First days at CCBRT

Official logo for the Fistula Ward at CCBRT

Official logo for the Fistula Ward at CCBRT

This is the hospital ward at CCBRT where I am based for the next two weeks….the following is my diary – written and visual of my time here.

Set up in 1994, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) was established as a Community Based Rehabilitation programme searching for people with cataract in Dar es Salaam. Since then we have grown to become the largest indigenous provider of disability services in Tanzania. We are a locally registered NGO aiming to empower people with disabilities and their families, improve their quality of life, and ensure access to medical and rehabilitative treatment. Committed to preventing disabilities wherever possible, CCBRT is also engaged in extensive maternal and newborn healthcare (MNHC) activities.

CCBRT serves the poorest of the poor in the community and tries to remove as many barriers as possible to allow people to seek treatment. We are changing the lives and communities of some of the poorest and most marginalised people in Tanzania. 

From the CCBRT website:

Sunday November 30th 2014.

We arrive at the airport in Dar es Salaam very late on Saturday evening. The heat, even at this time of day hits me like a wall and I am not looking forward to queuing for my visa. As it turns out everything goes through very smoothly and it strikes me that this first stage of the transition into a completely different culture and way of being is actually far easier then I expected, and significantly, far less dehumanising and intimidating than the same transition into the States!

A smiling driver meets and greets us and drives us through the city to our apartment. My first impression of the city is big, dark and daunting; the sort of place I would actually rather not be but I tell myself I am here for a reason. The apartment is also big and dark – and daunting too, but in different way. Places perhaps always look daunting in the dark, especially after a long flight. It is basic but functional and I have my own bathroom but no shower curtain. I wake with a start in the morning, called into the day by childrens’ laughter from the garden next door. They are riding their bikes around the dusty clearing that is a garden, shouting, laughing and generally enjoying life. The sun is beating down and I am feeling better. I lay on the bed a while longer, catching up with myself, before I getting up to shower – the small bathroom becomes a wet room – and remember to use bottled water for cleaning my teeth. I take a malaria tablet with a gulp of it. After weeks at home of thick jumpers scarves and boots it feels so good to get back into shorts, vest and flip-flops. It seems to be the outfit that suits my soul. David and Alison are already up so I join Alison on the patio where we drink tea.

The garden is beautiful, succulents, jacaranda, and many varied shrubs and flowers including the ubiquitous bougainvillea. The plants are set out in the large patch of dry ground without much of a sense of design but their own beauty counteracts any lack of sensibility in terms of aesthetics.

Then out – shopping – we need food. We walk a short distance to a local grocery store along a dirt path running beside a wide tarmac road. Three-wheeled taxis are everywhere, ‘bjajis’, driven expertly if a little recklessly by young men who are constantly calling for your business. The grocery store is a small and crowded haven of fruit, vegetables, and everything it seemed you could possibly need, or even think you need, in the grocery line. It was small, dusty and full of smiling staff who packed everything we bought into colourful plastic bags. We later went to a more conventional supermarket – it just didn’t feel right!

The enormous divide between rich and poor is very much in your face in this city. Its breadth however is not reflected in the level of contrast between abject poverty on one extreme and privileged affluence on the other. Somewhere deep in the heart of what feels like a fiery melting pot of a city, poverty, and all the grime and desperation that goes with it, is intricately interconnected with its opposite and both burn on the same tarmac roads and light up the same dusty streets. The place is seething with people, a heaving metropolis at whose centre the infrastructure that was designed for and estimated three hundred thousand souls now struggles to maintain four and a half million.

Jackie’s bar restaurant for lunch; rice and beans and a beer under a jacaranda tree. It is apparently a popular bar with the music fraternity and radio presenters. Skinny cats wander around, some with a ballsy swagger, some whose hunger has reduced such confidence to a hopeful lope. I am relieved, either way, to see that they somehow manage to maintain at least a reasonable degree of health.

Alison wants me to see the art market. It is an incredible cornucopia of paint and canvas and if ever I held a concept of what or what isn’t art this place requires me to redefine it! Vast ramshackle sheds that open to dusty courtyards house a huge and seemingly constantly moving art making machine, maintained by many, many people who are painting, stretching or simply selling the works to willing tourists. Inside the sheds, each a self contained parody of a renaissance masters workshops, painters working in small corners, surrounded by their mounting output, turn out the same painting time and time again, imagery designed to appeal to tourist sensibilities. The stereotypical emblems are all here, tall black people, elephants and other fauna, baobab trees etc. The idea of originality is worth far less here than the scale or the style with which the unoriginal is executed. Countless thousands of paintings of all shapes and sizes stretched loosely on roughly made frames, are stacked against walls and on high-rise, rickety shelves. There are piles of paintings on unstretched canvases stacked shoulder high all around. Outside thousands more paintings with or without stretchers are piled up or are spread out on the ground to dry in the sun. All of the imagery is, and perhaps has to be, formulaic, hardly any of the imagery owes more than a nod to reality and serve to perpetuate the overriding consciousness of pictured Africa but is this so bad I wonder? At least these are indeed paintings, done by hand then and there, rather than so many digitised prints. At least these painters make their own, however meagre living by offering a level of artisanship that gives pleasure to those who buy their work.

When we get home I find a brand new shower curtain has been installed.

We drink, eat bread, peanut butter and bananas while discussing David’s eye surgery patients and what is going to happen tomorrow at the hospital.

Monday December 1st

Sunday passes into Monday by way of a long and very humid night during which I lay for a long time listening to the rain that had threatened all day but finally fell after dark. In the morning I need to get myself together quickly so we could get to the hospital on time. I feel sleep deprived but no time for coffee – the kettle doesn’t work anyway! We haggle with the young ‘bjaji’ driver before careering off on a wild ride dodging puddles and other  traffic. I hang onto the open side of the crazy modified motorbike enjoying at least the cool breeze that breaks the dull weight of the humid air.

Everybody we ‘meet and greet at the hospital from the security guy at the gate to the Director are so very accommodating of what we are wanting to do. I try to explain myself as best I can and the general consensus seems to be that it is a strange (to them) yet exciting project. Overall I feel very welcomed and after much smiling, hand shaking and practicing simple Swahili phrases Alison and I retreat to the café in the hope of finding a coffee. No coffee. The man in the tiny hut where chapatis and doughnuts are being served is very apologetic about the lack of something for which by now I am experiencing withdrawal symptoms. He offers black tea instead and its strange ginger flavour along with the compensation of the accompanying doughnut, goes a long way towards being a good substitute.

The place is crowded. The architecture is of the inside/outside character that I am familiar with from Costa Rica, and on the way to the wards we walk past open area packed with people of all ages, men women and children, waiting to be seen at clinic. Some had clearly been waiting there for a long time, sitting on long wooden benches. All are patient, quiet, mostly still…all seem mentally and physically resigned. We walk past the orthopaedic wards on the way to the fistula ward, meeting on the way quite a few people Alison knows and being introduced by our guide Subila to almost everyone else. There are lots of children around, many are patients here. There are so many sensations that are new to me, unfamiliar, some almost incomprehensibe to my western expectations, so many colours, smells, sounds.

In the first fistula ward most of the beds are empty. The women are outside in the covered sitting area. Eric, who heads up the wards, welcomes us warmly and lets us know that there are around fifty three patients in the hospital just now but they have a capacity of around ninety. He looks very tired behind his huge smile. He has only thirteen nurses covering two vast wards. He acknowledges this isn’t enough considering the number of patients, but he ‘does his best’. In the ward we are standing in most of the patients are ‘post-op’ and in the second ward are the women who are waiting to have their fistula repaired. As we talk I notice an elderly lady sitting on a chair behind Eric. She has a plastic washing up bowl at her feet which holds the bag attached to her catheter. After the operation to repair the fistula the bladder must drain continuously for up to two weeks to ensure that the repair heals properly, so the women carry their bowls everywhere they go. The old lady smiles at me, I smile back and wave, she waves back, I mouth ‘Habari’ (Hello), she nods and smiles even wider. It may seem such a small thing, just a casual greeting, but it means so much – I feel as if I am making contact across a huge divide, and indeed it is staggering to think about all of the possible meaning and significance of our two lives coming together just for that brief moment, but at the same time there is something so very familiar, so very comforting, so very human about it all. It is hard to focus on what Eric is saying at the same time as being aware of a deep wish to be able to say something more – to communicate with this woman in her own language.

As Eric takes us around the wards, and on meeting some of the women who are there in their beds, I begin to feel powerful emotions rising in me. I surprise myself as tears come very close to the surface, I am beginning to feel overwhelmed. This is so very different from anything I have experienced before yet at the same time it feels so very familiar and the feelings are coming from somewhere deep inside me. It is the idea of suffering perhaps that is here confronted in no uncertain terms with the reality – and confronted to with the raw human ability to rise above suffering and survive.

Most of the women wear expressions that speak volumes, most look resigned, some looked very depressed but all, as soon as you catch their eye, break into a smile which it seems to me suddenly transforms their whole being. The smiles are huge and genuine. They are interested, hungry to see, to experience, happy to be part of something, anything it seemed that would break the monotony of their day.

Subila calls all the women together and introduces Alison and me. There are shy smiles, hopeful smiles, questioning looks and lowered eyes. I try to explain who I am and why I am here, I am feeling inadequate in my pathetic ability to understand Swahili and curse the fact that I forgot my phrase book. I was determined before I came not to let the whole language thing frustrate me and simply to work with it but today I feel I failed miserably on this count and just fell back into my old behaviour of hiding behind inadequacy and refusing to try to communicate with the women as I should. It is apparent that it is up to me to do this – to break the ice. They are shy, overly respectful and I will need to go forward on this with a bit more confidence of my own. It is my responsibility, not theirs. Today I will put it down to my being a little thrown by my own reaction to the whole situation. The newness of it all and the huge cultural leap I have had to make will serve as an excuse – for now!

We have agreed to do a drawing ‘workshop’ on Friday – this will help.

I draw, for hours, all afternoon. I draw the women folding surgical swabs to be sterilised, I draw them eating lunch, I draw them doing crochet having been given, each of them a ball of wool, and I draw a portrait, a young woman whose smile is so wide I cannot stop myself grinning like the proverbial Cheshire in response as I draw. The graphite scribble is met with shy giggles. I promised her a copy….I need to keep the promise.

In the next post I will put up some of the drawings I am making here:

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