. Then our attention was directed to the opposite side of the lake and we were told Kilimanjaro was visible. 'Where?' I asked, 'I can only see white clouds.'
'It's not clouds - that's the snow on top of Kili.'
That was it! My heart had fallen head over heels for this country...and the love affair was only just beginning :)

'every little thing' (part 2) *upsetting*

The ride to the hospital wasn't as jovial as it had been the day before. Beverley and I felt very anxious about the outcome of the little girl we'd met the day before.
We arrived, got changed and the sister greeted us. Tense on the events from the day before we immediately clocked there was a new resident in one of the incubators. Beverley glanced in reluctantly and said by the face this baby looked ill too. As it happened the doctor was already writing a care plan. The mother was lying in the bed adjacent to this incubator receiving a blood transfusion. It had been a home birth and the mother had a retained placenta followed by a hemorrhage.
The doctor asked Valerie to take the baby to NCU and that it was to have a 40ml blood transfusion, IV antibiotics, have it's Hb checked and be warmed. At this moment I felt relieved that everything that had happened the day before wasn't "normal" or a regular occurrence. There was a plan for an ill baby.
While the doctor had been discussing this Beverley had gone to the baby, then called the midwife. The midwife unwrapped the blankets and appeared to nudge the baby. Beverley caught my eye and immediately I felt deflated. The midwife called 'Daktari? Daktari?' The doctor appeared, they peered into the incubator, nudged the baby again while talking in Swahili. The mother began to stir and turned over to see. From where I was stood I could see a limp limb...the midwife spoke to the mother and while I couldn't understand what was being said, her tone was 'matter-of-fact' rather than sympathetic. The woman slumped down and began sobbing. The doctor went to her, patting her head as he spoke. Beverley checked for a heartbeat. While it appeared lifeless we were stunned that they had broken the news to this woman that her baby had died without certainty. The infant was wrapped back up, face covered, only the care plan the doctor had just written laid on top as identification. The mother was left with her bereavement.

After we'd asked, we were given the history of this mother and child. The baby was born 5pm the night before, then mother and child were transferred in due to the obstetric emergency. We were told that the baby had lost blood from the cord; that the string hadn't been tied tight enough. I asked why, if the baby had been born the night before, hadn't it been reviewed before now, or even gone straight to the NCU when they arrived? I was told they were busy looking after the mother. I continued to ask, while the midwives and obstetric team had been attending to the mother, why hadn't someone taken the baby to NCU to receive treatment at the same time? Why was this doctor writing a plan when he'd not even reviewed the infant? The midwife looked blank and couldn't give any reason. Nobody had been caring for the baby despite the baby needing attention too. Beverley went to the woman to try and give her some comfort. I couldn't hold it together, I went outside and wept. A poor baby that could still be alive if adequate care had been available. A poor mother who was lying in a bed, oblivious that her child was slipping away next to her. I was so angry that this child had been allowed to die. Angry that this was allowed to happen. And I couldn't be angry at anyone specific, it wasn't that the staff here just weren't bothered, just such huge demands on their time that they really have to prioritise their time. The mother had taken initial priority when they arrived and I don't know what other events happened through the night to keep them away from that particular baby. I was angry that the midwife and doctor seemed so unaffected by finding this lifeless infant. Again, I didn't perceive that they were two uncaring individuals, I got the impressions that it was more that these events were normal to them and they had no emotion left for situations like this. This was their normal working environment. I was angry that this was allowed to be normal - anywhere! That the staff had no other choice than to become passive - for their own emotional grounding. 
While I was sat outside the wind turned, the smell and smoke from the nearby incinerator hit me. I felt I might throw up. I went back in and busied myself with some cleaning, I couldn't handle anyone face to face. I was now dreading going to NCU to see how the little girl from the day before was, if she was still with us. Beverley appeared, we gave each other a hug and agreed to go to NCU. We told the sister where we were heading and I shook as we walked over.
We couldn't initially find a member of staff on the pediatric unit so went to the tinted glass door of NCU. In a bedroom before we spotted the mother, she looked relaxed which relieved me slightly. We went in, donned our hair nets and shoes and went to see the little girl. She looked better than the day before, was still having oxygen, but now had some tone to her muscles, occasionally moving her her hands or feet and responding to stimulus and her chest sounded much clearer and heart stronger. A nurse appeared and told us they'd been continuing with the antibiotics and NG feeds of the EBM. Things, thankfully, were looking up. We went to see the mother and I can't remember the exact details but we found that she'd not seen her daughter since I took her the previous day, so again we led her into NCU. It seemed unfair that all the other women came and tended to and nursed their babies as they pleased in the warm room, but this mother hadn't had that opportunity. I'd remembered to take my phrase book so with broken Swahili I introduced myself and told her that her daughter was beautiful. She told us that she'd named her daughter Mercy. I told her Mercy and I had become friends. She still kept her distance so again we both encouraged her to have some contact with her daughter. She started whispering to Mercy. We left them to get to know one another better.

When we returned to the labour ward, the woman from the morning was still receiving a blood transfusion and there was a labourer in the bed next to her progressing through second stage. We pulled the curtain around the bereaved mother so she didn't have to face a new mother and live baby. Although, we couldn't stop her from hearing the baby crying or the new mother praising and thanking God for the safe arrival of her child. 

After this new mother had moved into the postnatal ward I told the sister how at home in the UK, when there is a neonatal death we give the woman and family the opportunity to see and hold the baby, to say goodbye and how, for some people, it is a way of acknowledging there was a life, no matter how short and how this can help with their grieving. The midwives looked at me as though I had three heads, so the three of us mzungu tried explaining how some women appreciate this and find peace in at least having time with the child they nurtured and grew. The sister nodded towards the woman and said, 'she knows it's gone. It's dead.' They simply kept saying 'No' as if what we were telling them was not an option. Ever. The midwives could not understand why anyone would want to hold a dead body, one even told us that women there would be too scared to see a dead child. In a way, by not offering this closure, they're protecting women from having to face death. It was one of the cultural differences I least expected but one I found easier to understand and accept. 

I knew it was inevitable that I'd encounter death while here in Tanzania. But I didn't expect to feel such anger and frustration about it. It seems so unfair that lives are being lost just because of the lottery of where they are born and the resources and facilities available there. I knew before travelling that in Tanzania the neonatal mortality rate was 25 per 1,000 live births and even though I'd mentally prepared myself to encounter neonatal deaths I wasn't prepared for the circumstances surrounding the deaths. Unfair, unjust and tragic.

The day continued and a relative came to collect the body of the infant. On the way home we asked Tom to stop at the local supermarket; we needed a strong drink that evening, Konyagi was our poison of choice-the local gin! As the drive continued the sun was shining and the sky was the clearest it had been since I arrived. Instead of getting a glimpse of Mount Meru, we saw her in all her glory. Tom pulled over for us to admire, while we took some photos some locals working in a field were shouting and waving to the east...I think they thought we were crazy mzungu and were in awe of the wrong mountain-KIlimanjaro was to the east, but not at all visible. We got home and all had a little time to ourselves to digest the events of the day, Beverley went for a lie down, I did some washing in a bucket on the porch with the help  and guidance of some of the local children while Valerie read in the living room. Then we gathered on the porch, soaking up the evening sun, reflecting on our thoughts and indulging in our Konyagi. I was glad to be off the following day.

sing with me: 'Every little thing, Is gonna be alright' (part 1)

This following story takes place across my first week. For me it was very emotional. Possibly the toughest week of my life and the other girls really pulled me through.

Again Valerie, Beverley and I went to placement for my second day while the other 3 were away on an excursion. Everyone was quite bright on the journey to the hospital with jokes, laughs and reggae music which came to be the theme of the trip thanks to Fred and Tom's love of reggae. We all sang along to Bob Marley's "Three Little Birds". Not long after we arrived it was Valerie's turn to go and observe a caesarean. There were 2 labouring women occupying both beds. After we'd done some mopping I spotted a piece of equipment humming away that I'd not seen before, when I went over to look I noticed that one of the incubators was occupied and the machine was an oxygen pump. Beverley looked in and said it didn't look well, we asked what was wrong with this baby and we were told that it needed help breathing.

The baby from the caesarean returned from theatre and was placed in the incubator next to it. As this younger baby had been carried from another building where the theatre is, I decided to check it's temperature, it was cooler than it should be. At the same time Beverley felt the cheek of the first baby and said it felt cold, she felt the chest as this gives a truer indication of the core temperature. Still cool, got a thermometer and it was at this point we found the kanga closest to the skin surface of this infant was damp, I tried to listen to the heart but couldn't even make out the sound due to the sound of the lungs- which sounded very crackled - clearly had a lot of mucous on the chest, temp of 35.3•C and visual signs of respiratory distress. We reported this to the sister who suggested we get more blankets to keep both infants warm. We asked if this first baby had been fed since delivery and were told no as it needed oxygen so couldn't go on the breast. Beverley and I moved quickly to get a fresh dry kanga, get a hat and knitted cardigan around the baby, turn the incubator temperature up, from 'low' to 'high' as skin to skin wasn't an option due to oxygen therapy. The mother was asked to hand express some breastmilk to give the baby some energy and she managed some that was put into a syringe. Beverley tried giving this to the baby, it had no suck reflex so the tiny drop of colostrum remained in the cheek. I rechecked the temperature after 15 minutes and it had dropped to 35•C and all other observations sent alarm bells ringing. We got hold of one of the midwives and told her this infant needed reviewing by a pediatrician but she told us there wasn't a pediatrician in as it was a public holiday and that they didn't have any NG tubes on the maternity unit. We asked if we could bring the mother through to see her baby (we were convinced the child wouldn't survive) but were told this can't happen while there are 2 women labouring-as soon as they were delivered we could bring her through. The midwife rang the obstetrician for us who came and agreed the baby was hypothermic and needed transferring to the neo-natal care unit. He went and made a care plan of warming the baby, NG feeding of EBM every 2 hourly and IV antibiotics. We took the infant over to NCU on the pediatric ward and the mother soon followed. the NCU was behind a tinted glass door, we had to put hair nets on and change our shoes as part of their infection control. Once through this door there was 2 rooms, to the left was a room where the mother's nursed their poorly infants and things like hair nets, shoe covers were stored. The room to the right was where the infants stayed, this room was maintained around 30•C by two heaters mounted on the wall; it had a large bed that had been converted into 4 small cots and a resuscitaire - where our infant was placed.  I was quietly glad to see a piece of equipment I recognised! However although the resuscitaire appeared familiar I soon realised that it was really only a matress with an overhead heater. But this couldn't be used, nor the electronic thermometer probe attached, as the machine didn't have mains socket. The air, oxygen, suction, heat etc were all controlled by separate pieces of equipment in the most basic of forms.
The nurse had taken some time to gather the equipment to site a cannula but did appear to have a sense of urgency, the first I'd seen that day. The poor woman even apologised to us for not being able to find the equipment sooner. It took her a few attempts but she soon got a cannula sited and administered the first dose of antibiotics. She also periodically used foot controlled suction to clear the mouth of mucous, this reminded me of a camping bed foot pump in reverse - it had to be controlled slowly and steadily by foot-no suction rate/pressure on a dial like we would set on the resuscitaires at home. This was also much more complicated than expected as it took at least 20 minutes for her to find tubes that fitted together, then they needed sterilising as they have very limited single use equipment. In the end I had to hold two mismatching tubes together to ensure an airtight seal and she used an NG tube with the end cut off as there were no other tubes small enough to use in the mouth of this infant or a yankauer. During this time the baby began to feel warmer by touch and the skin colour was improving but the nurse didn't have a thermometer available to check.
It was now 1pm and Valerie and Beverley were leaving, I was due to finish with them but I couldn't leave that baby so arranged for Tom to come and collect me a few hours later. 

After they left, Marley's song was stuck in my head, hoping he was right-hoping this little thing would be alright, I started humming the chorus to myself repeatedly, almost as a prayer...and my sight became blurry as my eyes filled up. I was so upset, angry, scared, frustrated. This poorly baby had been in the hospital since about 7am and a formal plan hadn't been made until nearly lunch time. Midwives were so overwhelmed with caring for labouring women and new admissions that they hadn't had chance to do any checks on this baby. There were less staff available due to it being a public holiday. The baby had had breathing difficulties for so long what if it was too late already? This was my first encounter with an infant where I thought it may not survive and I felt absolutely helpless!
I went to find the nurse to see if there was anything else I could be doing. I couldn't find her and when I asked a parent of another patient if they'd seen her, they said she was searching for equipment. I asked if another nurse was around and was told no, she was on her own. My heart sank as I realised this nurse who'd dedicated so much time to the baby we had brought over was responsible for all the other patients too - at least 3 other neonates, 5 children in the diarrhea unit and minimum of 3 other inpatients.
I went to the mother of the infant I was with and with the help of another 'NCU Mother' who knew a little English and a lot of gestures, she finally understood my request of her to express some fresh colostrum. As I thanked her and turned she reached for me and started speaking to the other woman who'd managed some translation. They both looked at me and seemed to be asking something, I told them 'Sielewi. Pole' - 'I don't understand, sorry'. The second woman then asked 'girl? boy?' It was now that I realised the woman didn't know if she had a son or a daughter, she hadn't seen her child since they were transferred in immediately after delivery at 6am this morning! My heart dropped for her. Without saying anything I took her hand and led her after me, gave her a hair net and pair of shoes and ventured into the warm room where the babies were all asleep. I introduced her to her baby while she whispered 'asante' 'thank-you', I carefully unwrapped part of the kanga and showed this woman that she had a daughter. She kept her distance while continuing to whisper 'asante'. I pulled out my hand gel, squirted a bit onto my hand then motioned to put some on her hands, we rubbed our hands dry then I took her hand again and placed her finger in the palm of her daughter's hand. After a couple of minutes the woman stood up straight, said something to me I didn't understand (again) but from her gestures I gathered she was going to the other room to express milk for her baby girl. 

The nurse returned with equipment for siting a naso-gastric tube. As I'd already seen that they have very little single use equipment, I was intrigued as to how this would be done. She had a tube as we would have in the UK and some cooled boiled water in a sterilised cup. As she was preparing she asked me how we site an NG tube in the UK, I felt relieved that this was something I'd learnt to do on placement a couple of weeks before going to Tanzania. I told her how we measure the tube for the infant, how it's inserted and how the pH of the aspirate is checked before each feed to ensure it hasn't been inserted into the lung. She was very interested in what I told her and again apologised for not having such advanced equipment. I told her not to apologise, she's doing a wonderful thing and us mzungu are just lucky.
She dipped one end of the tube in water to lubricate it then asked me to hold the other end of the tube in the water, keep it there and tell her if I see any bubbles. She began inserting the tube in the right nostril and told me that if the tube is sited in the lung then as the baby breathes out bubbles would form in the cup. This was how she checked it's location. While I did think this was an interesting way, I did think that this technique must also carry the risk of an infant inhaling water via the tube. The tube was sited, there had been no bubbles and the water level in the tube had not moved either. The mother had brought some colostrum and I drew it up into a fresh syringe. The nurse gave the feed. Finally! Her chest sounded clearer, heartrate had improved, skin colour was better and there was no longer any nasal flaring! The nurse had got hold of a thermometer and while I can't remember it, it had improved, thankfully!
Time had flown and Tom was waiting to take me home. It had been a long, tough day. Now I was hoping the little thing was gonna be alright overnight and kept on humming the tune which soon became the theme-song to my time in Tanzania.

One of the incubators on labour ward

The cots in the neonatal unit warm room

The resuscitaire with foot pump suction and the oxygen pump to the left