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Call the Midwife is a charitable organisation that supports Maasai people in a group of rural villages in Tanzania. Our mission is to work in partnership with the villagers to enable everyone within the community to live with dignity, healthcare provision and self-sufficient, sustainable methods of income.


An attitude of gratitude

Liz Moore

Although Britain prides itself on its National Health Service, it does come in for  a lot of criticism.  When I am in Tanzania, I cannot help but compare here with there and vice versa.

Recent figures given in the latest junior doctors strike state that England alone has 1000 junior (but none the less doctors fully qualified) doctors for every 100,000 residents.  In addition, there is a well structured family doctor service and many hospital consultants as well as half a million other workers, all trained in-house.  By contrast, Tanzania has no family doctor service and only 2 doctors for every 100,00 residents. People are seen in outpatient clinics only and there is no ambulance service. Nurses have to pay to train in basic nursing.

The NHS is envied for its 'free at the point of delivery' care.  Sadly very few services in Tanzania are free. All medicines for everyone have to be paid for. There's no means testing or age benefits.

Once while chatting with my Tanzanian friends, they confided that they had each stood over a hospital cot containing their precious child. They felt anxious when told that the medical notes and prescription are missing so the nurse doesn't know what to do. Amazingly, the equivalent of 50 pence passed in a hand shake seemed to reveal the whereabouts of the missing notes, prescription or doctors' orders. The group then asked me how I cope when being offered a bribe to care for a patient, find the correct medicines or their medical records. They were totally astonished when I replied quite firmly that I had never been asked for a bribe--ever--and furthermore, I don't know any health care professional who has ever been offered a bribe. As one, the inquisitive group held their breath and asked again, just to check that I had understood the question. Again, I repeated, never, nobody, ever in 40 years. They each elbowed the person next to them. Did you hear that? never, nobody, ever? Silence enveloped us. It helped to underline to me that we live in a very different world with very different values.

I visited the local hospital last year where 'our' nurse and midwife Rebecca is in charge of Paediatric ICU. She proudly showed me the painted sign. 'Morogoro Referral Hospital'. The 'referral' tag gives it status above other hospitals. I wish I had not known that. I could only wonder what the other hospitals are like.  I couldn't help compare it with the vet practice that my daughter took her dog to for an operation on its tail the week before my trip.  I say 'compare' but actually, there was no comparison. The vet practice was superior in so many ways. For a start, it didn't have old squash bottles filled with slimy water holding long-dead peace lilies on the half height walls between beds. The lack of screens around beds is chilling to me who appreciates privacy. Africans value openness over privacy. Pulling screens would lead people to wonder what you are trying to hide. Poor patients. From the ward door, I could see all of them, lying on rubber mattresses with no sheets, most had no nightwear, just a ragged tee shirt and a piece of coloured cloth from home. Human dignity is eroded even further when I am told that there's no pain relief available today. Maybe at the beginning of next month, there might be a delivery. What a heartbreaking sight it was and made worse by knowing that it's always like that. 

From the window of ICU I saw a man in a suit. He seemed important. Under his arm, he was holding a tray covered in theatre-green linen and talking on a mobile phone.  Then I saw him in the unit attending to an unconscious child lying on what looked like a butcher's block in full view of the public gaze. He was attempting to cut down into a vein to put up a drip. He was trying to save a dying child and yet I wanted to run in and ask him if he had considered washing his hands at any point. Then I realised, we had seen the only available sink which was in the nurses' office. It was completely broken. Smashed in three places and wasn't going to be mended any time soon. Poor doctor, attending to one of his potential 50,000 patients and doing his best for each of them. My thoughts of criticism soon evaporated in the sense of esteem that  I now held for this doctor.

We went to the surgical wards to see some people from the village. It seemed that no matter what the diagnosis, this was where you were admitted. I was most disturbed by the burns patients. I don't know how they didn't all have wound infections.  The open fires that the Maasai cook over result in so many people, young and old being treated for burns. Every patient that I saw made my flesh creep.          

I use the word 'treated' as if they have the quality of dressings that we would expect in England. In reality, they had plain gauze stuck over the open sore with zinc oxide tape. I just hoped I wouldn't be present when the dressing would come off. I couldn't bear to think that there isn't even clean water to help to soak it off gently.  

These scenes came back to my mind when I phoned Timothy last week to ask if everything was OK as I hadn't heard from him. He said quietly that they had been to hospital as their two year old had fallen into the open fire and into a pan of boiling hot porridge that his aunt was cooking. My heart froze. I thought of the delay in getting to hospital as he wasn't in 'our' village with access to the ambulance. I thought of the long queues that they would have to wait in without emergency care; there's not even an ice cube and no pain relief. Then I shuddered as I thought of the gauze fibres of the dressing sticking to the burned skin.

I contrasted the look of pride on Rebecca's face as she pointed to that sign 'Morogoro referral hospital'. She was so grateful to have it available to her people.  I contrasted it with complaints I heard this week about health services available in Britain. I have to pause and create a gap between those two attitudes which are poles apart. OK, we may have to wait sometimes to access one of the half a million employees who can help us but we are actually very very well off aren't we? Yes, we are very well off indeed!