First impressions of nursing in Njombe from McGill MSc(Nursing ) student in Tanzania

This Monday, Amy and I attended a quarterly meeting of Nurses for Highlands Hope. We meet with Evangelista Koyombo, the head nurse at TANWAT and Chair of Highlands Hope of Tanzania, and several other members of the group in the cloudy, smoky, cold dawn that arrives every morning in Njombe. Betty Liduke is notably absent. Though she barely paused to recover from her first encounter with Malaria a few weeks back, her left hip has been giving her trouble and she has decided to take a rare day off.

We pile into the hospital jeep/ambulance and begin the two-hour drive over the bumpy road to Ikonda Hospital. The sky gradually begins to clear and the windshield wipers are put to good use chasing away the dust which, when stirred up by other cars, becomes a veritable fog and hazard.

Having arrived safely at our destination, we proceed to walk down the road to the little village of near the Hospital. Until this moment, there has been little, if anything, I have encountered in Tanzania that I would describe as quaint. Rustic maybe. Bucolic, perhaps. But nestled in amongst rolling blue and green hills, Makete stands apart.

Little dukas (stores) proudly display their multi-colored wares, thermoses stand to attention beside rows of oranges. Children in blue slacks and white shirts mill about, waiting for the school bell. Our party moves into a little restaurant where the waitress brings us Chai and mandazis- a sort of deep-fried-bun that is typically served for breakfast here. The mandazis are sweet but the Chai is sweeter and Evangelista tells us about how she used to own the restaurant we sit in, back when she practiced as a nurse in Makete.

Breakfast finished, we return up the hill for a tour of Ikonda Hospital. It is bright, clean and efficient. It smells like bleach and clean laundry. It has western toilets in every room, it has incubators, it has working CD4 equipment, and it has a well-stocked and organized pharmacy. It is a marvel.

In addition to offering all HIV/AIDS related services for free, it provides pro bono care to children under the age of ten. Unsurprisingly, it is a busy place: though they have 45 beds they are currently treating 60 patients, and it is funny how much this reminds me of home; seeing hospital beds turning hallways into impromptu hospital rooms.

The tour over, we settle in a sunny courtyard to wait for the meeting to start. Because time is slower here, or maybe just measured differently, and so waiting an hour, maybe two, is the inevitable precursor to any event.
The meeting begins, oddly enough, with a discussion as to whether or not it should proceed. Of the fifteen members scheduled to attend, only eight are present, and so there is debate as to whether to even hold the meeting. It is decided that we will continue, though hold off on the more important points until December.

Discussion centers on the need to increase membership. It is decided that on October 14th, representatives from Highlands Hope will make the three-hour journey to Lukalawa Hospital to disseminate information about the group and hopefully recruit new participants. Funding for this, as well as other activities, is critical and becomes a major topic of debate. The treasurer is absent and though the exact amount available to the group is unknown, the chair is confident when she stresses that money is tight. Yet expenses from the apparently slight- purchasing the paper on which the minutes are written- to the more obvious- transportation to and from meetings, are adding up. It is concluded that there should be enough in the treasury to provide for the trip to Lukalawa.

We return to TANWAT and a troubling sight. The hospital is located at the top of a small valley. About half a kilometer away and directly across the valley is the TANWAT Wattle Factory. We join a group of nurses and a doctor who are standing in the open hospital hallway that is also a balcony of sorts, staring with grim fascination across the way.

A fire set some time ago has grown out of control and flames the size of a small house dance dangerously close to the factory. Fires are not uncommon here; they are routinely set to regenerate the land, to burn garbage, really, if something gets in the way you just set fire to it. very cathartic and the air often smells like November at a cottage.

However, today a strong breeze is enabling the fire to gain strength and is pushing the flames towards the buildings. Had there been a fire extinguisher it would be too late to use it and there is no fire department waiting for a distress call. There is nothing to do but watch and wait. We stand together, mostly silent, and watch the flames grow and subside until our eyes become tired of the display and one by one we go back to our respective tasks.

The next day, we stand together once again overlooking the now charcoal black patch of land that is still lazily smoking. The factory is intact but TANWAT has nonetheless suffered a heavy blow. The fire managed to destroy a cache of lumber that had been treated to act as electrical poles. Valued at close to 100$ US apiece, this presents a significant financial loss to a company already burdened by economic setbacks.

Still, the day moves on like any other. And perhaps this is what I am learning more than anything else here, resilience. There is a KiSwahili word: "pole" that means "sorry for your suffering." It is poetic in that it is said to all patients, simply and without pity. People acknowledge hardships without dwelling on them; perhaps because the suffering here is more immediate there are no histrionics and there are no maybes. You take what you have and you make do and that may sound ridiculously trite and hopelessly unjust, but it is true. Whether it is finding the money to buy the paper on which to print the minutes of a meeting, or finding the necessary materials to improvise a splint for a patient, it is these little steps that people make everyday that allows for forward momentum.

Have a nice week and I hope to send some pictures soon,