Shaking my head, I walk into the empty room and crumble against the closing door, tears welling.
A few days earlier, I was stepping off the plane under the dark sky, bright with stars, into the unforgivingly hot night air. I can smell the heat. As it rises from the tarmac, I struggle to breath, almost like trying to breathe a cloud – dense, wet, saturating. Uncurling myself, I stretch out the kinks from the 28 hours of travel it has taken me to arrive on the African continent. My body remembers my many times here and naturally finds a rhythm that corresponds to the heat. I move slowly, like being in a dream, noticing the many white people rushing past me to line up for visas and customs. They are on their way to safaris and mountain climbs, while I am here to lead my team of 20 Canadians to provide medical care for the people of Ukerewe Island in the middle of Lake Victoria in Tanzania. Working with our Tanzanian partners, we will become a team of 40 setting out every day to a different village on the island.
As our team gathers, I grab Elizabeth. “Do we have everyone? Get your visa first and you can start collecting the bins and luggage, OK? Take Barb with you.”
The visa officer looks bored, and who could blame her, having hundreds of white tourists vying for a place in line. Every time it is the same. Bleary eyed tourists looking as confused as they feel. For me, the familiarity is reassuring as I sink into this feeling of coming home, of coming into myself. I find the visa supervisor and explain we are a group of Canadians looking for working visas.
The cost for a working visa is $250 USD while tourist visas are $75, so the supervisor is happy to have our group of 20 to process. Sitting at his desk, he is slow and methodical, simply doing his everyday job. Team members are done in, with a kind of anxious, restless energy – the trip itself has been exhausting. Trains, planes, buses, taxis, and we still have a 3 ½ hour ferry ride to look forward to.
Fifteen hours later we arrive on Ukerewe Island. Stepping off the ferry I am greeted by chickens, goats, women selling fruits, and young men selling an array of socks, watches, toothbrushes, and candy. The children are everywhere always finding a way to run and laugh at me as I pass by. Like the commercial that pull at your heart strings, they have no shirts, no shoes, and bellies that are big, infested with intestinal worms. However, these children are happy and don’t seem to be bothered by clothing choices, at least not today. I hope their parents bring them to see us on medical caravan so we can treat those worms.
Mzungu”, they holler and laugh. The name the children call white visitors, sometimes as a taunt, sometimes as a tease, and often following the lead of the older children.
“Rafiki (Swahili for friend)”, I call back letting them know I want to be their friend, and they laugh even louder. Running off they join more friends in a game of plastic-bag soccer using a pile of plastic bags held together in a ball with rubber bands. I notice a little girl in a purple dress ripped at the sleeve and belly, who is carrying her infant sister. The baby’s tiny face peaks out from under the colourful African kanga holding her to her sister’s back. Her mom maybe be in the fields or one of the sellers here at the ferry dock trying to make a few dollars to feed the family just for today.
We spend the next few days in meetings with our local partners at the hospital. The Tanzanian nurses and clinical officers are dedicated, friendly and so under resourced. Oliva, a nurse, smiles as I see her and quickly grabs her phone for a photo of she, me, and the chicken she is carrying home for dinner. There are very few doctors on the island. Glory, a clinical officer tells stories of helping to deliver babies with no gloves, something that would never happen in North America. People living on the island wait 6-12 months for the medical caravan from Canada to arrive, the only time they can access free medications for medical problems like pain, malaria, worms, and diarrhea.
Monday morning, we arrive in the village of Muriti loaded down with supplies, despite one truck breaking down on the way and a medical supply bin jumping off of the Land Rover mid journey. Each day for two weeks we will arrive in a new village to provide care to the best of our ability. 20 Canadians and 20 Tanzanians disembark to a crowd of hundreds of women, children and men waiting in the sun with broken bones, burns, high fevers, and malaria hoping to access the health care that otherwise they might die without. I am team lead. My sisters might say it is because I am the oldest, the bossy one. I guess my brother would say that too. After all, I was the one who sent them to bed when our parents were out and ignored them at school, being too cool to give even a quick hello. I have learned over the years to transition my bossy into a somewhat commanding presence, giving off an air of confidence and assurance.
Our team members have seen the news clips, read the stories, watched the films and documentaries about Africa and now they are here to help. I can relate, having been there myself years earlier. Their energy, anxiety and anticipation are brimming and pulsing in the heat as they ask question after question.
“Where do the bins go?” asks one team member with floppy hat, doused in sunscreen, and beaming with excitement. And I begin pointing, directing, shouting to be heard, and answering 10 questions at once. This is where I thrive, where my skills and talents come together. Both my sisters are teachers. Me, I would have made a great principal. I love understanding how things work, how they fit together like a well-oiled machine. Here in this space and time, I love figuring it all out. In the middle of a small village, we are able to set up an entire clinic that will see 400 patients. It looks like chaos, yet I can see the flow and I love it. I know what goes where, where everyone and everything belongs. I feel like the director of an orchestra, where each note sings with beauty. This is my seventh medical caravan in Tanzania. I am not just in a sweet spot – I am my sweet spot.
Deo, the local clinical officer, is in charge of the centre where we are setting up the clinic. We walk through the health centre, probably the nicest one on the island. The first building has a courtyard open to the outside in the centre, where some kind of bee makes its home and stings like hell. A couple of wheelchairs block the hallway and the odour from the indoor toilets has me breathing through my mouth, although even that feels gross. Together Deo and I look at the options for rooms that we will take over for the day. I have been here every year for the last six so am familiar with what is available.
“This one is locked – can you open it?” I ask.
“You cannot use this room”, he responds.
“Can I please have a look?”. I cannot take no for an answer. The more space we have the easier the flow of people coming and going to see medical, ophthalmology, HIV testing, gynecology and finally pharmacy will be. We take over every nook and cranny trying to make this delicate interweaving of Canadian and Tanzanian team members work to provide health care to as many people as possible.
The room is 5 ‘x 5’ with a large sterilizer smack in the middle. Nyanda, the dentist, has been my co-lead for all these years. We are friends and work together with a common goal. He is a slight man with a big smile and a heavy workload. He has worked in smaller spaces than this and is super flexible, no ego.
“Nyanda can set up in here. Thanks Deo.”
Stepping back outside into the heat baked fray of black and white faces, I search for her.
“Elizabeth, where are the charts? We need to get them out to the people waiting now! Take Bebe with you.”
Elizabeth and Bebe wade out into a sea of people. If we were doing a medical caravan in North America, people would wait their turn by standing in the line. We have a line-up mentality, first come – first serve. In Tanzania people have a grouping mentality. They form a large unwieldy crowd, with big groups and smaller groups all clustered closely together, and usually leaning toward finding some shade. Still they know who is next and when their turn is. For some new team members, it feels like mayhem. For me, it is different. Rather than my usual claustrophobia when people get too close, from the first time I was here in Tanzania I learned to embrace the closeness of the people gathered around me. I feel my feet on the ground, and I am here in the present moment. No Zen meditation needed. The positioning of tarps is being discussed to best protect waiting people from sun and shade. A pharmacy appears where an empty storage space sat moments ago, with medications piled high waiting for medical diagnoses. Medical stations are up, doctors, nurses and clinical officers prepped and ready to see patients. Logistics people have everything unpacked, and are armed with clipboards, Swahili phrases, lots of patience and big smiles. We are ready to begin.
I stand back for a moment to observe the miraculous flow of people and I feel proud for what we have created in such a short period of time this morning, here in this small village in the middle of the island far out in Lake Victoria.
A drop hits my head and I can see the rain coming, dark clouds quickly covering the sun.
“Inno, the tarps have to go up now. Grab that corner and tie it off to the tree. Where is Bebe? The rain is coming.”
I am moving quickly, running and climbing to tarp to trees and trucks, trying to keep the crowds out of the rain, because it will be a free for all once the rains begins in earnest. Tarps, garbage bags, umbrellas are passed around with the hopes of keeping the crowd in the line it took Elizabeth and Bebe two hours to get organized. A crack of thunder and the heavens unload. Hopeless, we give into the chaos. I grab the corner of the tarp trying desperately to keep the rain off the people, some sick and shivering, waiting for medical care, getting drenched myself. The people look at me curiously. I think they are wondering why would I stand in the rain until I begin to shake from cold and fatigue? How can I explain that there is nowhere on this planet that I would rather be than right here and right now. I feel useful and needed. What I am doing here with my team matters to the people we are serving, and it matters to me! And somehow that equation equals me having meaning, having value.
Fifteen minutes later, I am soaked to the skin and the sun comes out. Passing by grannies and mamas holding sick babies, I slip inside to see how things are going and to dry my face off. I gratefully take the coat Chris, our medical lead, offers so I can put something dry on my sodden body. Dr Sally rushes to my side.
“I have a 4-month-old baby weighing less than 1 kilogram, at least that’s what we think as she doesn’t even tip the scale. Her mother’s sister brought her in. The baby’s mother is dead, AIDS, and her sister has been looking after the baby and feeding her cow’s milk. I am afraid she is dying.”
I hold up my finger and shaking my head, I walk into the empty room, and crumble against the closing door. I can’t breathe. Four months old! One kilo! I am not making sense of the words. Last month I was with my youngest sister when she gave birth to a ten-pound healthy baby boy ~ five times heavier than this tiny four-month-old. I can feel my brain struggling, trying to understand, but there is no time. My job here is to organize, to assign money, to be the hub of the wheel. A sip of water, a big breath and out I go to find Sally and make this right.
This baby has eyes like saucers and bright as stars in the dark sky. Peaking out from Sally’s arms, this little girl, Neema must be a fighter to still be alive and like a battalion of loyal soldiers we will surround her and fight our way through to give her a chance at this life.
“The lunch truck can take her back to the hospital. Can we send one of the nurses with her and her aunt?” Irene, our Tanzania coordinator helps us to speak to the aunt who has left her own child at home and has no money for transportation. There is a long discussion.
“Can she go with Neema to the hospital? Does she have someone to look after her kid?”
Irene translates and the aunt agrees to go with Neema to the hospital. We give her some money for food for her family at home and for herself while she is at the hospital. The lunch truck arrives, filled with pots of rice, beans, and fried fish to replenish the team for the afternoon. We quickly unload and send the driver off with Neema and Aunt to Nansio Hospital, where there is never enough of anything and chickens are often seen visiting the surgical ward. I later learn that for every 1000 live births, 57.6 babies born in Tanzania will not make it to one year compared to 4.4 babies born in Canada. I do not want Neema to become a statistic.
Sally doesn’t go to lunch, she is worried. I can see her frowning as we send the next patient to her station. These medical people we have are incredible. Karin pops over to check on Sally and her translator. They quickly debrief the situation and make a plan to visit the hospital later. As the sun starts to set in a sky clear and blue, we have seen 500 patients and the team is beat. Deanna has gone out to play with the children who are singing and dancing around her and making her laugh. Our pharmacy team is still hard at it getting prescriptions out to the hundreds of people we have seen today.
“How much longer,” I ask Warren. It is a running game we play. Him dispensing medications and me counting charts trying to figure out what time we will be leaving for home each day.
“5:50” he responds, and I guess 5:35. We have been friends for years now, only ever seeing each other when we travel to Tanzania. He is a big bear of a man with a listening ear and a warm hug which many have taken advantage of through the tears of a situation they will recount that has broken their heart. Like our little Neema.
One week later, Neema is at the big hospital on the mainland in the malnutrition ward with Zachary the nurse. The Canadians have left for home in a wash of tears and hugs, we have packed everything up for another year, and Elizabeth and I are on the ferry heading to Mwanza on the mainland where, I have assured Sally that we will check in on Neema.
The smell of fish, the view of homely, filthy storks gathered around the ferry dock, the heat of the day pounding not like a hammer on a nail but more like the pressure of having your body slowly melted and flattened onto the ferry deck.
“Hujambo rafiki”, our friend and driver Goodluck calls out to us and my smile brightens as I see him bustling through the ferry workers, hawkers, sellers, and travellers to get to us.
“Sijambo, habari mchana” as I ask how his day is going. He grabs our bags and hoists them into the Land Rover his friend is driving.
“Can you take us up to Bugando Hospital first? We have a little baby who has been admitted and we need to check on her.”
“Hamna sheeda” he assures us this is no problem, and the driver turns the truck up the hill toward the hospital. We pass by markets overflowing with donated clothing, used cell phones, fish, rice, and used footwear. As we slow to the traffic a few children run up to the window begging for money for food. Goodluck’s friend tells us they will use it to buy drugs. Children from homes where parents cannot take care of them, where they have endured trauma and abuse, not unlike at home, in Canada.
The driver drops us off and we breeze through security, with a quick check of our bags. They probably think we are Visiting Doctors with our very white skin, but nobody asks. Goodluck finds the ward for us and there is Neema sharing a bed with another child. Her aunt is spooning high density protein formula into Neema’s tiny mouth and the little one is swallowing. The frailness of her skin and bones is in sharp contrast to the fiery light in her eyes. They have tested her for so many things and while they are not yet sure if she is HIV+, they are treating her for TB and malnutrition.
“She is a fighter, Elizabeth. I think she’s going to make it”. We tuck some money into her aunt’s hand and I send a message to the powers that be, the Universe, God, to help this little girl to have a life, a good life.
That evening, we are having a glass of wine in the airport lounge, reliving the days and weeks in Tanzania and toasting Neema and her aunt, who made a sacrifice by leaving her own child with others so that she could be Neema’s guardian parent at the hospital.
“She is a fighter, right?” Elizabeth states more than asks. As we both stare off into space, I am imagining a big life for this little girl, a life filled with love and opportunity. I am hopeful that we have done something wonderful, that we have somehow saved her and that little Neema will grow up to be big and strong.
Four months later, we are in the midst of a Canadian snowstorm, traffic backed up outside my door, driveway filling with snow and ploughs just beginning the work of cleaning the roads. Chilled, I light the fire and walk to the kitchen to grab a cup of coffee before returning to my office and chewing on my thumb nail, trying to get the wording down for a funding proposal for a women’s training centre in DRCongo. My phone pings as I open my office door and I take the opportunity to distract myself from the proposal. I am smiling as I open the message from my friend Nyanda, my touchstone to the world I visit twice yearly and hold in my heart every day.
“Cathy, I must report that the baby Neema has died.”
As my eyes cloud over, I feel myself crumble against the closing door. I cannot read the rest of the message. I am brought to my knees by the unfairness of this life, by the waste of losing another child. What am I doing there if I cannot even save one baby?
On the floor, in my puddle of dark despair, I spend a moment with my memories of Neema, her smiling face and fighting spirit. She fought so hard and I want to celebrate her courage. I pick myself up off the floor and return to the proposal for the women in DRCongo, women who are hoping that maybe someone somewhere cares enough to see them, to hear them and to assist them. I remind myself that I am not alone in this work or on this planet. And we do save some babies, just not this baby, not Neema. Not this time.