I have mentioned several times that one important aspect of The Toa Nafasi Project involves a "referral" phase in which we try to assist students who are under-performing in the classroom due to reasons other than a learning difficulty. We usually start referral appointments after the first assessment is completed and then follow up as need be over the course of the year, but of course, if a student presents immediately with a medical or psychosocial issue, we'll address it straight off the bat. Still, it is more likely that Vumi or I will notice a child maybe squinting at the chalkboard or leaning close to his notebook when writing which would indicate poor eyesight; or that, in talking to one of the parents, we find out something in the child's history that would lead us to want to have him or her looked over by a doctor, such as a missed milestone (not crying at birth) or maladaptive behavior (bed-wetting).
To address such concerns, we have developed a network of healthcare professionals on whom we can call when we see some of these other non-LD type issues. I've written recently and often about the services Toa Nafasi receives for Msaranga Primary School students from the Gabriella Center, and a few times about those provided by Comprehensive Community-Based Rehabilitation in Tanzania or CCBRT (mostly for maternal and newborn health or severe mental and/or physical disability). But many other of the docs we work with are located right in the main hospital in Moshi, a facility called Kilimanjaro Christian Medical Center, which is known to be the best in the region but which would probably shock the average Western patient right out of his or her hospital gown. Nevertheless, we have to work with what's available and - knock on wood - so far so good.
This year, we took probably over twenty different children to various clinics at KCMC, but they almost always have to start at "Casualty" which is (strangely) where we check in. (The word mapokezi means "reception" in Kiswahili which is, decidedly, less strange.)
Oops, I forgot to say that Vumi will have already explained to the parents that Toa Nafasi will cover the costs of the exam and any follow-up or meds necessary as long as the parent can a.) prepare the child for the visit and get to the hospital ON TIME and on the DAY SCHEDULED, b.) pay their own transport fees to and from KCMC, and c.) join the child or arrange for another family member to be there to hear any diagnosis given and treatment recommended. Toa Nafasi is here to help but WE ARE NOT FOSTER CARE, people!!
So far, this system has worked out pretty well though I have been suckered into paying for snacks and things when the day runs long which it almost inevitably does. Waiting at KCMC is about as interesting as watching paint dry and as time-consuming as well, and it's not like anyone besides me will think to bring a book or a bottle of water, so the kids can get kinda feisty and cranky.... and the parents are hardly any better.... I think for next year, Vumi and I should remember to tell them to pack their own snacks/lunches and that we should bring some coloring books or small games that can be played in the hallways during these down periods to keep cantankerous kidlets occupied.
Case in point: Namani below, who even the ever-patient "Angi of the Morning" found to be on the extreme end of the bad behavior spectrum. (Truth be told, he could probably benefit from some kind of ADHD med, but there's NO WAY I'm going down that road with these kids. The responsibility I would undertake in terms of long-term care and cost, and all the possible side effects of the meds notwithstanding, simply getting him or her to adhere to the dosage and scheduling would be harder than summiting Mt. Kilimanjaro.)
Poor eyesight is a common reason other than a learning difficulty why a child might be doing poorly in school. And, unlike in Western schools where the teacher might call in the parent to say, "Little Sarah can't see the board," there is not too much communication between teachers and parents in Tanzania. (Though Toa Nafasi is working on changing that!)
And finally, and quite unfortunately, what we see A LOT OF is problems with the mama related to either her pregnancy period or the time of labor that have resulted in shida or "trouble" for the kid. These run the gamut from lifestyle and environmental health causes (malnutrition, drinking while pregnant) to infections (malaria) to autoimmune disorders (HIV/AIDS). And they can result in neuropsychiatric illnesses for the child ranging from hyperactivity to autism to epilepsy to many things in between. There is a very good Dutchwoman doctor on-staff at KCMC to whom I always bring my kids for Neuro consults.
This year, we had the opportunity to go to the Ear, Nose, and Throat clinic for the first time so that a student could have his adenoids removed. According to mama, Francis was having trouble breathing which obviously gave way to myriad other troubles - inability to sleep, lack of concentration, poor quality of life in general - so we admitted him for surgery and after a couple days, he was back in school and doing much better. He was a real champ getting his bloodwork done prior to surgery, but when he first woke up post-op, he clearly didn't know what was going on and had a real tough time of it, poor lil' guy....
If a student is performing poorly academically, there could be various issues at play and it is up to us, once we've assessed the pupils, to address each individually and to provide as much of a solution as we possibly can. Such is the "referral" phase....
Now, my next goal? To edit the signage at KCMC.... I spotted this medical fridge in the Peds ward and just had to take a pic! I wonder then if a Tanzanian defibrillator is a defiblirator??