The second major theme woven through my weeks with the Community Health Department is, as I have learned, also the very foundation of community and public health: the care of mothers and children. Pregnancy and childbirth, as the places where life begins, are the absolute earliest possible opportunities we have to educate about, advocate for, and promote lifelong health. When communities are empowered to engage with awareness and healthcare initiatives surrounding maternal health, it is the very definition of “upstream” medicine. The care of mothers in pregnancy and child birth, then, bears not only extreme relevance to my aims with this scholarship but also, on a MUCH larger scale, to the healthy future of emerging generations all over the world.
At KCMC, my engagement with maternal and child health involved working in three different projects:
The first of these projects was a weekly clinical experience at KCMC’s Antenatal Clinic. Working alongside Tanzanian medical students and midwives on a Tuesday morning, I had the opportunity to greet the pregnant or post-partum women arriving at this clinic, take their weight and blood pressure, weigh their babies with the antenatal nurses, and practice my Swahili with greetings and easy conversation about how ridiculously hot it must be to pregnant in this tropical climate or how ridiculously adorable their fresh-out-of-the-womb babies were. More than anything, I loved the human-ness of this experience: the palpable buzz of energy that accompanies mothers and mothers-to-be who will do just about anything – walk just about any distance in just about any temperatures or amount of rainfall – to fight for the health of their children. This love and energy is, from my treasured observations in this room, a cornerstone and driving force in these public health services. Each new mother arrived with a hand-sewn hammock/bag that their baby could sit in and be hung from the weighing scale, and these bags – something I have seen in no other healthcare setting before – were made in the entire vibrant rainbow of local Tanzanian fabric, and served as another totally beautiful marker of the home-grown love for these children.
After these initial checks, pregnant mothers received regular checkups: ultrasounds, laboratory tests, vitamin and medication adjustments, diet and lifestyle education, and an opportunity to express questions and concerns. Newborns also received check ups, assessing their growth and general health, looking for any early red flags of ill-health or developmental delays and, when on schedule, receiving the WHO-recommended sequence of childhood vaccinations. Nervous first time parents were given education on the side-effects of vaccinations – like fever and general un-wellness – to ensure that parents are not scared off of the vaccination program and continue to return for the long-term health of their babies. This small clinic was a total hive of protective and preventative healthcare activity every week, and I loved it!
Maternal and Child Health Monitoring
Another of my weekly assignments in the department was to collect data on maternal and newborn health outcomes from the various relevant hospital departments, and compile it with incoming data reports from all over the Kilimanjaro Region. Even though data collection might sound like a little bit of a dull grind, I got a total rush (nerd alert!) from seeing all the numbers come together each week and watching as the “big picture” of such a crucial area of health unfolded in front of me. In order to develop this picture I started every Thursday morning, armed with a notebook and pen for some old-school data collection, to the Neonatal Unit and NICU. Entering this unit is like leaping headfirst into a kaleidoscope. Benches line its narrow corridor, and these benches are filled shoulder to shoulder with the backbone of Tanzanian society: the mamas. Sharing a few bare-bones mattresses in a corner by night, mamas with babies in this tiny unit stay here 24/7 for the time of their child’s admission, so that they can always be on hand to breastfeed. They sit by day, exhausted, crowded, and traumatized to tears by the illnesses of their babies, but dressed nevertheless in an incredible and optimistic array of stunning Kanga and Kitenge – the local fabric that makes Tanzanian women living works of art. From these seats, they hand-pump their breast milk into tiny frail mouths or small metal dishes. It’s really quite a sight to see and I, personally, could never get enough of these beautiful, stoic mamas and the gorgeous, delicate bundles they held. Unfortunately, my job on this unit was much less beautiful and optimistic: recording the week’s admissions and deaths. It was by looking through these records to extract my data that I was reminded of why all these women were here: prematurity, labour complications, birth asyphyxia, gastroschisis, pneumonia… a whole host of complications that, despite the presence of this supportive rainbow of mamas bursting with nurturing milk and nurturing love, were very often incompatible with life.
I’d carry on from the Neonatal Unit to visit the two Pediatric Wards, where children were being admitted and dying from a whole host of terrible illnesses: pneumonia, sepsis, acute and watery diarrhea, meningitis, necrotizing fasciitis, hypovolaemic shock and secondary to sickle cell anaemia, HIV and AIDs, malnutrition, snake bites. Many of these conditions I had never seen before, and all of them I would love to never see again in a child.
I’d finish this process with a visit to the Labour and Delivery ward, slipping into a pair of crocs amidst the sounds of screaming women, screaming babies and – I seriously love you, Tanzania – the soaring voices of an African gospel choir CD that is played on repeat. After locating the week’s birthing records, I’d take down the numbers: babies born, babies lost, mothers deceased, hearts broken. It was both an exceptional privilege and an agonizing reality check to make these rounds, moving in and out of the different departments and learning about the heavy and horrendous problems they face for mothers and children in those first delicate years of life. I was always welcomed warmly by the charge nurses I began to form relationships with and encouraged to learn from and reflect on this data: what it means about clinical care in this region and how it can be used to inform improvements. Because records at KCMC are not computerized, all of this data collection had to be done by hand until the final step – a report submitted to the hospital director and municipal public health officer – which made it both laborious and prone to the errors of hurried handwriting. It was yet another good reminder from this year of the challenges of conducting medical practice and medical research in low resource settings, but also of the grit and resilience that people working in those systems exemplify when they get the job done regardless. No room for laziness here!
Technology & Totos
Toto is Swahili for child, and Toto Health is an amazing NGO working in Tanzania that uses innovative mobile phone technology to bring pregnancy and early childhood health education information to the mothers who need it. In my third and final project pertaining to this maternal health theme, I worked my way through the Labour and Delivery and Obstetric Wards with my supervisor and helped women get set up with this program on their smartphones, which are as popular and heavily-used in Tanzania as anywhere else in the world. We helped them input the relevant medical information about their pregnancy or their new baby, and watched as they began receiving tailored text messages about how to protect and promote their health and the healthy development of their child. Even in her 60’s, Sister Mayo (my supervisor) is seriously keen to dive in and learn about newly-available technologies that can expand the access of her patients to healthcare information; and I am endlessly inspired by that attitude. Throughout Tanzania and East Africa mobile phones are increasingly being used for vital information sharing – from weather updates for farmers to vaccination reminders for mamas – and joining this innovation revolution for mothers and babies is a tremendous stride forward in public health. As I said at the beginning of this post, mothers sit at both the core and the very foundation of community health, and the more empowered they are to access and use healthcare information, the healthier their children and the future of their entire community will be.