Neema orphanage

Day 5

Following a recommendation from Mr Mushi (our supervisor) the four of us took the opportunity to visit a local orphanage a short walk down the hill. We arrived during naptime (I was jealous) so were first shown around by a Swedish girl who has been volunteering at the orphanage for the last few months. The place is almost self-sufficient as there is a fairly well stocked farmyard with cows, chickens and pigs, as well as a large area for growing fruit and vegetables.

The orphanage itself is a complex of quite modern buildings, a circle of small houses around a central clearing and playground. The place is funded by various charities, organised by the evangelical Lutheran church of Tanzania, and is run by a small team of hardworking nuns and some volunteers. There are about 40 children in total, divided into three age groups: 0-18months, 18months-3yrs, and 3-5yrs. Many of the mothers had died in childbirth, some from AIDS or road traffic accidents, though many were simply too poor to look after the children.

We spent most of our time in the first house, with the babies. Helpfully they seemed to wake up one by one allowing themselves to be washed and changed in an orderly fashion. I heroically attempted to help change nappies and now claim semi-competence at it, providing there is no requirement for this to be done quickly. I’ve not held many babies before but it’s not as terrifying or difficult as I’d imagined – I didn’t drop even one. The babies were delightful, almost universally quiet and happy, and curious about their strange-looking visitors. And of course, embarrassingly, we took clichéd pictures posing with African children.

I wondered whether we were inadvertently causing harm by swanning in and giving these children such enthusiastic attention before leaving forever- and perhaps spreading infection too. It seemed cruel and thoughtless that we took entertainment in the face of these children’s difficulties and the staff’s toil. Overall I convinced myself that it is good for the children to have a bit more human interaction. I don’t think there are sufficient staff to extend far beyond the feeding and changing duties and with such a workload the babies would often have to be left relatively alone and unstimulated.

A picture of yours truly (centre) and a surprised child (right).

Day 6

After church Mary and I followed Dr Mwanja on his morning rounds, seeing patients admitted the previous day and those who were quite unwell. Taped up on the wall of the female medical ward I found a handwritten list of the commonest diseases at Machame the first five of which are:

1.        Hypertension

2.        Peptic ulcer disease

3.        HIV/AIDS

4.        Gastroenteritis

5.        Malaria

Obviously this would be a more interesting list if I could provide a similar UK list to compare it to. I tried to get one but the internet’s not so quick here so I’ll just completely guess instead. I imagine it might contain a few different things that I’ve seen a lot of in UK hospitals, such as:

MI (Heart attack)/ Cardiovascular disease
Diabetes
COPD (smoking related- lung disease)
Dementia
Cancer (especially gastrointestinal, lung, prostate and breast.)

We saw a lady on ITU (the only room with oxygen cannisters) who had stage IV heart failure; she was extremely breathless at rest. Heart failure comes in at number 7 on the Machame disease list. The doctors think she had had undiagnosed bacterial endocarditis and now had multiple valve disease – her systolic murmur is audible without a stethoscope. Her X-ray showed that her heart took up most of her chest and she had ascites, liver failure, and peripheral oedema. Apparently her condition had improved following high doses of furosemide, a potent diuretic, though her prognosis remained dismal. I was shocked to learn she was only 30 years old.

Today the Imperial girls (Poppy and Sarah) move on to Zambia, we’ll go for a farewell dinner with them in Moshi later this evening. They’re replaced by the return from the coast of some German volunteers, one of which will be my flat-mate for the next three weeks and is currently at the hospital being tested for Machame diseases numbers 4 and 5.