Visit to Tanzania in May 2023
Report of the journey of Harry Borst and Henk de Boer
On Wednesday morning, May 3, 2023, Harry Borst and I left again by KLM for Dar es Salaam in Tanzania. For Harry that was the 4th time and for me already the 14th time.
We help there on behalf of the Morogoro Support Foundation (MSF) in the St. Kizito hospital in MIkumi and in the St. Agnes clinic in Lugono. MSF was founded in 1998 from the Alrijne hospital in Leiderdorp. The 25th anniversary will be celebrated in September this year. The Foundation's spearhead is training the hospital's employees, but a medical team also goes there every year. We deal with technical matters such as water supply and electricity. In recent years we have already carried out various solar energy projects for both the water pumps and the lighting.
But the general maintenance of the buildings and equipment also requires a lot of attention. We had to fly a bit because KLM did not want to fly over Sudan.
Thursday, May 4: Picked up from the hotel in the morning by Antusa, head of the hospital, and Andrew the driver. First we visited Restituta in Lugono where we were welcomed with dance and branches and yet again were offered a whole meal despite the fact that I had insisted not to make a fuss for us. But that is not possible in Tanzania. Arrived in Mikumi in the evening.
Friday, May 5: first visited the morning áppel . St. Kizito is a Catholic hospital, run by the nuns of Mgolole, so the call begins with prayer! A number of employees are present, the latest events are discussed and what is on the agenda this day. We were warmly welcomed and Antusa told quite extensively what MSF has meant for St. Kizito and is doing again with the digitization project with which we want to digitally store the X-rays, the medication registration and the patient files because this has been made mandatory by the ministry and the insurance company. I introduced ourselves, briefly explained what we want to do and complimented the employees because the buildings were neat again. Last year we had already started painting dirty brown walls and they picked that up well. I immediately got a big round of applause because they don't get compliments that often! A contractor from Arusha is busy building a new building for the emergency department. An episcopal fund from Italy has donated money for this.
Because the main road from Dar es Salaam to Zambia runs right through Mikumi, many traffic casualties occur here. It will be a rather large building, right in front of the entrance to the hospital. In my opinion in the wrong place and way too big. I do worry if this will all work out but Antusa always says God will help us and we should just make do with that. Time will tell. I think it's a shame that a beautiful thick tree had to be cut down for this!
Saturday, May 6: Harry and Jackson repaired a bicycle that we took with us in the container last year. A solid bike but the sprocket had broken down on these bad roads. Then they started refurbishing all the beds and other items that were stored in the workshop. I spent all day cleaning out the electrical warehouse because it was a mess. It is a pity that the electrician was not there today (Saturday), but I will explain to him again on Monday how you can store everything clearly. There were already various things that I had taken with me in my suitcase at his request! Main switches 125 A, blade cartridges 125 A and a number of other items.
Also able to repair the small angle grinder again, sanded contacts of the switch clean. Tonight, watch the video that the St. Kizito choir recorded in December 2022 on the grounds of the Kizito hospital. (you tube: kizito choir mikumi and then mtakatifu mikumi). This choir also always sings in the parish church that was built in the years 1972-1973 by Piet de Boer (family far away).
Sunday, May 7: Church service at 9:30 a.m. fell through, no priest available. So back to the bike. We were able to repair the electric boiler in the quest house, the thermostat did not work anymore, so we now have hot water when showering. Rained all morning so lots of muddy roads.
Monday, May 8: Again a lot of rain tonight, normally that is in April, but here too people notice that the climate is changing. Harry has been busy with the men of the TD to make a saw chair for the firewood. There were a few hand bow saws in the workshop and now they can saw the logs much easier. On Saturday they were cutting all that in half with an axe. They were very happy with it because there was quite a mountain of wood for a long time, all cut down because of the new ED building. They also dismantled and disposed of the old unnecessary items such as defective echo devices. Of course we already keep screws and washers and the old iron is sold
I worked with the electrician Herry and the plumber Ernesti to replenish the stocks of lamps, wall sockets, taps, cisterns and siphons because there was nothing left in stock. The eternal problem: no money for maintenance! It was quite an amount because everything has become more expensive here too. I also visited the water treatment plant that my son Fons and I had built together with a team of Tanzanians in 2015. It has been working without a problem for 8 years now, no pumps, no more smell and clean water at the exit! Occasionally clean the dirt grid and mow the grass. People regularly come to see how this works and who will make it that way. The herons do pick out the fish. I went around the site with Kibendera, head of technical services, and I was shocked. There is so much maintenance to be done: 2 staff houses are empty and need to be refurbished, 2 houses for employees ditto, gutters that have rusted through, corrugated iron roofs rusted and leaking and I could fill a page like this. Still, work is being done here and there and you can see how it improves. In any case, we can again replace 15 defective taps and repair 40 light points.
Tuesday, May 9, 2023: I lost all the stuff we bought yesterday. I expected it to be in the warehouse, but everything was locked up with the sister who keeps the records. She said that otherwise it would be stolen in no time.
Now we still have a long way to go to replace a lamp! Today I also cleaned up the boxes with screws and plugs. That was all mixed up again and it takes so much time to look something up. Explained again that you should store all plugs S6 in one drawer and not in 5 different ones in 5 different places. All tools are also stored in all kinds of cupboards behind different locks, Kibedera is afraid that they will be stolen. That also happens, but it is difficult to work. We also opened the chimney of the incinerator again, the smoke did not go up anymore. This one was just hidden. Explained that you should clean a chimney regularly! Especially if you use it every day and have to burn all kinds of medical waste. It turned out that the pond hadn't subsided much after the rain so Harry went with some men to the outlet of the ponds on the river, which turned out to be clogged with a dead catfish 70 cm long. He wanted to get out of the pond but that didn't work out! That means that the water is reasonably clean in the last pond because there are a lot of fish. It was quite a consternation when that fish suddenly shot out because of the water pressure and a wave of water came out with a big fish. Kibendera was apparently so shocked that he became unwell in the afternoon and we took him to the hospital in a wheelchair. That was of course not far and we heard later that he was already doing quite well again. Went to the operating room with Herry the electrical engineer.
The operation lamps gave almost no light anymore. for the large lamp I had brought special 120 W medical lamps and the lamps for the other operation lamp were just here in the warehouse!
Didn't Harry remember! But they were able to operate in full light again. But the operating table also turned out to be quite shaky and sometimes suddenly fell down. A bit tricky if you are just working with the operating knife! After we crawled under the operating table (better than on top of it) it turned out that a bearing was completely worn out and I don't think it can be repaired. But there is still a good operating table in the container, so we will try to swap the tables this week.
Wednesday May 10th: Kibendera fortunately recovered a bit after a night here in the hospital, has to rest at home today. Hopefully he can come again soon because he is our contact person here. We started today to make a new tool board because it's not work if we first have to search for hours where the materials and tools are stored. Especially now that Kibendera is gone. Furthermore, all kinds of chores were done with Herry and Jackson: dark room sink of the X-ray department, leaky sink at the OPD, repaired kettles, refurbished hospital beds and made them ready for use.
We also went to look at the new nurses' school. This was set up by Jeroen Degen of the Friends of MIkumi Foundation. They want to start the nurse training in October with 40 students. Jeroen is now working with a few other people to install all the computers, a water source has been drilled and the first buildings are ready.
It all looks solid and neat and is nicely and spaciously laid out. In the first phase, 24 students will go internally, the rest externally. However, the water pump still needs to be connected and the electricity from the energy company has not yet been requested. The intention is that 120 students will soon follow the 3-year course. There is still some addition to be done.
Thursday, May 11: Did all kinds of chores again and continued with the tool board. It's unbelievable how many tools came out of every nook and cranny, we can fill five boards. Our list of jobs is also growing every day, there is work to be done everywhere. I also sat around the table with Antusa, Dickson, Flavia, Kefas and two other staff members this afternoon. We went through all the projects again: 1. a new computer system. 2. new laundry room 3. renovation of three empty staff houses. 4. setting up the emergency room (A&E). 5. Expansion of the solar lighting. 6. training program with further training courses for the employees.
All in all, quite a list. We as MSF can never cough up all that, but we just have to see how far we can get. Salaries also have to go up because they have not been adjusted for years and everything is becoming more expensive. There is also only one radiographer for the X-rays, there are only two pharmacists who now have to work late into the evening for 6 days and anesthetists have to be added.
Fortunately, Peter Silayo passed his diploma in anesthesia this week, the course of which was paid for by MSF, so that gives us a little bit of room. I'm glad I don't have to be in Antusa's shoes because it is not easy to get everything done financially. Baraka dropped by the questhouse in the evening. I helped him with his studies at the university in Dar es Salaam. He is now a doctor here since January 1, 2023 at St.Kizito hospital and is doing very well. Now works in the maternity ward and already does caesarean sections. He is a cousin of Antusa and came to bring a nice shirt as a thank you for the help. It's here at 7:00 PM. already dark and then I write this report every day after dinner.
Friday, May 12, 2023: Reassembled the sink in the X-ray darkroom with Ernesti. It had been completely detached for a long time and could not be used. We had found a reasonably good frame on the old iron heap and Jackson and Harry refurbished and painted it. Charles the radiographer was extremely happy with it and was able to rewind his film. It was fixed in half a day and the men now see how you can solve something effectively and that it doesn't have to cost much.
Harry has started working with Jackson in the maternity ward to fix the brakes on the beds. Of the 40 beds, the brakes no longer applied in most beds and the mothers with the babies often moved around. We could easily readjust a number of them, but for most it was a bit more complicated. In the evening there was a mass on the terrace of the questhouse on the occasion of Florence Nightingail day. Then all nurses and orderlies are put in the spotlight. There was also a farewell party for the three interns who worked here for several months at the hospital. Kizito's choir sang at mass with Kees Klerks' organ. Lots of speeches, lots of music and food and drink. This is not necessary for us, but the Tanzanians love it.
Saturday, May 13: continued in the workshop with the maternity ward beds. We have devised a simple solution to also repair the brakes of these beds. Harry has filled a dangerous gap at a road junction on the property before people break legs. He also repaired a wheelchair for the maternity ward and finished a wheel. It was nice to rest in the workshop because there is no work on Saturday. Eleven small blood pressure monitors given to Antusa that Alex had given. She was very happy about that because they didn't have one left in the whole hospital and they can also be used on the outposts. I have kept five for Lugono next week .
Sunday, May 14: first measured the laundry, after which Harry made a drawing of the new situation. The laundry room needs to be renovated because the dirty laundry must be separated from the clean laundry in order not to transfer bacteria. We make a proposal and then Kizito can adjust it if necessary and request a quote from the local contractor. We also cleaned up and disassembled a closet that was outside.
I also made a drawing of the electrical installation of the new nursing school so that a connection can be requested from Tanesco. The entire TD team was also turned out because the new well's submersible pump had broken off from the pipeline.
Probably the rope on which the pump hangs was not properly secured. Very messy!
But in the course of the afternoon the pump worked again. The other source is also doing reasonably well and that pump runs on solar energy so we were not without water.
We took it easy and ate dinner at Veta nearby because the cooks have a day off on Sunday.
Monday 15 May: this morning we first took some miter saws out of storage. We had taken them with us in the container last year, beautiful devices but had not yet been used here. With this, Harry and Jackson sawed formwork to make new concrete tiles for the rain gutters along the covered gallery. There are 90 of them defective and apart from a sloppy face, it is also very dangerous if someone accidentally steps into it. Jackson is amazed when he sees Harry demonstrate that and quickly picks it up.
He learns a lot in this week that he can use for the rest of the year. The iron buyer was also there today to collect all the old iron.
They had brought a bascule to weigh the iron, and Cephas the clerk recorded all the kilograms. They came with a kind of cargo bike on which everything was transported at the end of the day, heavy iron beds that could not be lifted by 2 men. They were busy all day with 5 men. But they have been able to earn some money again and the workshop has been cleaned up again. I measured the entire solar system with Herry. I had given him a DC ammeter 100 A so that he can measure the charging currents of the batteries. Coincidentally, the power company went out tonight. Some time ago, thanks to the Carolusgulden in Leiden, we were able to restore the solar of four buildings. It was pitch dark everywhere, but they could now continue working in the maternity ward, children's ward, laboratory and operating room. We have installed LED lamps of 5 and 7 Watt in those buildings, which do not use much and therefore they can now work all night. I received thank yous and smiling faces in all departments. So with this: thank you Carolusgulden on behalf of the employees of St. Kizito. We now only have to provide the women's and men's department and the connecting corridor with solar lighting, but for that we first have to look for a sponsor.
Tuesday May 16 : last day here in Mikumi. We poured the first 3 concrete tiles of the 90 and they can now make the rest themselves. A number of repairs have been carried out, such as the maternity refrigerator, the heat lamp for the babies, the sterilizer for the OR. Harry has repaired some gutters with Ernestie and Jackson and I have gone through the list with Kibendera of everything that can be done in the near future.
I've asked them to send a photo when it's done, that puts a bit of pressure on them!
Also talked to Rosalia and made a contribution for the orphans who can still go to school that way. In the evening a farewell dinner with Antusa and the rest of the staff.
Wednesday 17 May: today moves from Mikumi to Lugono. Lugono was busy with visitors: Pudensiana, the head of the nuns, James Mpakamoto, the priest and former administrator of St. Kizito, Antusa, Rosalia and Leticia who had accompanied us, Jeroen and his wife Lieveke with a befriended couple. The St. Agnes clinic is located in Lugono and has been taking care of patients from various villages in the area for about 8 years now. There are 5 nuns who are doing very well because more and more patients come from further away. Walked around with Benson to see what we can do the next few days. We also brought some tools, plugs and screws so that we don't always miss out.
Thursday, May 18: Started with a mass in the chapel of the sisters, the priest from Uganda did the mass. He is the pastor in Melela village. Measured the solar installation because the voltage went out at 8 p.m. last night. Yet everything works well, but the problem is that the solar panels are only 125 W each and there is not enough sun during the rainy season to fully charge the batteries because quite a bit of electricity is already used during the day. The solution would be to install larger solar panels and some more batteries. But there is no money for that, so the sisters sit in the dark, but they still remain cheerful and go to bed early. When the rainy season is over it will be better again. Harry has been working with Godwin to repair various taps and rainwater pipes. I tried with Benson to fix James' organ. He had called an organ mechanic who had been busy all day and went to Morogoro to get 2 transistors. I wonder if that is the cause. We also went to look at the new staff house. It consists of 6 houses and it looks neat. It has been empty for 2 years now because there is no water and electricity and the money has run out.
Thursday, May 19: Started plastering the chicken coop. We had built this a few years ago with red clay bricks . They are not very hard and then wash out over time. To prevent that, we have put a stucco layer there. that is a bit neater and also lasts longer. It was a discussion whether the guards would also help, but they wanted extra money for that. Restituta was able to solve this by agreeing that they would only be paid extra for overtime. They can also take turns sleeping at night. That went very well and at 10 o'clock a wall was already finished.
Harry and Mathias, the structural engineer, then started renovating the toilet group in the sister house into an extra room for the sisters. They now have 4 rooms and there should be 5 sisters working in St. Agnes. I went to Morogoro with Benson to buy stuff. Restituta wild mosquito nets over the beds. For this we had 20 iron T-pieces welded in Morogoro and purchased 20 nets. We were also able to purchase a small welding machine and some other tools. We also visited the mechanic who is repairing the car of the St. Agnes dispensary. He needed some extra money for a setback. He promised that the car will be ready on Monday, painted, seats reupholstered, engine overhauled. It is a Toyota land cruiser, 4-wheel drive, with benches for 5 people, a sturdy roof rack on it and a spacious cargo area. An ideal car for St. Agnes because the road to the dispensary is a mud puddle during the rainy season.
Saturday 20 May: the entire team was present again on this free Saturday. Harry Mathias and Benson spent all day breaking down the dividing walls in the new nurse's room. They immediately removed the rubble to the access road, which again had many holes in it due to the rain. It was hard work in the dust and heat, but they see how hard Harry works and that you make big steps. Who knows, the penny will drop one day. They tend to take a rest here and then spend half an hour on the phone with everyone. Actually the same problem sometimes as in the Netherlands. I've been busy organizing the container a bit again, everything was in a pile again! Also repaired the stretcher with a new cover. I brought a stapler from Morogoro. Then another tap connected to the water tank so that they can easily tap water. The water pump now works very well on solar, the tanks are all full of free solar energy. The generator has been out of order for some time. The other men have continued to plaster the wall of the chicken coop. That clears up nicely.
Sunday 21 May: At 10.30 am to the church in Lugono. That was of course 11 o'clock. Another whole experience. The organ still worked well, Benson is now the conductor. Surprising how he not only picks up a lot in the dispensary but is now also very active in the village, including at the church. In the evening I was invited to the Ugandan pastor in Melela who also celebrated mass with the sisters last Thursday. He had another whole meal ready with even ice cream! He has been with this parish for over 2 years now, but has already achieved a lot. He is now building a large reception hall, has 2 cows, 8 pigs, lots of chickens, duck, rabbits and also a lot of fruit in his rectory garden. And then also 2 full churches on Sunday with more than 300 churchgoers at a time, 3 outdoor posts for church services and various schools. Hats off!
Monday, May 22: askari plasterers have continued with the chicken coop. Harry, Mathias and Stanley have broken away the last piece of wall in the new sister room so they can now rebuild, sewerage, water pipes, tiling, etc. This room is intended for Speransia who will soon have to follow up Restituta. Benson and I also made new covers on the other exam tables, they didn't look good, all torn and dirty. Then I went with Dominick to the Melela farm because the inverter for the water pump did not work there so that the pump could not run on solar. I had brought a new Grundfos display because Dominick reported that it was broken. But that was not the case. The inverter was faulty, probably because it had swapped the high-low sensors causing the relay to flutter. Now looking for a new inverter! There was a masai boy killed there last week by an elephant, pierced from behind by a tusk. There has been a lot of damage here lately from the elephants. It is a large group traveling back and forth from Tanga in the north to Mikumi. Shooting is not allowed, then you will go straight to prison. The same problem as with the wolves in the Netherlands.
Tuesday 23 May: our last working day here in Lugono. We adapted the beds for the mosquito nets I bought in Morogoro last week. Tried to weld the supports with the welding machine but because it was very cloudy we didn't have enough voltage through the solar. So fastened with bolts. We have also transferred the wall sockets in the room where the radiographer makes echoes every Saturday to the solar, so that he does not have to work with all kinds of extension cords.
We went through all the works again with the men and said goodbye.
Tomorrow, Wednesday 24 May, we will leave for Dar es Salaam again for the plane to Amsterdam. With this I close our report and will try to send it to you. The internet is very bad here at the moment so I don't know if that will work. We can't check in either, so I hope they don't transfer us to a later plane like last year. We have seen a lot in these 3 weeks, a lot of overdue maintenance in the hospital, tools that were all mixed up, no good organization and division of labor. However, there are also many positive developments. Buildings that were neatly painted again, a new ER building, a new nursing school. There is also a lot of construction throughout Tanzania, roads are being built, rubbish is being cleaned up. A major problem will be the many young people who do not have a job and the large-scale relocations to the cities. Dar es Salaam currently has 12 million inhabitants!