Two ants in Tanzania: July 2009

Sunday, 19 July 2009

A Trip around the country (Where does that road go.....?)

We took the opportunity of the public holiday of Saba Saba ( 7th of July) to tour around the country behind where we are staying.
It is an area of rolling hills with swamp in the valley probably representing where Lake Victoria once extended.

We are in the dry season and it has not rained for a month. The roads are dusty and the grass dry and browning. There are many small grass fires, leaving a tails of smoke stretching across the sky. The ground is reasonably fertile lower down in the valleys but it is fairly barren on the hills.

Women and children carry huge loads on their heads move aside for the occasional car. We thought of giving them a lift but were not sure the suspension would have taken it.

We arrived at a river with ferry and Annie patiently waits for some activity

(The women and children carrying their bananas hurrying to catch the ferry)
We all piled on the ferry which was ably pulled by several cheerful ferrymen. We shared the passage with lots of bananas, having been carried there on bikes and on heads by the women and children.
On the other side we were pleased to be able to give a lift to a mother and her three small children and luggage. They were miles from their destination; people have to travel great distances here to visit relatives and friends.

We passed the ruins of what must have once been a pretty church with Roman arched windows, now inhabited by monkeys. The smart new, more functional church stood proudly across the road.

In the evening we frequently come across cattle coming home. We never cease to be amazed at their huge horns, which are apparently hollow, so are not as heavy as they look.

It was a lovely day out; we returned dusty but refreshed for a change of scene.

Betrothals,Send Offs and Weddings

It is now the dry season and the popular time for family celebrations. We have been invited to several.
First there is the betrothal day when the bride’s family celebrate her engagement. This is a family and community affair with the usual meal and drink. There is usually a large area prepared with awning and fresh cut grass on the ground and a sound system with music and commentary to pierce the eardrums! The bride processes round introducing herself to the assembled group (and also soliciting donations) and there is a little dancing and singing. Negotiations start about the bride price that the fiancés family have to raise.

Later there is the Send Off (held about two days before the wedding,), which is held by the bride’s family. The bride appears in her finery and is supported by a maid of honour and her bridesmaids. She processes slowly to a kind of throne and has a veil over her face. The fiancée has to positively identify her and agree that she is The One. She introduces him to her family. There is dancing and some speeches and a cake is cut. The groom with his supporters sits out most of the time. Later there is dancing and music.

During the celebration there is a MC with a mic giving a running commentary. The bride has to look sad the whole time and is not allowed to smile, to show how sorry she is about leaving her family.
Two days later the wedding takes place at the groom’s place with a different group of guests.

We also went to a 25th wedding anniversary where they all dress up and have prayers or mass, speeches, cake again, singing and dancing and feasting with the usual tribute of gifts given by the guests. The expense is great but contributions from the guests help to support the cost.
Much represents traditional culture but the externals of western culture are taken on in the shape of extraordinary hairdos, very smart clothes, jackets and ties, microphones and huge speakers, wedding cakes, a bottle of bubbly shaken and sprayed about the place (why?) and the matching dresses of the brides entourage. One must remember to bring ones invitation in order to get a plate of food and a bottle of soda. However the rest bring their pombe (local beer) in their plastic containers and join the celebrations.

These are Winifreda's sisters and brothers giving them a new matress and other presents. They are enjoying themselves.

This was a Kagondo contingent with Oliva, an ex matron of Kagondo and Jenessia

There are always dozens of people hanging around on the perimeter, having a good look -- also a splendid business opportunity for the food vendors as the spectators get hungry and thirsty too!
These events are usually held on a week day; we went along after work (many take the day off to go) and although we missed the main feast, we were given food especially saved for us by the hostess: matoke – banana cooked with beans, onions tomatoes (a staple here), pilau rice, beef stew cooked Swahili style—all delicious.

A good time was had by all.

The Care and Treatment Centre

The outpatient clinic for HIV positive patients, the CTC continues to develop. We are registering about 20-35 new patients a month and now have about 400 on our books. A clinical assessment is made and we check their CD4 cell count. If this is low or they are clinically very unwell they will start Anti Retroviral Treatment (ART). They need to pick a treatment supporter, ie someone who is willing to come to the clinic to get their drugs if they are unwell and who will encourage them to stay on treatment. Both the treatment supporter and the patient need to attend on three different days for adherence counselling before starting ART.
There are about 190 people who have started ART (about 15000 in the Kagera region alone) and they have to attend every month. The default rate is remarkably low and is less than 5%. This is lower than many CTCs in USA, since many HIV positive patients in the West are drug addicts and have chaotic lifestyles. The response is usually rapid with 5 – 10 kg weight increases in the first 6-10 weeks. Certainly most of these patients would have died without ART. Some have been taking them for 4 years and are leading normal lives.

I (Rupert) often do joint consultations with Sister Immaculata, which helps us to learn from each other and speeds up the process. However if she is busy or away I do joint consultations with Godeliva, the hard working CTC nurse. The aim is to train her up to do routine assessments of monthly attendances herself.

The work is enjoyable with a deal of humour over my inability to speak reasonable Kiswahili. We have two good peer educators, Adventina and Gosberth who help to encourage the patients and do the register. We work almost non-stop till about 2.30pm then home for lunch and rest and admin work.
I (Annie) am spending more time in CTC helping out as we get busier, as well as linking in with the mothers and babies. We run a mini dispensary and I dispense all the ARTs and prescribed drugs, explaining how they should be taken. I try to help keep the registers up to date. All ARTs have to be signed for by the patient and some of the regimes can be very complicated, especially for new patients and small children. We are pressing for another nurse to be appointed to CTC to be to trained take up the work I am doing… “..we hope for one next month..” I have managed to learn a (very) few KiHaya words, which delights all the patients and sends them into peals of thigh-slapping laughter, giving them something to discuss for ages. Must be my accent!
We have our occasional heartbreaks of course, mainly involving children. Last week a sick 16yr old came in on her own and whispered to Rupert and the nurse that what was the point of taking her medicine when she was going to die from hunger, not having eaten for 2 days? She’d spent her last pennies to get here. We quietly all clubbed together to get her some food and chai and were able to refer her to an excellent NGO who helps orphans such as her.
But generally we have a lot of laughs amid the hard work and we feel the patients genuinely appreciate our efforts to help and thank us often.