FROM THE GROUND UP
AN EXPLORATION OF ENERGY EMPOWERMENT
Energy poverty is foremost a women’s issue. And women are key to effecting grassroots change.
In partnership with the Caterpillar Foundation, we explore the intersection between Tanzania’s struggle for reliable energy and the campaign to empower its mothers and daughters.
By Brittany Nims
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HE STANDS HUNCHED OVER HER open abdomen on the operating table, fat and muscle tissue layers severed and pushed aside. He holds two ends of a ruptured tube in each hand. Medical students crowd closer to watch as he clamps the ends to control the bleeding. It’s quiet, except for a dull, electric buzz whirling through the air.

The white lights flicker, a soft POP ! rings from the ceiling, and then there’s nothing but darkness.

Dr. Bwire Chirangi calls out to another person in the room, who already knows what to do next. He rushes outside into the earthly night, across a small courtyard, and into a tiny, square, red-brick shed. An antique generator fills most of the room. He pulls the cord several times. Nothing happens.

Back in the operating room, Chirangi waits, thinking through his options. He’s all too familiar with this medical complication -- postpartum hemorrhaging accounts for more than 24 percent of deaths in the area, he estimates -- but on this night he’s forgotten his flashlight. He asks the students for a cell phone. Members of his staff aren’t fazed, they’re used to this problem: the electricity cutting out unexpectedly and the sudden need to improvise quickly. The quiet has grown, and the air is thick with tension as the shocked students, many from abroad, squeeze closer to watch him finish the surgery by the backlight of the single cell phone.

Chirangi sits behind his desk on the second floor of Shirati KMT Hospital, where he is the facility's medical director.

That was over eight years ago, Chirangi says matter-of-factly from behind his desk on the second floor of Shirati Hospital. “I've been here for more than 10 years,” he continues. “Go eight years back, and Shirati was always dark, all the time.”

It’s a warm mid-October evening, and the golden-hour light is peeking through the open window in his office. He’s flanked by teetering stacks of loose papers, folders and spiral notebooks. A calendar, still flipped to September, sits at the edge of his desk, with a quote attributed to Jack Lalanne scrolled across the top: Your body is your most priceless possession; you go take care of it!

Shirati KMT Hospital is a medical oasis in rural East Africa. The hospital sits only two miles from the shores of Lake Victoria in the town of Shirati and serves a population of more than 200,000 in the Mara Region of Northwest Tanzania, an area desolated by a lack of affordable and reliable electricity.

Having gone at least once without electricity for up to six months, the hospital now operates on a cocktail of energy supplied by Tanesco, the local Tanzanian electric company; on-site-generated solar power; and a backup generator. It’s a godsend to the dozens of dispensaries and midwives in the surrounding villages who send patients to the hospital when complications are beyond their medical expertise.

Lake Victoria
Shirati
AERIAL VIDEO
AERIAL VIDEO
The Midwife
The Doctor
The Changemaker
The Survivor
AERIAL VIDEO
Shirati is a small town with a population of about 50,000 in the Mara region of northwest Tanzania. Located about 2 miles from the shores of Lake Victoria, it's an area that has been desolated by a lack of affordable and reliable electricity.

“People think I’m crazy here sometimes,” he continues. “They say, ‘What are you doing in Shirati?’” Chirangi is from Musoma, the administrative capital of the Mara Region. More than 60 miles separate Shirati from Musoma, its nearest large city -- and travel between them is mostly spent on treacherous, craggy, red-dirt roads. By virtue of his training (a master’s degree in science and public health from Maastricht University in the Netherlands; a volunteer clinical instructor at the University of California San Diego’s reproductive medicine department), he could be practicing elsewhere, with superior facilities, doing work that isn’t as mentally taxing and physically draining.

When women are empowered, they then empower others.

Though he’s not the hospital’s only doctor, being the facility’s medical director means he’s always on duty. He’s a triple-tasker, perusing emails and making patient calls by speaker phone throughout the day while being interviewed. Small details about Chirangi betray an exhaustion fueled by passion that runs deep and wide. He says he’s conducted three deliveries the night before, and that he never sleeps. An oversized travel thermos of tea sits next to the laptop on his desk. When entering the operating theater later that evening, he removes his shoes, revealing black socks with neon green marijuana leaves printed on top, but casually waves them off. “A gift from a friend in Colorado,” he says nonchalantly, like he tossed them on without giving them a second thought.

“[But] why should I not try to use my skills and knowledge to save this poor community? I feel like this is special for me, that I need to support this community and to save these poor people who don't have any choice, because this is not their choice.”


A FEW STREETS OVER, in a dusty, two-room brick house tucked away among two-story-tall papaya trees, Lucanael Odero sits at the edge of her small bed under a teal mosquito net. Her raisined body is wrapped in a sky-blue kitenge, with her dirt-caked feet peeking out from underneath, skimming the earth floor.

It’s dark, but for a few isolated rays of early-evening light let in through the lone north-facing window. Inside, the air smells subterranean: stale, earthly, faintly of urine. She says she doesn’t know her age, though she’s certain she was born well before Tanzania’s independence from Britain, in 1961. In any case, following the death of her mother and her divorce from her husband, Odero has no one to ask who might know.

Odero holds a koroboi, an inexpensive kerosene lamp that produces a dim, smoky, open flame. Despite the health and safety risks it poses, the koroboi is one of the most common energy sources for people in the area.

In her aged hands, she holds what looks like an oversized aluminum can with a small piece of material poking through the top. Known in Swahili as koroboi or kibatari, it’s an inexpensive kerosene lamp that produces a dim, smoky, open flame. Despite the health and safety risks it poses, the koroboi is one of the most common energy sources for people in the area. From sunset to sunrise, it’s her only source of light at home. She explains how she must fumble in the dark for matches -- which she keeps next to a knife on a small wooden table near her bedside -- every time she needs to use it. The glow of the moon on clear nights is brighter than its tiny flame. And from the struggle to simply illuminate her home at night, a host of complications follow.

“Her life has come back again to this kind of life where she doesn't have light and opportunity,” the translator explains.

If poverty had a face, hers would be a woman’s.

It’s clear that energy poverty is sexist.
-Todd Moss, Senior Fellow, Center for Global Development

Of the 767 million people globally who live in poverty, it’s often cited that a staggering 70 percent are female. It's a statistic that Sylvia Chant, professor of Development Geography at the London School of Economics and Political Science, calls "completely elusive." Though exact statistics on how many of the world's poor are women and girls are dodgy, gender disparities in poverty are well documented. This is particularly true for single mothers, who are more likely to be poorer than men in both developing and developed countries.

The World Bank’s updated global poverty line is demarcated as earning less than $1.90 a day. In 2012, 20.6 million Tanzanians were living below the global poverty line. Seventy percent of Tanzanians live in rural areas, where poverty is pervasive.

But poverty isn’t just an expression of one’s economic plight; energy access is also a factor.

“Energy poverty” may sound like an absolute lack of reliable electricity, and has traditionally been thought of as not having enough energy to fulfill basic human needs, but, according to Joy Clancy, gender and energy specialist from the University Of Twente in the Netherlands, energy poverty is a much more complex condition. Rather, energy poverty is about a lack of c hoice in accessing the energy options that are available.

There are more reliable, high-quality and safe energy options for Tanzanians (like full-home electrification and large-scale solar-powered systems), but they’re also expensive and out of reach for not only the majority of locals featured in this story, but for the 38 percent of people in the world who continue to rely on bioenergy sources, like firewood. If your only affordable option to illuminate and heat your abode is to either spend hours each day collecting wood or earmarking a significant portion of your income for kerosene several times a week, is that really a choice?

“In poor households, women carry a huge burden for keeping families running, fed, educated and clothed,” says Todd Moss, senior fellow at the Center For Global Development. “Doing that is exponentially more difficult if you don’t have electricity. I t’s clear that energy poverty is sexist.”

Of the 1.2 billion people around the world who do not have access to reliable energy, the majority live in developing Asian countries and sub-Saharan Africa. They often have two options: spend productive daytime hours walking to collect bioenergy like firewood -- though due to lax governmental regulation and vast deforestation, they must continue to walk farther at great risk to their personal health -- or, spend a portion of their valuable income on unclean fuels like kerosene for dangerous and inefficient lanterns, like Odero’s koroboi.

One cannot just choose a life of light versus a life of darkness and smoke. But, one can create it.
-Neha Misra, Co-Founder, Solar Sister

“One cannot just choose [to have] a life of light versus a life of darkness and smoke,” says Neha Misra, one of the founders of Solar Sister, a nonprofit that works in Tanzania, Uganda and Nigeria to empower local women to bring energy to their last-mile communities as self-made entrepreneurs. “But, one can create it.”

And what happens when the access-to-energy dynamic in a woman's life is upended, even incrementally? What we see is an output somehow much stronger than the input that created it. Just as women suffer the impacts of energy poverty disproportionately, we often see them harnessing newfound energy empowerment to the benefit of those around them.

Ogunde stands outside her home in Roche village, where she is a community mobilizer. NGOs rely on her to talk to her community about their various issues, ranging from reliable energy to health care and HIV support. It’s how she became involved with Solar Sister, bringing solar lanterns to hundreds of families in her three years with the organization.

WOMEN ALL AROUND Rorya District say they want to be like Monica Ogunde.

Ogunde is living with HIV, and she was once ostracized by her community. “Life was a living hell,” she says of her past, speaking through a translator. Now, she is a symbol to the women of her village, flesh-and-blood testimony to the resilient spirit of confident, hard-working women.

Women from here, it's like they're men.
-Monica Ogunde, Entrepreneur, Solar Sister

Ogunde’s home is in Roche village, where she lives with one of her sons and a niece. It’s a tiny village several miles north of Shirati within Rorya District, and only about a mile from the Tanzania-Kenya border. It’s a slow and bumpy 45-minute ride between the two, down red-earth roads and patchy grass paths, or five hours on foot.

Tall grass and overgrown brush obscure the view of her home from the road. A tiny ‘Y’-shaped dirt footpath is the only indication of human presence hidden behind them. The yellow brick house sits on a clearing a few yards back, with a breathtaking view of nothing but brown and green speckled hills and translucent blue skies as far as the eye can see.

Ogunde and her family sit around an old teal wooden table after drinking tea earlier in the morning. There’s a jar of Clere Body Crème on the table next to a travel-sized box of Whitedent Herbal Toothpaste. The home is similar in style to Odero’s -- small, two rooms separated by a concrete wall, a strip of fabric hanging in the doorway between the two -- but it’s brighter and tidier, and has a concrete floor.

Growing up, she says, Ogunde and her family never had electric lights, and their alternatives came with many risks. The straw roofs found on many rural homes are quick kindling for even the smallest of open flames. “We used candles,” she says. “Candles, sometimes maybe [when] you're sleeping, can fall out. Something can happen. Our houses. Our kids, they're dying because of this issue of light.”

Ogunde sits inside her home in Roche village. In the past, she made a living selling household items. The extra income she brings in through Solar Sister allows her to build up her stock of Solar Sister products to distribute, pay her children’s school fees, and purchase healthier, nutrient-rich foods that increase the effectiveness of her HIV medications.

Ogunde sits in a cerulean plastic chair, her elbows resting at ease on the arms, feet firmly planted on the floor. She looks relaxed, as if she’s the kind of person who will tell things to you straight when you need to hear them. Her burgundy kitenge is an eye-catching contrast to her neon orange Solar Sister T-shirt, which reads on the back: “Light. Hope. Opportunity.”

Ogunde is a community mobilizer in Roche. NGOs rely on her to talk to her community about their various concerns, ranging from reliable energy to health care and HIV support. She brings the issues up at a community women’s meeting, which is how she became involved with Solar Sister.

She was the first Solar Sister entrepreneur more than three years ago, bringing solar energy to hundreds of families in that time. The Solar Sister model is simple, but effective. Solar Sister entrepreneurs are everyday women in oftentimes rural, last-mile communities who invest in a stock of various solar products, that they then sell for a profit to their peers. It’s an example of how energy supports more than a humane livelihood, but it also promotes economic development. It’s one thing to survive; it’s another to thrive.

“Most businesses fail,” says Katherine Lucey, another founder of Solar Sister. “We want to lower that entry risk for our entrepreneurs. I envision it as offering it on an open hand but then they have to come and take it out of your hand, that business opportunity.”

In her previous life, Ogunde earned her income as a businesswoman, selling kitchen utensils such as cups, bowls and plates. But, the back-breaking work of carrying heavy products didn’t generate recurring sales since household items aren’t things most people buy every day. She now makes a living selling more than two-dozen of Solar Sister’s simplest lights a week (the most in-demand item for Tanzanians, Lucey says), most of them to women.

“In Rorya, in general, women, they’re more empowered than men,” Ogunde says. “Women, they're the ones who are mostly in business. They're willing to do business. Women from here, it's like they're men.”

The extra income she makes has been life-changing for both her and her family. She’s able to build up her own stock of Solar Sister products to distribute , pay her children’s school fees, replace her straw-roof home with a tin-roof one, and purchase healthier, more nutrient-rich foods that increase the effectiveness of her HIV medications.

The one who is suffering due to the lack of energy is a woman.
-Monica Ogunde, Entrepreneur, Solar Sister

“The one who is suffering due to the lack of energy is a woman,” Ogunde says matter-of-factly. “She is the one who is cooking, she is the one who is after the kids, after the family, whatever. The woman, she's the one who will suffer a lot when there is no energy in the family.”


IN MOST REMOTE VILLAGES, when money is tight and sources of energy are scarce, the burden is overwhelmingly placed on women to collect free or inexpensive cooking and lighting needs. “If you look at all societies, men and women tend still to do different things,” Clancy, the gender and energy specialist, says. “The more you go to rural traditional societies -- it doesn’t matter if it's Latin America, if it's Africa or Asia -- then you get much more clearly defined [gender] roles.”

You can’t hear blood, you can’t hear a hemorrhage.
-Shannon Fulton, Solar Ambassador, WE CARE Solar

There’s evidence of this even in the U.S., where despite the common “shared housework” rhetoric, studies show that many Americans still tend to think of housework as women’s work. The same goes for many rural regions in developing countries, where women are charged with taking care of household duties. As a result, women are often in charge of providing food and warmth. In male-female households, men on the other hand typically make energy decisions when it becomes a costly purchase, like whether to pay for electricity or install a solar panel on the roof, Clancy says. Women are primarily focused on fulfilling life’s basic needs; men, on financial ones.

Though men and women have different roles when it comes to fulfilling energy needs, most energy programs don’t view energy supply and demand through the lens of gender. Programs that don’t explicitly address the needs of women will always be biased toward men, experts say, even though female-led organizations are more likely to implement programs that explicitly focus on women’s issues.

Laura Stachel, co-founder of WE CARE Solar, was observing clinics in northern Nigeria in 2008 when she first realized there was a positive correlation between touch-and-go electricity and the region’s abnormally high maternal mortality rates.

A staff member stands inside one of Shirati KMT Hospital's two operating rooms. The hospital hasn't modernized much through the years. Mennonite missionaries settled in the Shirati area in 1934. The first hospital structures opened in 1953, and, in 1960, the Shirati Hospital School of Nursing opened, which remains today.

“Something that we were considering a healthy event in the United States, was basically a life-threatening event in these [energy impoverished] countries,” Stachel, an obstetrician-gynecologist, says. “If you're a hospital, you need electricity 24 hours a day. You can't choose when you're going to do an emergency c-section, or choose when someone needs life-saving equipment.”

WE CARE Solar is a nonprofit that provides health care clinics in developing regions with a reliable source of electricity in the form of “solar suitcase.” The suitcases are compact solar electric systems that have the ability to provide power to overhead LED lights, LED headlamps and cell phones. The maternity kit also provides a fetal Doppler.

“I was astounded to see a hospital where at night, the lights would be off, and you couldn't even do a good exam on someone,” Stachel says. “You couldn't do a c-section. You couldn't use machinery that was in the operating theater.”

Up to 99 percent of all maternal deaths occur in developing countries, and the overwhelming majority of victims are poor women living in rural communities. The most common causes of maternal death are postpartum hemmoraghing, postpartum infection, high blood pressure and complications from delivery -- all medical emergencies that are infinitely more difficult to diagnose and treat without electricity.

Up to 99 percent of the more than 800 women who die every day from preventable causes related to pregnancy and childbirth are in developing countries.
Source: World Health Organization
Only 15 percent of Tanzania's population of 53 million have access to power, leaving more than 45 million in the dark.
Source: The World Bank
The average Tanzanian uses just 89 kilowatts a year. That's roughly the amount of electricity an american would use in two days.
Source: The World Bank

“You can't hear blood,” says Shannon Fulton, a solar energy professional who serves as a Solar Ambassador to WE CARE Solar. “You can't hear a hemorrhage. It's often not easy to see with a cell phone light or a kerosene lamp. Just for them [midwives and health care staff] to have that little bit of help makes them -- because they're so resourceful -- just infinitely more capable of taking care of more people.”

It’s a problem that Monica Ogunde and her neighbor Unita Akugo are sadly familiar with. Akugo is one of five local midwives in the Roche village area. Akugo says an overwhelming majority (up to 80 percent, by her own estimation) of the babies she’s delivered are born at night. And, in a village far removed from even the markedly rural town of Shirati, choices are limited for Roche’s pregnant women.

There are three options for getting to Shirati Hospital, Ogunde says. You can catch the only bus from Roche to Shirati at 3 a.m. (“If you’re late, it’s up to you”); you can bicycle; or you can walk. Ogunde says she has done all three while pregnant.

“It's not an option to use a midwife,” Ogunde says. “It happens because you don’t have money. Traveling from here to the [Shirati] hospital takes a lot of money and also time. The best option a person can choose is it’s better to go for a midwife. She goes there because she lacks something here.”

In the past, Akugo has used a large solar light to help with her nighttime deliveries, but after it broke she was forced to use a very small, simple light -- purchased from Ogunde -- but it isn’t as effective, and her patients have noticed.

“She [Akugo] was getting so many customers,” Akugo tells us, communicating through two translators -- one from her tribe language to Swahili, a second from Swahili to English. “But currently, because she doesn't having the big one [solar light], she's using the small one, so she's not getting many customers. The light is very small, compared to the big one. Now, actually she's not providing a good service.”

[Confidence] It's not tangible like holding a light. How do you hold confidence? You don't hold it. You see it beaming.
-Neha Misra, Co-Founder, Solar Sister

When women become empowered, they in turn help empower others. This pay-it-forward mentality represents a flicker of hope for women who struggle more than men in their communities due to their gender-specific roles for coping with energy scarcity in their homes and communities.

“Being a leader and serving yourself first, that's where true empowerment starts,” Solar Sister’s Misra says. “That is so critical, and not something people talk about as much because it's not so tangible. It's not tangible like holding a light. How do you hold confidence? You don't hold it. You see it beaming.”

Akugo is one of five local midwives in Roche village. Akugo says an overwhelming majority — up to 80 percent, by her own estimates — of the babies she’s delivered are born at night. The large solar light she has used to assist with local births in the past no longer works, and she’s been losing patients because of it.

TANZANIA IS AMONG the countries with the lowest electricity consumption in the world, which stems from the fact that Tanzania is also among the poorest countries in the world. Only 15 percent of Tanzanians have access to power, leaving more than 45 million in the dark. For those 15 percent, their access is reliably unreliable, and the average person uses only 89 kilowatts a year. That’s roughly the amount of electricity an American would use in just two days.

“I always hear gasps when I tell people about midwives, how a midwife would keep an old-fashioned cell phone in her mouth and press it so the only light during a birth is the backlight,” Misra says. “And the dichotomy of that happening in the same age when we are talking about space tourism? That is injustice.”

In recent years, energy inclusion has become a major initiative among resource-rich governments, international aid organizations, foundations and NGOs. In 2015, the United Nations introduced its 17 Sustainable Development Goals, and No. 7 is to give everyone around the world access to modern energy by 2030.

There are competing positions at the highest levels around the relative value of small- versus large-scale solutions to energy poverty. According to some experts, bringing small-scale solar solutions to remote regions is not enough to lift a country out of energy poverty; governmental investment in large-scale infrastructure is one of the only long-term solutions. In Tanzania, it’s a supply and demand issue: the government doesn’t have the resources to invest in sophisticated energy initiatives like building out the power grid, and Tanzanians don’t have the resources to pay for energy consumption at a scale that makes the investment feasible.

It's clear that the number of those globally living in poverty decreases as access to electricity grows. Unfortunately, only 15 percent of Tanzanians have access to power, leaving more than 45 million in the dark.

The only way to have a sustained power grid is to build one; small-scale distribution won’t have the same reach of impact. “People trying to bring electricity into poor countries will often times give families a solar lamp or a small rooftop kit,” Moss, the Center For Global Development fellow, says. “But people need more than the bare minimum. You can’t modernize a country by giving everyone a solar lamp. You also need large-scale power to run factories, airports, businesses, cell towers.”

But, experts disagree on the substantiveness of the impact. For example, energy distribution in the U.S. is typically thought to have reached a massive scale, but reaching a massive scale doesn’t necessarily mean we are able to witness the effects of that massive impact. It can be argued that small-scale distribution -- whether it’s a single solar lamp used to light a family’s home or a small generator that powers a dispensary -- isn’t any less valuable if it changes a person’s outlook and life in a thoughtful way.

“You don't necessarily see the impact of those larger systems, because it essentially is on such a big scale,” says Laura Walters, a solar energy professional who serves as a Solar Ambassador to WE CARE Solar. “But when you're seeing an actual person turning on a light for the first time or replacing a kerosene lantern on the wall, and putting up a solar light that they know that they're going to be able to turn on when they need it at night, it’s a completely different feeling.”

Yet, even in northwest Tanzania’s more urban centers like Musoma and Mwanza, electricity isn’t necessarily an always-on utility. There, electricity can cut out more than half a dozen times in one evening, most frequently on Sundays, according to locals. Although outages typically last less than 20 minutes, blackouts lasting hours at a time do happen, and they’re most frequently due to electrical maintenance. In Shirati, the energy cuts are especially frequent because the city’s power is supplied from both Musoma and Tarime, a city southeast of Shirati. When there is an energy disturbance at either end, Shirati feels the effects.

The country’s abysmal electricity situation is so notorious that well-known Tanzanian hip-hop group Wagosi Wa Kaya, known for their gritty lyrics about the country’s political issues, produced a hit song about the problem, “Umeme Na Maji Umeshakuwa Kero.” In it they exclaim:

Umeme na maji Tanzania umeshakuwa kero ... watu kero kero!
Electricity and water in Tanzania has become a calamity ... a calamity, calamity!

And yet, despite current conditions, Tanzanians are living with an eye toward the future. In homes across Shirati there are telltale signs that residents are living in anticipation of a life wherein electricity is seen as a utility for a better life, not a luxury.

We should aim to make sure that women and girls have a life where they get to make choices that are based on what they want from life.
-Emma Saloranta, Co-Founder, The Mom Pod

“People will often be shocked when they go to developing countries,” says Emma Saloranta, gender expert and co-founder of The Mom Pod, a podcast about global maternal health. These foreign visitors see a poverty in which local people live in huts, yet they also own TVs, Saloranta says. “I don't think we should be shocked about that or in any way think that that's a bad thing. I think, for women's and girls’ empowerment, especially from a feminist angle, that's exactly what it should be.

“We should aim to make sure that women and girls have a life where they get to make choices that are based on what they want from life,” says Saloranta, who lived in Arusha, Tanzania, for a year with her son and husband. “Not because they are in a position where they are forced into one choice because they have no other options available to them.”


BACK AT SHIRATI HOSPITAL, evening is quickly falling, and Dr. Chirangi has received an emergency call about a 25-week pregnant woman with severe bleeding from placenta previa, a condition in which the placenta lies unusually low in the uterus, he says.

He leads the way across a courtyard under a covered sidewalk and into the labor ward, where he disappears behind a curtained hallway to check on the patient. The ward is relatively quiet, except for the sound of a distant crying baby and the soothing sound of birds chirping through the open windows behind the nurse’s station, where there’s one lone incubator shrouded in golden late-evening light. Inside are three tiny babies tightly wrapped in white blankets.

The hospital has the aged facade of a building that was top-of-the-line, state-of-the-art back in the late 1960s, when the hospital was likely last remodeled. Mennonite Missionaries arrived in then Tanganyika (now Tanzania), settling in the Shirati area in 1934. They opened the first hospital structures in 1953, and, in 1960, opened the Shirati Hospital Nursing School, which remains today.

At first glance, the hospital feels much like a U.S. hospital -- drawers clearly labeled for clean syringes and needles, a hand-written doctor’s rotation scheduled pinned to a corkboard behind the nurses’ station -- but then abrupt flashes of reality forcefully pull you back to where you are. There’s a poster that explains how best to prevent mother-to-baby HIV transmission pinned to the teal and white striped wall. Down a hallway perpendicular to the one in which Chirangi disappeared, a pregnant woman wrapped in a flaming orange k itenge waddles out of a curtained room carrying a shallow bucket -- a wash bin. She fills it with water, and, very slowly, carries it back into her room.

A pregnant woman carries a wash bin full of water back to her room in Shirati KMT Hospital's maternity ward.
A woman holds her less-than-day-old baby inside one of Shirati KMT Hospital's maternity rooms. Chirangi explains that she has named the child after him, something that happens often in the area. "Yeah, it's fine," he says. "They ask all the time. I say, 'It's fine, no problem.'"

When Chirangi emerges again, he says things with the patient are fine for the time being, though he reveals how far ahead he had planned should things have been more dire. “I was there wondering that if she’s still bleeding more, I'm going to plan to take her into the operating room,” he says. “If I'm going to the operating room, I need light, I need the anesthesia machine to work with electricity. You cannot perform any health intervention, or any health services here without electricity.”

He continues on his patient rounds, heading down the hall where the waddling woman emerged minutes before. “That's why we want reliable and sustainable electricity,” Chirangi says. “That's our mission. To ensure that if there is no electricity, we have backup and as soon as possible.”

He enters a second patient room that contains four beds, one in each corner, with loose curtains acting as dividers, though none are drawn closed. Taped above each bed is a handwritten sign in blue marker. Below the sign for BED NO 05, a woman sits up holding her baby, born less than 24 hours earlier. She smiles when Chirangi enters, the two speaking Swahili for a moment before he reaches into his pocket and hands her a Tanzanian shilling. She’s named the child after him, so it’s customary to give a gift in appreciation, he explains. He says it so casually you’d think it happens all the time. Which it does.

“Yeah, it’s fine,” he says. “They ask all the time. I say, ‘It’s fine, no problem.’”

Chirangi continues his rounds through the facility, checking on patients, chatting with their families, and debriefing a team of nurses. He makes his way outside once again and stops outside of a small, open-air courtyard. He explains that the courtyard will become the hospital’s new ICU, though for now it doesn’t look like much more than a patch of no man’s land. A half-buried boulder sits at the edge of the courtyard, a smoldering stump wedged into a small crevasse on top of it.

He explains that, in a rural area like Shirati, excavation machinery is hard to come by. They instead rely on an old technique of heating the massive stones until they finally expand and break into smaller, more manageable pieces that can be carried away. It’s not the fastest, easiest or most effective remedy, but it gets the job done.

He walks on, stopping briefly to look at each wing of the hospital. “I understand there are a lot of challenges in our communities, especially in the villages,” he says. “We have wind here, but how many windmills do we have? Very few. We're just four kilometers from the lake, but there’s no water in this community.

“I hope in the future in Africa we can have the best continent, too, with all the basic needs,” he says. “Maybe in the future, Africa can be the hope continent.”

The Doctor The Midwife The Changemaker The Survivor The Region