Back on Track

Hooray!! We’re back online (sort of). After 10 days of communication isolation our modem is back. However, we apologise that we were unable to upload last week’s promised video. After trying 3 different copies and paying about £10 in mobile phone fees, we failed. And we have had problems attaching documents to emails. Oh the joys of ‘always on’ broadband in England – sweet memories! But I have loaded the video on Youtube, so I hope the following works. http://www.youtube.com/v/ZniR0wO8K8Y&hl=en

On Saturday we went to Dodoma by bus to get some money (we were down to our last £2) and shopping. As a capital city, Dodoma has about 6 ATM machines – all of which were out of order – except for one where after queuing for about 20 minutes watching others walk away with nothing, Malcolm managed to withdraw the maximum of 200,000 shillings – about £80.
We had a very relaxing lunch at the Hospital Manager’s house on the way back from Dodoma. Katrin and her husband are very particular about food so we had an excellent salad and ‘beef casserole’ (although it is a posher German dish than that) followed by crepe suzettes (or pancakes to Malcolm). And after lunch Malcolm managed to watch some cricket – he hadn’t even realised there had been a first Test Match against New Zealand, let alone a second!

One of the highlights of this week was Tuesday. Simon and Laura, our neighbours, had the new Archbishop of Central Tangyanika round for tea. (I know – name dropping!!). We popped round when we heard the church choir/rock group singing and dancing in the back garden. It is the first time we’ve ever met an Archbishop – particularly listening to a church choir in a garden. We had a chat – seems a nice bloke, and he wished me the best in learning Swahili.

We had our fourth Swahili lesson straight away. We’re up to ‘Please close (or open) the window’. Not something we’ve had much call to say yet – particularly as there are not many conventional windows, being mainly glass louvre shutters with mosquito screens. Malcolm’s problem is that 10 minutes after the lesson he’s forgotten every word he’s ‘learned’. The word for ‘to close’ is almost the same as ‘to open’. Can you spot the difference between:
‘Samahani, unapenda kufunga derisha’ and ‘Samahani, unapenda kufungua derisha’? He does try Swahili at work but has found out his chief cashier (and only member of staff) is developing an act mimicking his attempts at speaking Swahili in a ‘soufeast’ London accent.

Apart from meeting the Archbishop work continues to be challenging. Malcolm is trying to sort out a budget for the year beginning July – unfortunately he has very little to work from. Most of the financial records up to January disappeared with the previous management team and the accounts havn’t been audited for a year or so, at least. He’s discovered the previously approved budget had some significant errors meaning that rather than making a surplus, the hospital agreed a plan to spend about 50,000,000 shillings (about 15% of its turnover, or 2 months paybill) more than its income – a plan they have achieved as its limited reserves have been wiped out and debts have escalated to such an extent it is now difficult to pay staff. There was a meeting with the District Medical Officer on Friday to discuss the problems, and to consider the implications and demands of the Hospital being upgraded to a Designated District Hospital in July. The funding from the District Council is less than was hoped far. The Manager is meeting the Minister of Health with the DMO next Wednesday to find out how the Government will fund the Hospital.

Irene continues to sort out the filing system. The piles of unsorted files are beginning to disappear which gives her some hope that the task will end. However, she is aware of the need to ensure that the filing clerks are able to replace files used by the doctors in the right place – not a problem for most people you might expect. However…..

She has now bought the material for a new dress. It will be a skirt and blouse and the material cost 4,500 shillings – almost £2!!! Now to select a ‘fundi’ to make it.

On Friday Irene did go and speak with the owner of a clothes company. George Davies (of ‘George’ at Asdas) (name dropping again) flew into Dodoma (in his own jet) to lay the foundation stone for the extension at the Mvumi Secondary school. Stuart Rose (Marks and Spencers) and Malcolm had hoped to be there but they couldn’t make it. Irene had a chat with George – a nice, down to earth bloke. Malcolm’s not sure whether a deal was struck, but has been told she got a kiss from him – the first time she’s been kissed by a multi millionaire.

So – planning for next week:
· more work on sorting out the Hospital’s budget in preparation for a meeting with

the Diocese Finance Board sometime in the next fortnight
· Hospital Manager to meet Minister for Health
· yet more filing for Irene
· and Malcolm has an appointment with a dentist on Tuesday!!!!!

Almost stumbled

This was quite a difficult week. It has not been helped by the failure of our modem which means we have not been able to communicate with the outside world. We planned a quiet day at home on Saturday. Irene visited a’ fund raising fete’ for the new St Andrews church which included old favourites such as ‘splat the rat’ (not a real one!), and local favourites such as, ‘find and pick a pen up whilst blind-folded’ which seemed a hit with everyone. Malcolm stayed at home and spent a long time trying to download a user manual for a cash machine, using Simon Walton’s modem, because an engineer had come 25 miles from Dodoma to programme the machine but had brought the wrong manual.

Sunday was the fund raising service for St Andrew’s church. Enough was raised to complete the building – over 500,000 shillings (£200). The ‘highlight’ was Malcolm presenting a gift from his home church – not too sure about the Swahili however – at one point instead of saying ‘they pray that God (Mungu) will use this 100,000 shillings to bless you it sounds more like ‘the pray that the Mongoose will use this 100,000 shillings to bless you’. (I wanted to attach a video but after 4 failures have given up - sorry). Still, the congregation seem to enjoy it. However it was a long day in the sun – about 4 hours.

More tiredness to come on Monday. It was the annual celebration of Florence Nightingale day when scores of nurses came from across the District. It was an afternoon of parade, speeches, a candlelight procession around wards followed by dinner (and more speeches). For some there was also a party going on to 2 am. This was probably the worst day for Malcolm. He was tired, wondering through several hours of speeches in Swahili what on earth he was doing here. That day he had heard that the Magistrate hearing the case for recovery of NSSF (Tanzanian National Insurance) debt that the Hospital must pay £20 million shillings by Monday 26^th – an impossibility. It seems very difficult even to pay the Tsh 7m he promised the Inspector by the end of the month, pay PAYE to the tax man and then pay the staff their salaries for May. All in all he hit the 3 week wall that probably most people starting a new job experience – added to a different culture and language. However, by the end of the week, as he has got stuck into the Budget for 2008/09, things have improved – not that the finances are any better but he is growing more confident in dealing with it (or surviving it!).

Irene has also had a tiring week. She has spent most of the time in the filing room to ‘supervise’ people putting the 50,000 or so files into numerical order – however its been more ‘doing’ than supervising. A number of staff and nursing students have been along to sort a handful of files into order for 100 shillings a bundle, but almost all have found it too hard and given up. Even the filing clerks, employed to sort files, are finding it difficult. Numbers are not a strong point for Tanzanians!!! And to make things worse she has found out that so far only about half the files have been brought up to the store-room.

And the oven has broken down!!

For a bit of relief Irene went with the Hospital Nurse Tutor to the village to speak to a ‘fundi’ (craftsman) to discuss making a dress for about Tsh 9000 for the material (£4) and Tsh 4,000 for Labour. (£1.60). She is thinking about it – doesn’t want to waste money!!!. We were also invited to dinner with a lady who works at the local secondary school, with a Dutch neighbour (Corrie, the tall lady in the video walking inside the new church), an American priest from a neighbouring village and a couple from Australia helping with the priest’s project to re-establish plants and trees in the village. This is a multi-cultural location!!!

So – what could next week bring:

- Saturday - A shopping trip to Dodoma with lunch at the Hospital Manager’s house.

- more work on sorting out the Hospital’s budget in preparation for a meeting with the Diocese Finance Board sometime in the next fortnight

- more filing for Irene (a regular item for the next few weeks (months))

- and Malcolm still needs to find a dentist to replace a bridge!!!!!

Over the first obstacle

This week wasn't quite as planned. Even now I am typing this during the second power cut of the day – thank goodness for lap-top batteries. I am also unable to use my modem so am publishing this on another computer. Hey ho - This Is Africa!!

We did our first 'solo' 50 mile round major shopping trip to Dodoma on Saturday. Although you can buy a range of basic items, fruit and vegetables from the daily Mvumi market' for other things, such as Cornflakes, meat, fish and hardware, it is better to go to the 'big' capital city. The single fare is about 90p each – not bad for 25 miles and a two hour journey!!!! We pre-booked seats which was just as well as the bus is crammed with standing passengers for most of the journey. Unfortunately you either have to catch the 'luxury' bus at 6.45am, or you can have a lie in to catch the only other bus of the day, 15 minutes later!!!!

Prices for locally produced goods are low. We bought a yard rake / broom, a large shopping bag and a 'brush' (a bit like a bunch of twigs) for about £1. A pack of cuppa-soup would have cost £2.50, but was quickly returned to the shelf. We have learned the term 'a Dodoma day' as it takes far longer to do things like shopping than you expect – and nothing seems to go to plan. On our return journey (the 'other bus') there was an unplanned stop for about 30 minutes as they replaced one of the tyres – one of the other passengers calmly told us that the same thing had happened the week before. The roads are a grave-yard for tyres (and suspensions, and battery boxes)

Since then Malcolm has had three more trips to Dodoma, and has the bruises to prove it:
• on Sunday we went to the Diocese's farewell presentation to the Education Officer who had worked in Tanzania for 13 years. As is normal she was presented with a number of 'Kangas' which are large square of coloured cloth and form a popular part of Tanzanian dress having many purposes such as an over-skirt, shawl, carrying babies. No doubt Irene will try one before the 6 months end
• On Monday the Florence Nightingale day was postponed as the District Medical Officer died over the weekend, and Malcolm attended the funeral with a group of managers from the hospital. It was a typical African Catholic ceremony. We arrived at the house for the mass sometime before 1 pm, stood in the sun during the service until about 4.30pm. Left early (missing the opportunity to view his body) and following a brief stop for refreshments on route to the grave-side on his farm, left before the end at about 6.30pm. Some of the interesting points were:
o the women sat completely separately from the men throughout the service, and looked very smart in their 'kangas'
o at one point at the grave-side a woman came from the back of the crowd of about 2000 people, wailing. Malcolm was told she was not the widow but as she made her way forward the other women joined the wailing. Perhaps that's why the men sit somewhere else?
o Malcolm was surprised that what looked like an iron mesh used to make reinforced concrete was placed over the coffin. Later he was told that the coffin would be encased in concrete to prevent the body being stolen for witch doctor magic – not a problem Malcolm had to face at any authority he worked for.
• On Wednesday Malcolm visited an Inspector for the National Social Security Fund (the equivalent of National Insurance) to discuss the hospital's debt of over 100 million shillings, half of which is penalty for non-payment. Although 'only' about £45,000 this is a fortune for Tanzania ) over 10% of the hospital's annual budget) and beyond the capacity of the hospital to clear. We had a good meeting with the Inspector being as helpful as he could be. Not so long ago Malcolm would have been in his position meeting with someone who owed the Council Business Rates or Council Tax, so what the Inspector said was very familiar. He seemed pleased that the hospital now has a professional accountant who he was sure would find the money. Malcolm explained he had left his magic wand in England!!
In between visits to Dodoma Malcolm has started looking at next year's budget, with a meeting with all Heads of Department today. The financial year starts on July 1st, and as the hospital will become a Designated District Hospital there will be major changes to the funding which he is slowly coming to grips with. In addition he continues to look at how the security of the Hospital's financial procedures could be improved.


Irene has started on two tasks. The first is to sort through crates of clothing given to the hospital, so that they can be given to members of the village by the hospital chaplain. It will also free-up a room to become the medical store for the hospital. One thing she has learned is that no matter how well-meaning the donor is not everything given is of use. The tradition in the village is to wrap new-born babies in kanga's so small baby clothes and baby-grows are of little use. Neither are knitted hot water bottle covers, though surprisingly knitted jumpers for babies are a prized possession, even though there is a risk of over-heating. There is also a box of pillow cases – which is a shame as Tanzanians do not use pillows and there are none in the Hospital. The hospital has the same problem with some donations of medical supplies. Tanzanians generally have small hands and narrow arm, so large gloves and canulas are of little use, yet cost a lot to ship into the country. It has reminded us of the importance to ensure that gifts are appropriate for the recipient.

Her second task is to organise the new filing room for patient's files. This is a gargantuan task as there must be at least 50,000 files which have been filed according to about 3 different filing methods which now have to be brought into one. Fortunately she is doing the organising, other staff should (repeat, should) do most of the sorting.

So – what will next week bring:
• tomorrow, Malcolm is on 'call'. Not, he hopes in case he needs to carry out an operation, but in the event of some other civil emergency. He's not sure whether his Emergency Planning training in England will be too much help here.
• on Sunday St. Andrew's church is holding a building fund-raising day where Malcolm will present a gift (speaking in pigeon Swahili, maybe) from Emmanuel Church, Chesham
• on Monday is the next routine Magistrate's Court hearing concerning the debt of 100 million shillings to the NSSF. Someone from the Diocese should attend to represent the Hospital.
• the postponed Florence Nightingale Nurses day bash is on Monday
• further work on preparing the Hospital's budget for submission to the Diocese Board on 28th May
• and Malcolm needs to find a dentist to replace a bridge – Oh joy!!!!!

The first corner

Hi.




It has been a very pleasant week weather-wise. Just like very nice summer's days in England – except we are approaching winter. Sun rises about 6a.m and sets about 7p.m. Because we are close to the equator there is very little change in sunrise and sunset between summer and winter. Malcolm was talking to our Tanzanian hospital administrator today and was surprised that she finds the weather too hot. She is from the North of Tanzania, near Kilimanjaro, which is cooler because of the higher altitude. I thought is ironic that she seemed to be suffering more than a pale skinned English man!!!!

Our house:
We have received a comment that our chalet/bungalow/hut looks nicer than our Chesham house. Well, it:
- is bigger.
- has three bedrooms
- has quite nice gardens (if you like the scorched earth look!)
- is fairly quiet (no / very little traffic)
- is peaceful (no street lights)
- receives unexpected visitors (in addition to salesmen/beggars we have had goats, chickens and pigs pass through the gardens)
- is close to the town / market / shacks (300 yards)
- has a grand piano (out of tune) with a book on how to repair and tune a piano




However:
- there is no running drinking water
- there is no hot water (Malcolm doesn't mind cold showers)
- there is no shower
- rats scurry about in the loft (subject to the rat poison we have put down)
- ants seem to love our kitchen
- has no carpets – only a concrete floor with a few straw rugs
- no refuse collection – and no Council Tax!!!!


Just as well we used to camp!!


However (again), it is far more luxurious than most locals – it is made out of concrete rather than mud, has furniture and at least there is running water 12 hours a day and electricity (usually).




We have employed a young woman (Mama Asante - which means 'Mother of Thankyou' (Thankyou is the name of her eldest child (Irene is sometimes called Mama David)- some children are called 'Trouble' or 'Pain') to do the cleaning , washing etc. She is working now and Irene has to teach her how to clean for westerners. She is very nice but we do have one minor problem, she speaks no English at all. Irene is hoping that later on, when they can communicate a little better, she will teach her some African cooking, and how to make bread, gestures can only go so far!




Meat will be a very rare part of our diet now but you will be happy to know that every thing is very fresh, straight from the ground to the local market to us, the milk comes in warm from the cow next door! Lots of different beans, chapatis, rice and fruit. Beans and rice have to be sorted through before cooking (that will be Mama Asante's job too) to get rid of all the stones and bugs.







We will also be heavily into recycling. Forget about fortnightly collections and wheelie bins here there are no waste collections at all! Any food scraps will be put into a bucket for Simon and Laura's chickens next door (they are trying to persuade us to have some ourselves, chickens that is not scraps) paper and burnable scraps are burnt outside and anything else e.g tins is put into a large hole in the garden, (known as a tak tak).

Our work
We started working at the hospital on Monday. Highlights for Malcolm have been:
- supporting a hospital manager who is focussed on raising the medical standards of the hospital and correcting some of the mis-management previously introduced
- enjoying conversations with staff who make fun of his attempts at Swahili
finding out on Monday we couldn't pay the April salaries (due 30th April) as there was not enough money in the bank
- when sufficient funds were received, being involved in his first cash payroll for about 30 years. A bit of an eye-opener. Staff have become used to not having pay slips (so not knowing why they get the amount they do). And lets just say that the system is not up to UK probity(yet)!!!
- meeting with his predecessor who left under a cloud, but who is protected heavily by labour laws which are more favourable to the employee than in the UK. He won't resign and the Diocese won't sack him – sounds like a future legal case – but who's help we need to recover missing prime documents which support government grant claims
- trying to learn how electronic cash tills work in order to consider re-introducing one in the cashier's office
- establishing a budget, and printing lunch and dinner vouchers, for a celebration on Monday 12th May of Florence Nightingale nurses day which will involve visitors to the hospital from across the Region.
- having discussions with some managers who think raising funds for laptops (when they havn't been using computers etc previously donated) is more important than repairing leaking roofs
thinking about what to say at a meeting next week with the National Health Board (equivalent of the Inland Revenue) to explain why the hospital is unable to pay a sum of about £50,000 (equal to about ¼ of its annual budget) in unpaid National Insurance arrears.




Highlights for Irene have been:
- beginning to understand when someone speaks Swahili
- looking at projects to improve the feeding of babies, and distributing clothes to the community with the hospital chaplain (Meshak Sudayi)
- making friends with a woman generally considered to be a bit of a martinette (takes one to know one)
- having fizzy drinks and doughnuts served at meetings
- seeing on a tour with the Hospital Manager the need to improve hospital conditions and ensure nurses are seen more in the ward than in the grounds.

Church
Last Sunday we went to Simon and Laura's church, St Andrew's. The furnishings were basic with benches to sit on. Some things were familiar with a liturgy and communion, and a worship group with electric guitars and drums. Many things were different – there were 4 choirs, each taking there turn to sing a number of choruses. And everything was in Swahili (with a friend interpreting) except when we had to stand up and introduce ourselves – a tradition that all visitors have to do, or those who miss more than a couple of services on the assumption they will bring blessings from other churches they have visited. Seems to me a good way of encouraging people not to miss a service, and to discourage visitors – but then I'd rather keep out of sight in a new place!!!!

So – what will next week bring:



- tomorrow, our first shopping trip alone to Dodoma by local bus – 6.45 a.m. Start!!
to visit a different church (oh no – another introduction)
- a Diocese farewell celebration in Dodoma on Sunday to an Australian who's worked as Education Officer for over 10 years
- the Florence Nightingale Nurses day bash on Monday
- the meeting with the National Health Board about the current criminal action against the hospital for unpaid National Insurance on Tuesday
- finding out more about the hospital's (lack of) finances and wondering which holes in the Financial Systems to look at

We're off!!!!!

We have arrived!!

A lot has happened in the past few days with new experiences. I won’t try and describe everything – I have to leave something for later weeks.

It is not as hot as you might expect.

Winter is approaching. The weather is quite pleasant – a bit like a hot English summer’s day. On our 24 hour stay in Dar es Salaam there was a heavy rainstorm which left large puddles in the mainly unmade road. One American we met had a driving lesson and went through what she thought was a puddle only to find it was a ditch – it is difficult to tell the difference after heavy rains .

On Wednesday we caught the ‘deluxe bus’ (it is difficult to know how it earns that description but we havn’t tried the others yet) to travel the 250 miles to Dodoma. Fortunately the road is one of the few decent tarmacced roads in the area so the journey was fine. The fare (about £5 each) included a bottle of water, a bottle of lemon squash, a packet of biscuits and a handful of chocolate éclairs which were a pleasant surprise

The first 3 cooked meals we had here, including the one at the ‘services’ at Mogorogoro half way on our journey, all happened to be fried chicken – must be a popular dish. The countryside and villages we passed through were fascinating, with the locals on the bus, in the know, asking to stop at some villages to buy things like bread and large bags of vegetables.

We were met by Laura Walton for our 45 minute car ride to Mvumi through what is prettier countryside than I expected. It is a hilly, almost mountainous area which the dust / unmade road passes (or bumps its way through) and the village sits on a hill in a valley.

We have moved into our bungalow which has been recently basically painted and equipped by Jack and Maria who work for the hospital. For those who visited our rented house in Chesham we have been well prepared!!!! By European standards the furnishings are simple – by African standards, luxurious. Most of the furnishings are ‘mature’ in age (just like Chesham) and we have simple equipment (just like Chesham) but no carpets. The main disappointment is that the hot water system doesn’t work (a big hole in the tank) though we have noticed a solar panel on the roof so wonder if anything is salvageable.

Buying second hand and recycling is a way of life. There are no waste collections. Plastic bottles are valued for storage and any waste needs to be burned or fed to the animals. We spent a day in Dodoma yesterday, mainly shopping. Our iron was bought from a market that buys used items from, say, Oxfam which they don’t want to sell in their shops. We bought a range of kitchen equipment which is cheap in quality and price. All our vegetables were bought in a market – no plastic carrier bags there.

We also had our first meeting with the Mvumi Hospital Task Force Advisory Group, which steers the restructuring work which we will play a part. Key issues for us our:

- Malcolm will start looking at out-sourcing the Nurses school catering facilities (reminds him a bit of Compulsory Competitive Tendering in Local Government) and reviewing the system for reclaiming from the Government drugs issued to staff under the National Health scheme – the pharmacy know it issues drugs valued at about 900,000TSH per month (£35,000) but paperwork sorts a claim for just about half that amount
- Irene will focus on finding out how the babies and children’s unit works and see how she might support it
- An outstanding issue is the termination of employment of the previous accountant and obtaining appropriate legal advice – I hope this doesn’t become an ongoing issue for us.

‘This is Africa’ (TIA) refers to how things don’t happen as you might expect. Unfortunately key people were unable (or unwilling) to attend the meeting including a Government officer – the solution seems to be to pay people to attend. That would be a new one in the UK to ensure Civil Servants to attend what are effectively meetings with an organisation under special measures. Hey ho - TIA.

Monday next – start work at 8.00am for the first time for over 9 months. It will be an interesting time. My main role seems to be to implement procedures that UK Councils take for granted to ensure that monies due to the hospital stay with the hospital and that patients don’t pay unofficial extras to ensure treatment. I hope to tell you how it goes next week.

PS. One or our little ‘pets’ has died. We got home late last night to discover in our lounge a large black ‘fly’ (about 2 cms long), a black lizard and a small, dead, rat type animal. Just as well we used to keep tame rats! The body disappeared from the back door-step overnight. I wonder what took it?