Memorial cross to AIDS victims

Orphans’ funeral dance for lost parents

Orphans calling out to their lost parents

Funerals, sadly, are an expected part of life in Tanzania. In fact today a funeral procession, one of three, left the nondescript block building next to the HIV center and passed through the Kilema Hospital gate, a cross like the mast of a ship erected in the back of the small pickup carrying the coffin. It was followed by a second pickup filled to capacity with musicians and brass, clearly a family of some means to afford an accompaniment of horns and music. Sasha and I and curious staff came out of the offices to listen. It sounded more like a wedding, with the bold and joyful African rhythms we’re used to hearing from musicians who weave through the streets of Moshi in wedding processions, until we realized this was a funeral. Rarely do we hear music on the mountain when pickups leave Kilema hospital for how many can afford the cost? Most often it is a quiet, sober exit perhaps with the cries of mourning women and murmurs from those watching another truck passing through the gates.

Last week word came that D., one of our supported orphans, had become what is known as a complete orphan; he lost his father. The man was brought to the hospital in the back of our OVC jeep driven by my colleague Rick who had slid through Ngangu clay to retrieve him. Though he died upon arrival the outcome of his illness couldn’t have been a surprise even to D.. He had been ailing all year and, like many men, was resistant to follow-up. The rest of our day was spent discussing how the orphan program should respond to such circumstances. With so many aging Bibis and Babus, the death of caregivers is an inevitable worry though we all agreed we were not in the business of financing coffins. Still we knew that the remains of this family could not afford the 85,000tsh necessary to buy the simplest of board coffins, let alone one festooned with white paint and purple ribbon like those by the dalla dalla stand in Marangu. Over two days the desperation of the family increased and where they had not attended or contributed to other funerals in the community, now few were contributing to D.’s funeral responsibilities. The wazungos of Kilema pulled together 85,000 shillings to get D.’s father in the ground. No pickup left the nondescript block building. Only a boy on foot holding a cross, leading pallbearers and coffin from the morgue to the cemetery, and not by way of the cathedral.

We’ve had a spate of sad departures. N., some of you might remember, died of an AIDS related illness just over a month ago. Through your donations to the Kilema Support Fund, Chris and I had sponsored him to begin a mechanics program at Mandaka Vocational School just down the mountain from Kilema. He fell ill even before starting classes and failed to recover from Cryptoccocal menengitis. All the HIV center staff, Mama Nyaki, Mama Kessy, Mama Rosalia and our Dr.Chris felt the tragedy. Bistra, the pharmacist from Montreal, cried all afternoon and we all remained downcast for days. Even Satish Gopal, a young pediatricican working at KCMC Hospital in Moshi, paused sadly to remember N. who he had treated as well.

N. was a very determined and capable young boy who knew he was ill but his mother refused to tell him. Dr. Nyaki told me N.’s mother had fled her office when she pressed her to tell N. his status. The mother feared all the stigma and fought to retain deniability. Mama Nyaki pulled her back from under a tree and persisted, begging her to let N. to take control of his own life and his mother eventually agreed. N. proved to be very faithful to his treatment. But alas, he failed to make it.

So what is offered at end of life? Talking to Mama Nyaki about palliative care lately, I showed her an accounting of the clinical use of opiates in the world, with developed nations like Austria (No. 1 with 115 mg/capita) Canada (No. 2 with 64mg/capita) Denmark, USA, and Iceland showing the greater clinical use. The nations which use opiates the very least were all African with Tanzania at the bottom (.001 mg/ capita). Together, Mama Nyaki and I looked at a most graphic comparison. In the 1960-70’s the WHO recommendations were cautious and paranoid and the legacy of that has made Africans fearful about the use opiates. So for the people who come in late to Kilema with full blown AIDS, disastrous cancers and other life-ending illnesses there is little relief from symptoms. Little relief from pain, perhaps none from respiratory congestion or breathless which can be worse than pain itself. What did that chart say to Dr. Nyaki who sees how compassionately some people leave the first world? Perhaps how fearful we are of pain? I argued that maybe Africans are more familiar with the end of life, more accepting of the ‘beads falling off the string’ and for these medications are just never asked for. We both agree that things need to change. Dr. Nyaki and Kilema Hospital would welcome a year of voluntary service from any willing palliative physician.

The very day we received news of D.’s father, further sad news came that HBC A.’s elderly father had passed away. I work closely with A. and was eager to represent the OVC(Orphan and Vulnerable Children) program at the funeral in Legho. So on the day a few of us including Mr Tem, a friend and HBC colleague, tried to navigate the village road and failed, fishtailing in a slurry of red clay. Abandoning the car we set off on foot and arrived like other villagers, wiping sweat from our faces and adjusting our clothes. In the well-swept clearing between pole and mud houses, an altar had been erected with frayed white and purple fabric. Father John presided over the glazed wooden coffin and a sea of family and villagers all dressed in their best shirts and kitanges, some of who I recognized. Mr. Tem passed me a note with the calculation of the elderly man’s age: ninety years. What a relief to consider not only a long life well lived but also this man’s amazing genetic fortitude in a land of such apparent and persistent natural selection. With heads bowed I had ample time to study muddy shoes, pants tucked into socks and calloused well-worn feet. Beautiful singing occupied the time needed for the family to bury their father on the shamba, behind their hut.

Later we enjoyed a extravagant plate of rice, cooked meat, bananas and a Serengeti beer and mindful of the coming rain, then paid our respects. Leaving got us only as far as the neighbour’s house, Leocadia herself just back from the funeral. Now this is the wonderful, wise woman who gave Lockie his chickens so we were easily pulled in for hospitality. Distracted by an exceptional view and the beauty of spoken Swahili and Kchagga, I was reminded by Mr. Tem that my drinking speed was a concern in light of the approaching weather. Leocadia gifted me a beer and avocado and lead us some way out of the village but again we were pulled in to another house, they too well into funeral celebration. And there was our friend, Albin! At the next and final house we were offered not beer but an umbrella for the winds had started and the drops were beginning to pound. Aware we played our cards badly yet unrepentant, we approached the return with an odd mixture of adventure and resignation and headed down with curtains of rain lashing from every direction. The road became a river and we looked for high ground and traction, just hoping to remain upright. We skirted torrents of red water rushing to the ravine bottom, cleared the flooded bridge trying not to get swept off, and marveled at drama of nature, water coming from everywhere. With no regard for shoes now (Mr. Tem in his dress shoes) we began the climb up, sloshing in water running downhill toward us  as dark arrived, passing children using cassava leaves for umbrellas. Only when we were on the level did a carefree step land me in the mud. From a small shop in the shadows came quiet laughter which I was helpless to resist…the mazungo’s down. Laughter all around. I arrived home saturated and very wet too, but also very happy ….for Africa is like that.

I will leave you there….