RATIONALE

Sr. Mary Reese, recalls a letter addressed to Mother Mary Columba, February 6, 1947, from Fr. William Collins saying, "There is work here for the Sisters. Without Sisters, we can not do very much with the girls and women. The mortality rate among infants is terrific due to the lack of education among women. All of us hope that some day the Sisters will come."

Care and help for the women and children was a top priority for both the Maryknoll Fathers and the Maryknoll Sisters. As the Fathers started new Missions, the need for medical work was recognized as an important service to give the people of the area. Government health services were few, and a health facility in an isolated area was always welcomed and appreciated. Because of the dedication of mission personnel, mission facilities had a very good reputation and were sought after by the people for care and treatment.

Only a few years after Sr. Reese arrived in Tanzania, the first Maryknoll Sister doctor came ashore. Sr. Marion Jan Puszcz remarks:

In the latter 1950's health care facilities were few and far between in the rural areas of Tanzania. Under the British system, no attempts were being made to respond to special needs. The latter would include mother and child care, nutrition, preventive medicine and tuberculosis programs. But the Maryknoll Sister's health care facilities did indeed offer services in all these areas. Then in the mid-1960's, with independence, there was a remarkable shift in thinking regarding health care. The Tanzania government began to emphasize maternal and child care, especially "under-five" clinics. Also, scholarships from Makerere University's infant Nutrition Program were offered. At this time, Kowak Hospital (which had been limping along) received some government financial assistance for staff. The services were able to be extended beyond the walls of the hospital as outlying villages in the catchment area were visited regularly by staff (in what became known as 'safari clinics').

These visits usually occurred once a month and lasted for three days. The local catechist often processed patients for the visiting team. At the end of the 1960's, Kowak boasted of an outpatient dispensary, a bedded maternity facility, regular tuberculosis and leprosy clinics, as well as a forty bed hospital in a converted primary school building! In a pinch, nearby thatched buildings of mud served patients for short term needs!

Sr. Muriel Vollmer began working at Nassa, an area southwest of Kowak. On matters of motivation for medical ministries, Muriel Vollmer reminds us that "in health ministries we associate with people, non-christian as well as christian at important moments in their lives. Our ministry and relationship can touch them deeply with the compassion and love of God."

One of the first Maryknoll Lay Missionary doctors to work in Tanzania, Dr Thomas Temme, who arrived in 1985, expands this by explaining,

Where the needs are so great, each of us can make a distinct difference. To serve the sick is to share in God's healing, re-creative love. It is a privilege to be an instrument of that love, and to receive it in return from those we serve. What we accomplish ultimately becomes less important than how we go about our work and how we ourselves are changed and renewed by the experience of our ministry. Only if we perform our tasks with joy and peace will we be effective witnesses of Christ's message of love and hope.

In 1996, our reasons for continuing a Maryknoll presence in health care in Tanzania were described by Eileen and William Velicky, Maryknoll lay missionaries ( a physical therapist and a prosthetist, respectively).

We came to share our skills in a developing country; to be part of a faith community in Maryknoll. Tanzania is where it seemed our skills were most needed. It is one of the poorest countries in the world, a country where most people do not have clean drinking water! The people are plagued by Tropical Diseases, and ravaged by periodic drought and the resulting famine. The problem is money. Tanzania's National Health Services are struggling just to provide basic health care. Health insurance is unheard of.

We think the exciting part for all of us in our profession wherever we are is helping people. Our future plans include improvement and expansion of our facilities with funds donated by Maryknoll sponsors. Also, we are seeking commitments from the 'first world' in terms of funding, equipment, material and personnel. The quality of health care for the Tanzanian people can only decline as pressure mounts from the World Bank and International Monetary Fund to change Tanzania's economic policies.

On the more mundane level, we must admit the obvious action of God calling missionaries whose gifts include health care skills. These missionaries allowed Maryknoll to respond to the particularly severe need for health services in Tanzania - from 1948 to present. In summary, we can say that we do health care work because of the tremendous need, as a participation in Christ's healing ministry, as a witness to God's love and concern and because God has called those with these special gifts.

THE WORK

Kowak, a word synonymous with Maryknoll Medical Services in Tanzania, is the name of an area in Musoma Diocese where Maryknoll medical missionaries have worked from 1948 to the present. By recounting the history of Kowak's health services, we will be able to remember the largest single group of our medical personnel to have worked in Tanzania.

Our very first Maryknoll medical missionaries, Sr. Mary Bowes, leads our long line.

She remembers the first medical facility provided by the Maryknoll sisters was opened in Kowak, July, 1949. The Fathers had been giving out medicine in the parish office, but had promised the parishioners a real dispensary. The medical work was begun in the Sisters' bathroom - a large closet like room with a door and long white porcelain bath tub (there was no running water or electricity). The patients sat on the ground around the building. Brother Fidelis made a cover for the bath tub so that it could be used as an examining table. That left very little room for two workers to stand! At first we used whatever medicine had come in shipments from home. We bought mepacrine, aspirin and worm medicine; only available in Nairobi or Kisumu. Injections were a surprising favorite over oral treatments! Medical problems were compounded by other problems such as belief in witch doctors and traditional sacrifices. Last but not least in obstacles was communication. We studied the local language, but there were many Bantu patients from several different tribes. So, the aspirants to a native community of Sisters would translate for us in the dispensary, explain customs to us and teaching health to the patients; each in their native tongue. With fifty to one hundred patients each day it was apparent to us that preventive education was a great need. But we had neither the space nor the personnel for such a service at our beginning. When a patient was brought at night, he or she would be on a native stretcher carried by six men armed with spears. By the mid 1950's, the new dispensary building was progressing, but then the walls tumbled down - and we began once again from our foundation. Finally, in August 1951, Kowak had a dispensary! We employed local men to register patients and give injections. One young man took over our laboratory after we had sponsored him for training. Before I was assigned to Nyegina Dispensary in 1953, we had managed to institute both a 'Well Baby Clinic' and health education classes at Kowak.

Mary Reese provides some more history.

As the workload of patients increased at Kowak in the late 1940's early 1950's, Sisters Agnes Jude, Nuncia St.Pierre, James Florence Blanchard and myself were assigned to Kowak. A six-bed maternity unit had been built with government funds. The plan was to train village midwives o assist the women during childbirth in their villages. The formal course never materialized. However, many young women helping in the maternity unit were trained on the job.' These women were good helpers and were able to do a normal delivery with skill and to recognize dangerous signs and symptoms which alerted them to seek more experienced assistance. In general we had one Maryknoll sister in charge of three or four Tanzanian helpers at any given time. Kowak was always busy and had an excellent reputation for good care. In the late 1950's wit h the arrival of Sr. Dr. Marion Jan Puszcz, M.M. a simple school building was transformed into a small hospital where minor surgery could be done - inclusive of Caesarian Sections. This service flourished and provided excellent care.

During the years I was at Kowak, all the newly arriving sister nurses came to Kowak to spend their early months becoming acquainted with health care in the Tanzanian milieu".

In the latter 1960's, Kowak was called a Bedded Dispensary and Maternity. Many sisters spent a short time at Kowak between 1967 and 1970. They were Maryknoll sisters Margaret O'Brien, Theresa McSheffrey, Joyce Burch, Paula Kuntz, Sylvia Postles and Elizabeth Gormley.

Sr. Margaret O'Brien returned to Kowak in 1970 for a period of eight years. She was the lone Maryknoll sister during this period. The Immaculate Heart Sisters of Musoma joined Kowak's medical team in the early 1970's. This allowed Margaret O'Brien to spend more time at a satellite dispensary called Rosana, where the Maryknoll Sisters had worked prior to 1973 - but were no longer able to staff it. In 1978 Margaret O'Brien left Kowak. In 1986 sister Mary Brummagyn and a Maryknoll Associate sister Patricia Ginty answered the call to help at Kowak during a cholera epidemic, but by 1987 there were no more Maryknoll sisters at Kowak.

Maryknoll Lay Missionaries

During the mid 1980's Maryknoll Lay Missionaries began to work at Kowak. Dr. Susan Nagele remembers being Medical Officer in charge for Kowak Bedded Dispensary (upgraded to a Health Center in 1988) until 1991. One of the biggest problems during the first three years was measles. I remember watching two to three children die, or rather, suffocate to death, each day. After four years the incidence fell from about four hundred, to eight per year and during 1990 and 1991, we had no deaths recorded due to that disease. In 1987, I saw what I thought were our first two cases of AIDS. The numbers increased exponentially after that. We also had a cholera outbreak in 1987 which killed six to ten people. We completed our renovation project in the fall of 1988, and had much better facilities for inpatients and minor surgery. We established a good working relationship with the nearby Mennonite Hospital, Shirati and sent all major surgery referrals to them. We never succeeded in introducing blood transfusion facilities (although the Maryknoll doctor who followed me did). Neither did we develop our Primary Health Care Outreach Program as much as I would have liked.

While at Kowak, Susan Nagele was accompanied by a Lay Missionary Nurse, Sandra Cavandish, who recalls that that six years of nursing at Kowak were always busy and fulfilling - but for the most part routine. A typical day included assisting with minor surgical procedures, labor and deliveries, ordering medication and supplies, teaching and maintaining adequate staff, teaching english as well as staff development regarding the assuming of more responsibility and accountability in work. There were two experiences, however, which were memorable ones for me since they happened when both physician and priest were away from Kowak. I was alone (or so I thought) in crisis situations. The first emergency took place near Kowak when a lorry (truck) filled with about thirty villagers overturned. All survived the accident, but sustained multiple fractures and serious injuries - which included an arm amputation. After supplying the injured with intravenous fluids, splinting fractured limbs with broomsticks, changing and dressing wounds, the more seriously injured were transported to Shirati Mennonite Hospital. The second emergency involved my transporting a bleeding patient by van, again to Shirati Hospital. The trip should have taken two hours. But the road became nearly impassable because of mud from heavy rains. We became mired in the mud! I prayed for help and it came from villagers who seemed to appear from nowhere to lift the van out of the mud. Four and a half hours after starting our journey we reached Shirati. The young woman survived her ordeal. At Kowak I learned to use every available resource, especially Divine intervention. In retrospect, I would not trade these experiences for any others in my lifetime.

Dr. Nagele was fortunate to have another Maryknoll Lay Missionary doctor follow her. Dr. Gregory Ryan remembers becoming Kowak's Medical Officer in Charge in June, 1991. In August of that year they experienced a meningitis epidemic. The area had a drought at the same time causing the corn and millet crops to fail. This combined with the lack of cassava produced a famine. Medicine became a luxury. Kowak Health Center suffered financially as attendance plummeted. If not for the tremendous response of our Lady of Lourdes (Kowak's twinning parish in Rochester, New York) financially, the Health Center would have had to suspend or severely limit the services it provided. Instead, it was able to increase its outreach to the poor during that most difficult period.

The ordinary case load at Kowak included 2,000 inpatients per year with 12,000 outpatients and 400 deliveries. In early 1993 Kowak succeeded in establishing blood transfusion facilities. By the end of that year, they were giving over seventy-five transfusions a month (mostly to infants with severe anemia due to malaria). Margo Cambier adds an update to Greg's account. "To assist in the running of the Health Center we have a management committee which meets weekly. It is comprised of the head Nurse, Medical Officer in charge, an employee representative and the administrator. This is a valuable forum where major items are presented and discussed. The cultural dynamics are many and reach into the community".

No other medical service in Tanzania or Africa for that matter, has been so influenced by Maryknoll for so long, as Kowak has been. But there are other Tanzanian facilities which have enjoyed Maryknoll's medical missionaries over these past fifty years.

Sr. Mary Lou Andrews, under the invitation of the Maryknoll Bishop Edward McGurkin, spent nearly a decade at the Diocesan Dispensary at Buhangija Shinyanga during the 1960's. Fortunately, Sr. Andrews had spent a few months orientating herself to Tanzania's health services at Kowak before moving south. She then proceeded to develop the services to the point that almost all the services we noted for Kowak, were available at Buhangija. She was especially thankful for the decrease in cases of small pox during her time there. Other Maryknoll sisters spent shorter times serving at Buhangija, they were Srs Muriel Vollmer and Katherine Taepke. The routine of rural medical services had become painfully predictable for missionaries, as Tanzania's economic poverty was ubiquitous leading to similar disease states everywhere.

In the early 1980's, another Maryknoll Lay Missionary M.D. William Fryda, became Health Director for Shinyanga Diocese. Along with patient care at Buhangija dispensary, Dr. Fryda worked to upgrade health services at each of the twelve diocesan dispensaries by training indigenous personnel and coordinating the procurement of medications and supplies. After ordination in the late 1980's, Fr. Fryda worked at Sengerema Designated district hospital for several years before taking his years of Tanzanian experience to Nazareth hospital in Limuru, Kenya.

The last Maryknoll Lay Missionary M.D. to serve at Buhangija, did so in the late 1980's. He, Kerry Watrin, and his nurse-wife, Terry, had a fine Maryknoll foundation to build on at the dispensary and did so for several years. After them the local church has taken all responsibility for the same health services.

The work spreads

The Diocese of Shinyanga enjoyed the Maryknoll presence in other facilities over these past fifty years. The Maryknoll sisters created dispensaries at Nassa, Mipa, Sayusayu and Mwamapalala besides Buhangija. The sister most associated with health care in Shinyanga is Katherine Taepke, as she gave decades of her life to care for the sick of that area. She recalls, although her medical mission began in the late 1950's in Musoma at Rosana and Nyegina dispensaries, the next few decades would find her more often than not on Shinyanga soil. Her assignments included Buhangija, Nassa, Mwamapalala, Bariadi and Old Maswa. Her vast knowledge and love for the Tanzanian people (both the sick and health workers alike) found her being called on by the Medical missionaries of Mary for work in Singida, and finally by Archbishop Mayala for AIDS Homecare in Mwanza.

Other Maryknoll Sister Nurses who gave years to health care in Shinyanga include Sr. Theresa Sauter, who was at Sayusayu dispensary in the 1960's and Sr. Eileen Kelley, who was at both Nassa, Mwanangi at about the same period. Also in the 1960's, Sr. Muriel Vollmer, M.M., R.N., was at Mipa dispensary. There she emphasized clinics with support from nearby Mwadui Mine hospital and Ndoleleji's medical team. Sr. Vollmer believes here vigilance for opportunities to teach health as well as to practice curative medicine accounted for much of the improvement in health in that area at that time. Afterwards she took that lesson to Buhangija.

Going south, deep into the Diocese of Shinyanga, we arrive at Ndoleleji Dispensary where Maryknoll's medical Lay Missionaries first appeared in the mid - 1970's. Elizabeth Mach and Mary Orth spent several years at Ndoleleji where they began mobile Outreach Clinics to twenty-six villages serving children under five years of age, and pregnant mothers. The eradication of measles was a goal of these ventures. Mary Orth narrates a classic "Safari Clinic" for us.

We're almost there. Finally! who could believe it would take two hours to drive twenty five miles? There is Magalata, a village on the far reaches of the parish. Unfortunately for us there is no road out there. It is the rainy season, we are as stuck as possible. The bottom of the Land Rover is hung up on hard mud, and all four wheels are spinning in the air. It takes a lot of effort to dig ourselves out. There are two inches of sticky mud on the bottom of our shoes. Anyone passing by stops to help push. As we pull up to the mission run dispensary, we see a crowd of black clothed women (moslems), with their children and babies. They stand with anticipation. It is time to start our Maternal Child Health Clinic! one of our staff starts to teach a Nutrition lesson - with illustrated posters. Then the mothers and children line up at our baby scale. Each child's weight is plotted on their chart. Then we assess each child's appearance. Next, the appropriate immunization for each child are given. We also examine the pregnant women. We check their haemoglobin and blood pressure, give them vitamins and malaria prophylaxis, and recommend they give birth at a hospital if we could anticipate complications. It is always a thrill the next month to come back for a clinic and see the proud mothers with their healthy newborns. Well, our clinic is finally over. After about five hours in the heat, we pack up, say good-bye to the local dispensary staff, and hope we get home without getting stuck too badly. Today we have seen about two hundred and fifty children and twenty-five pregnant women.

Mary Orth finishes her narrative by stating that living in Tanzania has made a bigger impact on her life than anything else she has done. "I am much more aware of what is important in life, and I try to reflect this in the way I am raising my own children. I have truly been blessed and privileged to share three years with the Tanzanian people".

Ndoleleji welcomed another Maryknoll Lay Missionary, Dr. Thomas Temme, a few years later. Dr. Temme says "since starting work in mid-1985, my time has been divided between direct patient care, teaching and diocesan administration functions. It has been a good experience both professionally and spiritually." Then, as Dr. Temme was completing his three year contract, two other Maryknoll Lay Missionaries arrived at Ndoleleji. They were Joan Sharky and Judy De Christopher.

Risking having forgotten an aspect of Maryknoll's medical history in Shinyanga, we move back north to Musoma, to the area of Bunda, where an experiment in local lifestyle was in place in the mid-1980's. Sisters Joyce Burch and Judy Siliviera (Maryknoll Associate), while living in a mud house in a village setting, staffed the local dispensary-called Kung'ombe. Maryknollers at Bunda Parish supported this serious effort to indigenize both in the work site and home setting.

Just up the road was Makoko a village of Musoma Town. There we could find Srs. Margaret O'Brien and Nuncia St. Pierre at different times in the 1980's and early 1990's serving as the "local general practitioners" at Makoko Family Center. During part of that period we could find a Lay Missionary Nurse, Yvette Dumont Connell, assisting Sr. O'Brien. But Yvette Connell's other responsibilities included being the school nurse at St. Pius Junior Seminary at Makoko (which included teacher's families as well as hundreds of students). Nurse Connell's teaching abilities became known and soon she was teaching in the same Seminary as well as at the local Rural Medical Aid School at Musoma General Hospital.

Fifteen years in the same medical facility is almost unheard of among our Maryknoll medical missionaries. But one, Sr. Agnes O'Keeffe, enjoyed her years in Nyamwaga's Parish dispensary from 1974 to 1989. It was in a most rural area of Musoma. In the late 1960's, Fr. Edward Hayes had established Sr. Marilyn Snediker in the first make shift dispensary complete with bamboo partitions. In the early 1970's, two of Sr. Snediker's local assistants carried the workload by themselves for a couple of years before Sr. Agnes O'Keefe arrived to take over where Marilyn had left off. Sr. Agnes recalls after assessing the present work and visiting the area, we decided to stress aggressive work with children (under five clinics) and pre-natal care. We increased the staff from two to ten workers. Local studies complimented on the job training for lab work and physician assistant skills. Everyone was trained in rapid assessment of a critically ill child. Seeing nearly two hundred patients a day, any day, meant little "time-off"."

Bugando Hospital

The final geographic area from which to recall Maryknoll's medical history is in Mwanza, on the shores of Lake Victoria, in a ten story cement and steel structure called Bugando Hospital. Here Maryknoll supported the local Tanzania Church in a joint venture with the Government, together trying to resurrect this eight hundred bed facility; in gross disrepair only ten years after its construction in the mid-1970's.

Doctors were needed and Maryknoll responded with two, Fathers Scott Harris and Peter Le Jacq. These were welcomed by Father John Eybel a Clinical Pastoral Education Supervisor, who proceeded the Doctors by a couple of years. All three were soon painfully aware of the impending epidemic of AIDS in the Hospital's catchment area of seven million. Their plans for classical C.P.E., General Surgery and General Medicine-complimented by chaplaincy and physical plant repairs, had to be altered. AIDS dictated otherwise. Local Church and Government authorities supported the use of C.P.E. to prepare AIDS Counsellors (as Tanzania had no Counselling facilities or courses) and encouraged Frs. Harris and Le Jacq in the development of AIDS prevention materials and seminars. Later, AIDS Homecare would occupy much of Le Jacq's work hours.

Le Jacq and Eybel would be the only Maryknoll priests at Bugando from the late 1980's to the mid/1990's. Le Jacq's earlier years spent in rural Tanzania, at Mugumu Hospital, were few compared to Eybel's dozen years in rural Musoma. The latter's cultural insights effected much of the Maryknollers' approach to an AIDS response. Simultaneously, routine chaplaincy and Tropical Medicine lectures were attended to by this team. And eventually, the hospital's sanitation, water, and kitchen areas were renovated with Maryknoll sponsors' support.

At about this same time, from the late 1980's through the early 1990's the medical Maryknoll Missionaries in Tanzanian met several times a year for prayerful reflection and mutual support in a most difficult setting for modern medicine. This was called "Medical Pastoral Theological Reflection". The natural attrition alleviated the need for such a group, but its timely input to the Maryknoll leadership while it functioned, was much appreciated and acted on.

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