Clinic Days At Bugando

Bugando is a part of Mwanza Town that, in my mind (having been there now) would be considered a slum area of the city.  I honestly don't know if that would be correct in the minds of Tanzanians but it was certainly my experience when I visited the homes of some of our clinic patients.  Mwanza itself is an actual "Region" in Tanzania, with a population of about 3,000,000 people according to the last census. Igoma, where the Urafiki Health Centre is located, is part of Mwanza Region.  Mwanza Town, as it is known (the city) is the second largest city in Tanzania, behind Dar Es Salaam, and has a population of about 480,000.  So Bugando is considered a part of Mwanza, just like Scarborough is sort of part of "Toronto" (hope that makes sense!).  Our clinic teams were a combination of our team of 8 RN's and some of the Urafiki Health Centre staff...including a lab technician who came, with microscope, to diagnose Malaria from blood smears and all sorts of intestinal worms and parasites from those oh so pleasant stool samples! (:

We spent two days in clinics at Bugando: the first day we saw about 160 people and the second day over 400.  The make-shift clinic was based in a large concrete church that was built there just over a year ago.   Within the walls of the church, we set up our Pharmacy area, three consulting areas, triage area and of course the bulk of the space was used for people waiting.  And they waited, and waited, and waited some more.  As I wrote in my journal at the end of our second day in Bugando, "So, SO many people - everytime I looked back at the crowd there was the same amount of people...they just kept multiplying and multiplying.  We had to have seen over 400 people today. At the end we were literally triaging in the crowd - Marilyn was out there walking around with a box of tylenol and ibuprofen (mostly all that we had left by that time)." 

Our "welcome ceremony" at the Bugando Church was so amazing for the start of the clinic!  We entered the church, carrying our supplies (of course assisted by many of the local people...a huge insult to turn down their request to help) and over 100 people were there singing and as we walked down the aisle, the women began to trill their voices in celebration - such a phenomenal sound!  We were welcomed by the Pastor of the church and also a Governmental official.  It was overwhelming to realize that all of these people were here to be helped...little did I realize how many more would appear!  By far, the majority of people that came to the clinic were women and children...which is vitally important.  The reality for women in Africa is that they are the last ones that get care.  In many cases, it is the women who are working to provide, with babies wrapped on their backs, cooking, taking care of their children...and they really are not taken care of by anyone else.  So the fact that so many women show up to a clinic that provides free healthcare makes sense! and is essential to provide for the healthcare of the whole family.

Funny story...note the picture above right, of the woman sitting on a hard concrete floor.  I asked Matari, who was basically our "host" for the whole trip...he oversees the Urafiki Clinic, if we could get some more chairs in the triage area for the older people.  He smiled at me and said, "Julie, these people have been sitting on floors their whole lives...they are okay." (sigh)...the adjustments to culture!

I want to share a few a stories with you...the first involving the photo directly above.  Peter is the young boy on the left in the picture...in the Spiderman shirt.  I have truly never met such a sad looking boy.  He  had a sorrowful face and in fact even had salt stained tear tracks down both of his cheeks.  He really struck my heat in a deep manner.  My heart physically ached when I saw him and it was difficult to keep focused and not fall into tears myself. Peter is orphaned...both parents having died, and is being raised by his Aunt, who you see in the picture with him.  I wanted to just pull him into my arms and hug him and pray that his little heart would one day know joy again.  Peter represented the reality of many childrens' lives in Africa...no mother or father to call him "son".  I'm grateful that his Aunt has taken him into her home, but oh how my heart hopes for this young boy...that he would smile once more.

Alex is the boy you see to the right, wrapped on his mother's back.  He is 10 years old and was once a vibrant young boy who ran and played with his friends.  When he was about 7, he began to lose muscle tone and in fact now appears more hypertonic, with his muscles having stiffened up from lack of stretch and movement.  He is unable to place his feet flat on the floor and completely unable to walk and so that is why his mother carries her 10 year old son on her back..and also why she suffers from chronic back pain! Initially, Dr. Mukulla (who I was working with at the time) and I thought perhaps there was a total developmental delay with Alex...but then his mother shared his history.  Also, Alex spoke! and what did he say?...the classic english: "Hello. How are you? I am fine."...all in one sentence and with the most stunning smile..as you can see in this picture.  He remains a bright young boy...but a boy limited by his physical abilities.  It is likely that he acquired an infection or virus around the age of 7 that went untreated and impacted his body, leading to the loss of muscle tone.

One of the hardest things I discovered in treating people in these clinics is that some come with such serious ailments or chronic ailments (such as Alex) that we simply don't have the ability to treat in that setting.  With Alex, all I could do was show his Mom some range of motion exercises to lengthen the muscle again and stretch it out, in the hopes that perhaps this would encourage some mobility.  Of course, we could also provide some vitamins for a time and treat the intestinal worms he had.  What was difficult to swallow though was the fact that there was no intervention at the beginning when the help was really needed.

I am reminded also of a young mother who came in with her baby who had obvious microcephaly (literally an abnormal smallness of the head resulting from the lack of brain growth). I knew right away, looking at this beautiful baby girl and her movements, that she had Cerebral Palsy.  Her mother talked of how she would sometimes become so irritable and difficult to settle.  As I delved into her history, what I feared was true...she had had trauma at birth and required oxygen and resuscitation and clearly she ended up with brain damage, causing the CP. I felt so bad for her mother - looking for hope and for us to be able to intervene somehow and yet although we could provide her with very little, she still seemed grateful.

It's difficult for me to know where to stop writing about each clinic day because the reality is there are so many stories and so much that I learned.  I remember Dr. Mukulla pulling me in to see a leprosy patient in his consult area.  I've never seen leprosy! This woman had the early signs of it and I so deeply appreciated his willingness to teach me and expose me to the types of illnesses that he sees so often.  I was struck by his gentleness and patience and honoured by his acceptance of me into his country and to work alongside each other in serving these people.