Rural Health

While in Africa last month we had the privilege to visit Songambele Hospital, which is located in Nkololo, Bariadi District, Simiya Region of Tanzania.  To make it simple, Nkololo is located in the northern part of Tanzania and just west of part of the Serengeti National Park and Game Reserve.  While it is near the Serengeti, the location of the Serengeti gate is distant from Nkololo, and the local road network resulted in a drive of about 2.25 hours (from gate to Songambele).  The last 12 miles of the trip took about one hour, due to the condition of the dirt roads that have not been maintained by the local government. To understand why the hospital was placed in such a rural and difficult to reach location one has to know more about the founder of the hospital: Fr. Paul Fagan.

Guest House at Songambele

Paul Fagan is a Maryknoll Missionary priest who is now 87 years young, but has already completed in the this part of Tanzania work of several lifetimes for several persons.  Fr Paul has been working in Africa for over 59 years.  He abided by the Maryknoll motto "If someone is there, go further."  This  led him first to construct a parish, and undertake social, health and educational improvements at Old Maswa and then about twenty years ago relocate even further from what had become civilization with Old Maswa to the more distant and rural Nkololo.  When he arrived at this hamlet there were no roads, so he built about forty miles of roads.   He decided to establish his hospital, and new parish, St. Peter's Church, in Nkololo as it was centrally located to an area that had no medical care.  (Interestingly, the hospital administrator, Stefano, was born in Nkololo and his mother taught Fr Paul Swahili.)  He first opened a small dispensary and today the hospital grounds contain about 19 buildings from staff and visitor/volunteer housing to surgical suites and inpatient wards.  The hospital laboratory is state of the art and has the highest possible ranking, and it is an official blood transfusion center. No small feat in a rural area of a developing nation.   Today Nkololo, is a community of about 10,000, but has a population of about 22,000 with adjoining villages.  The hospital, however, serves a much larger territory with a population estimated at about 250,000 persons.  To put this population in perspective, the State of Wisconsin has a population of about 5.8 million persons in 72 counties.  However, only four counties have a population of over 250,000, and the fourth of those, is Brown (think Green Bay), with a population of 263,378, so about the same population as that of the region served by Songambele.

Fee Chart

To say it is difficult for persons to receive health care in this area would be an understatement.  Just the travel time, and road conditions are well beyond our normal first world comprehension.  My goodness, even Minnesota has better rural gravel roads. I will have a future post to deal with the local community conditions.  Ambulance services are not provided by the local unit of government, but by the hospital.  The ambulance owned by Songambele, prior to our arrival, had been run off the road by another vehicle and turned over, and so now they await a different ambulance. I am glad I did not have to drive anywhere in Tanzania.  My wife app would have been on overload, and I would be concerned that the app would have required a re-set.

Lab

Health care is a core human need, which Fr. Paul recognized.  Songambele fills that need in an under-served area of the developing world.  In a recent 12 month period over 15,000 patients were treated at Songambele.  Almost 1,900 were admitted to the wards (daily capacity of 30).  Ninety major operations and 220 c-sections were performed.  There were 388 normal deliveries.  The hospital has a staff of 66 including four doctors and 4 clinical officers who do diagnosis and make rounds.  Nursing care, at least in terms of number of nurses present, is no where near that of what we have in the United States.  Although nursing staff at Songambele is equal to that at the largest regional hospital.   Lack of staff has led to problems.  At times infant mortality is high, due to length of travel for the mother to get to the hospital, prenatal care, or other medical reasons which lead to complications.  But it is also due to lack of proper medical equipment, and the need for better infant resuscitation methods.  They have tried to work on the latter, but a recognized pediatrician  from Minneapolis who was going to train staff at the hospital developed his own medical emergency after arriving and needed to go back to the United States.  A Canadian ER Doctor, working with the Italian Group Doctors with Africa, which usually works only in the AIDS section (and which he says their AIDS section is well run) is hoping to provide some of that training. He needed to take a week off after his experiences in the infant unit. He also said, that even though Songambele may have some issues, Songambele is better than the large regional hospital.

Care Room 

Unlike US Hospitals were most all patients are in one large building, in rural Tanzania, care is spread out in separate buildings.  To assist with improvement to mother and infant care, a maternity care center was under construction.  This state of art facility will be one of the first in that nation, and the government cites it as an example to be copied.  When we viewed the structure it had its concrete block walls and roof in place, but they were awaiting regulatory approval of the final layout before continuing with construction.  They would receive that approval on the day of our departure, only needing a few minor interior wall modifications.  Realizing the dearth of nurses in the region, and that the region has no nursing school, the next large planned project is a $3 million dollar nursing school to be constructed on property near the hospital.  It is hoped the school will improve staffing at such a busy hospital.

Mixer for Concrete Block

A workshop on hospital grounds produces the concrete block used in building construction.  One benefit of being near the equator is that neither day light or temperatures have great variation.  Temperature variation, I believe I was told, is generally from 60 to 85 degrees F). This means they garden year round producing various produce for nourishment.  Two fish ponds will soon produce Tilapia.  They  are only a few degrees south of the equator, so it was their "spring."  Corn planting was being accomplished in much of the rural areas in which we traveled.  Other staples grown are beans and rice.  My fall planting of radishes, lettuce and spinach was froze out by the early freeze we had in Wisconsin this year.

Concrete block form

Being from the west, I think we all realized the importance of not being judgmental of the way things get accomplished in a developing country.   The Canadian Doctor said pretty much the same, as he noted his first intent was to watch and learn, but the infant mortality issue made him take a greater role sooner than he desired.  He will be in service to Songambele for six months, and when we met him he had been there for just over a month. He previously worked in an Iraq war  refugee camp in Afghanistan.  The man has seen his share of suffering. The ways of the western developed world may not be the correct way for a different culture, setting and environment.

Concrete blocks drying

Obviously most of the hospital equipment is from the west, but that poses problems for training and getting the equipment to work right.  After being set up and put in working condition the tech guru from the company for one high tech piece of equipment was to return the following week to train staff on the use of the machine. Weeks later they are still waiting for that person to return.  Calls are not returned.  In a recent purchase of some medical equipment from Europe, an infant incubator was thrown in, but upon its arrival it did not work. The Canadian Doctor knew how to operate it, but of course the staff had not training.  A technician from Dar Es Salaam said a new control board is needed, and they were awaiting his return with the control board from Dar Es Salaam.

Sunday Mass at St Peter Church

Yet, are they more open to other methods than perhaps is the west?  Two persons, who will be volunteering at Songambele, who hail from Richland County, learned a method of burn treatment from the Amish that uses a salve, and burdock leaves.  While they have had some success explaining its use to a few US clinics, here in the US a waiver is required since it is a method not approved by the FDA, or recognized by any medical group as appropriate protocol.  Yet it seems to have a better success rate than conventional western methods. They know what ingredients are in the salve, but not the proportions and they hope the hospital lab at Songambele will be able to breakdown the proportions so they can see if a salve from local products could be used.  A large shipment from the US arrived while we were there, but I understood it to be pretty much all damaged, perhaps due to freezing in the cargo hold of the airplane.

Children after Sunday mass

Yet, as much as we may think we are so much more advanced, let me point out an article that was in the November 12, 2019 Wisconsin State Journal.  This article noted that from 1996 to 2016 the number of counties in Wisconsin without an obstetrics care unit increased from 20% to 40%.  This means that there may be a travel time not unlike that experienced in the Songambele service territory, but over much better roads.  Of the rural hospitals in Wisconsin, just 56% provide delivery services.  Women's health is much more than the one issue.  The importance of mother and infant care was recognized by Fr Paul Fagan over twenty years ago in rural Tanzania.   Here in the west we think all places are like the well served urban areas.  Perhaps we can learn some things from Fr Paul's efforts in Tanzania.

Our Group with Fr Paul and Some Songambele Staff