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Saturday 29 June 2013


I sit on the steps to the hospital entrance sipping a warm Pepsi. People amble around me, chatting, laughing, and singing. Three old men are perched on a tree trunk, smartly dressed in suits, clutching bamboo canes and swinging their bare-feet in the dust. Two girls walk past with huge golden papayas balanced skilfully on their heads. A Masai tribesman draped in deep red robes paces under an acacia tree talking fervently into a mobile phone. Welcome to Berega.

I reflect on this week’s highlights. Unexpectedly I have found myself overseeing the paediatric ward. Two children were admitted over the weekend with soaring temperatures, bright yellow, and in deep deep comas. Every year, 18 million Tanzanians get malaria, and of these 60,000 die. Nearly all deaths are children aged under 5. The environment is just the right (or wrong) combination of warm climate and poor housing, leading to maximum biting from parasite filled mosquitoes. Children suffer the most as they have not had the years of exposure to the disease and ultimate resistance which that brings. The children we admitted had the most severe form possible, cerebral malaria, with involvement of the brain. Without treatment it almost always results in death. The team treated them diligently, we crossed our fingers, and watched anxiously on the first, second, and third days as they slowly improved but failed to revive from their comas. Then miraculously on the fourth day they were eating breakfast, and on the fifth day they both walked home.

Not all has gone well. I saw a two year old girl last week with Kwashiorkor, the most extreme form of malnutrition, whose parents refused to allow her to be treated in hospital. This is a life-threatening condition where the whole body starts to shut down, the most obvious manifestation being generalised body swelling, thin brittle hair, and a lethargic demeanour. This poor, tiny girl was so weak she was unable to cry, managing only a few muffled sobs. The mother, without an extended family to care for her remaining children, found it impossible to remain in hospital and fled overnight with her little girl. She has not returned and there is no way to trace her. The mortality of Kwashiorkor is high, and without specialist treatment and intensive feeding it is difficult to be optimistic. As a team we are deeply upset. We struggle to find some meaning or lesson to take from this. We muse on the huge social and economic pressure that illness puts on society, and especially on women. Mothers, daughters and aunts are relied upon not only to provide the most basic elements necessary for life (water, firewood, maize from the farms), but also to remain in hospital providing the majority of nursing care for sick relatives. This mother was forced to choose between the health of her daughter, and the feeding, warmth and security of her entire family. Perhaps without her presence at home another child, deprived a few bowls of maize porridge, would drop a few calories closer to malnutrition. Akin to Sophie’s choice, no one can hold her responsible for her disappearance from hospital. Unfortunately, the problem is not as simple as sending money, or food. Something, somewhere in the great antiquated systems driving economic and gender inequality is to blame. We must strive to fix this. We must think. We must learn. And in the meantime, we must do our best with the remaining patients.

I spend the evenings attempting to learn Swahili. On the whole my speaking is unintelligible, with occasional flashes of fluent idiocy. Thankfully, instead of demanding my immediate resignation, the patients have the grace to laugh. A ward round begins as I ask a giggling mother whether her baby has been doing much cooking the past few days. At the next bed the impeccably polite nursing staff cannot hide their grins as I enquire how beautiful a boy’s stools have been. Finally, as I leave the bedside of particularly terrified looking six year old girl I’m informed that I’ve just told her that a goat will be along to weigh her.

So as the sun sets over the dusty, green valley, my solar powered computer battery slowly dies. I hope to write again soon. Even during the past few days I’ve accrued a year’s worth of stories- hope, sadness and futility thrive here. Thank you for reading.