Thorns and Needles: Tanzania Week 7
Korogwe District Hospital, also known as Magunga, sits right across from the NIMR office in Korogwe. I pass it every morning and evening as my work days begin and end. Occasionally, I pass when the sun has dipped slightly below its zenith as I walk down the dirt path to Mama Chipsi’s squat, tin roofed eatery. She makes the best Chipsi Mayai in town and she still finds it hilarious that the mzungu speak better Swahili than I do.
Magunga is not a very striking building. From the outside, it would be easy to mistake it for something other than a hospital if not for the giant billboard listing prices and medical services in hand painted blue and black strokes. On the inside, it was impossible not to see, or smell, that this was a place filled with the sick. There were no individual rooms, only wards or sick bays lined with beds. Some of them had dividers between them. A few of the more unlucky patients shared beds with each other. Some areas, like the pediatric ward, had paper signs with ailments scrawled on them fixed to the walls above the beds. Burn. Malaria. Unknown. Mothers sat on benches with their sick children and patiently watched the next person in line take the five foot journey from the waiting area to the head nurse’s desk to receive consul, medicine, or both in full view of the others. In the open air dirt center of Magunga, and in the grassy channels between the various small buildings that were detached from the main halls, the ever present, vibrantly colored kangas swung on clothes lines and hips alike. I was told that for Magunga, this was a quiet day.
A retired doctor and former District Medical Officer felt that if I really wanted to know about the management of febrile convulsions at the hospital level then I should see what it was like for myself. All the health workers I interviewed, from village dispensary nurses to district hospital doctors, had mentioned the use of Diazepam as an anti-convulsant. However, he was quick to point out the high likelihood that any given ward would not have it in stock. Even if it was in stock, there was a high chance that a given health practitioner, usually a nurse, would not know how to find it very quickly in an emergency.
So we tested it out. We entered the Surgery Theater. He asked if they had any diazepam. They didn’t. But, an old woman sitting in a wheelchair, IV drip snaking out from the bottom of her half-empty saline bag, around the pole the bag perched on, and into her veins, had a small, black, plastic bag in her lap. The nurse walked over, plucked the bag from her lap without asking, dug around for a few seconds and found a vial of diazepam and a syringe and handed it to him. Not surprising, as common practice for surgery here involves giving the patient a list of necessary drugs, like ketamine, and supplies, like sutures and syringes, to go buy, usually out-of-pocket, from a private seller for the surgeon and nurses to use. The only real stock the surgery theater ever has is whatever is left over from the last operation.
We continued to explore and question. The Maternity Ward? No diazepam. Pediatric Outpatient Clinic? Nope. Women and Children’s Clinic? The head nurse supplied Diazepam tablets and insisted on their efficacy, despite the obvious issue of getting a small child in the midst of a seizure to swallow a pill.
In the Pediatric Ward, four nurses sat around a small card table talking amongst themselves. Once again, he asked “Do you have any diazepam?” The three nurses closest to us averted there gazes and said nothing. The one directly facing us, her bright red and yellow hijab hugging her small round face, pointed to the shelf behind us and said ”Ipo”. The shelf was empty, apart from some emptied vials, one of which was, or at least had been, filled with diazepam. When the doctor pointed this out, she defiantly got out of her chair and marched down the hall into another room, shuffling through drawers and cabinets as she made her way further and further back into the room before moving on to the next room and repeating the routine. Finally, after a few minutes, she was able to produce a small box with 5 vials of diazepam. The doctor caressed one in his hand, rolling it around between his wrinkled fingers.
His point sufficiently demonstrated, he thanked the nurse and accompanied me along the three-car-length walk back to the office before we parted ways. After that, I conducted my final interview and finished collecting data for my study.
I didn’t realize until later that evening, but I don’t remember him ever giving either of the two vials back to the nurses.
The next few days were largely uneventful as I waited for translations of the interviews conducted in Swahili and took notes on the interviews I conducted myself in English. Friday, I caught a ride to Tanga with two of the Danes living in Korogwe, Rune and Sophie. Katrina, our abroad program coordinator, and Dr. Vuckovic, my International Health Promotion professor who had a lot of experience in Tanzania, were visiting all of the sites in this country and meeting our preceptors but wouldn’t have time to come to Korogwe. So I was coming to them. Driving in a private vehicle was significantly faster than taking the bus, so I arrived in Tanga before Nick was done doing field work. I decided to take advantage of the Wifi to look through more graduate school information as I waited for him to return. The decision making process for my post-graduation path has begun to loom larger and larger.
After meeting up and grabbing a beer, we went to have dinner with Nick’s two new friends: Jiwon, a South Korean working in Tanga, and a German medical student who was currently couch surfing at her place for the weekend along his travel break across Tanzania. He had just taken a small dhow with dozens of people on it from Zanzibar to Tanga in the middle of the night. A terrifying ride across a seemingly dark and empty expanse, but he had a clear night sky and plenty of stars to calm him along the way. The two of them prepared an amazing mish-mash of cultures and flavors that had my mouth watering as I waited to eat. We were then joined by three Norwegians and a Swede for dinner. Between them, the five Danes in Korogwe, and the 50 Norwegian nursing students Nick had also just met in Tanga, I’m beginning to think the Scandinavians have a think for Tanzania.
The next day, Nick and I paid a fisherman to take us to Toten Island, a tiny blip of land in the Indian Ocean off the coast of Tanga. Once we landed, he offered to show us around the island. We followed him along a little path deeper into the trees, instantly regretting not wearing closed toe shoes as he picked up a large stick to bat the thick brush into submission. From ahead of us he cheerfully chirped “Don’t worry, no dangerous animal here except bird!” as we passed old German graves. A bird call that mildly resembled a human baby rang out from deeper in the woods. Not too long after that, he casually said “Oh, except snake. Don’t step on them” before continuing on.
Suddenly, he spun around, put his finger to his lips, and told us “Do not speak. No touch trees”, before continuing on without explanation. Confused, but not wanting to stray away from our guide, we followed. The path had changed, opening up into relatively even dirt. A new type of tree lined this stretch, bowing over us from either side like a tunnel, the canopy creating a dancing display of shadow and light on the floor that we tried our best to tread lightly on. Nick made a muffled, but distinctly alarmed sound and grabbed me as I heard a loud buzzing. He pointed past my head then up. A large and strange insect that I can only describe as a giant wasp with spider legs, had flown past my head. And there were more of them above us. A lot more of them. Once we reached a certain point, our guide finally turned around and explained that if we made too much noise or accidentally shook one of the trees they would all come down and sting us till we swelled, mimicking how large our faces would get with his hands. We reached the other side of the island and saw the cliffs before returning to the beach.
At one point, our guide began stepping very gingerly and poking around with a stick repeating “Careful! Mwiba! Mwiba!” Alarmed because he was alarmed and because we didn’t know what that word meant, we asked what it was, but he couldn’t think of the word in English. After a long while, it finally came to him.
Thorn. The one thing on the island that truly worried him was, of course, a thorn.
