Memories Back in Canada

Our Tanzanian adventure has officially ended and classes have already begun. Tanzania was such a short time ago but the old familiar life has managed to take hold again. I would like to commit a few more memories to paper before they fade behind the pile of textbooks that await me. For this, I will begin at the end, and the end for me was the foot of Mt. Kilimanjaro. Most of the team took a week or two extra after our work period was over to explore the many landscapes of Tanzania: the lush rainforests, the turquoise water and white sand paradise of Zanzibar, the baobab-studded plains of safari, and the dusty villages of the Maasai.     A few of us decided that climbing Mt. Kilimanjaro should be the grand finale. Known as the ‘roof of Africa,’ it erupts suddenly from the green terrain of the North with its flattened top and surprising cap of snow. Like a magnet, it attracts tourists and tourist money from all around the world. With its gradual and walkable incline, it is supposedly one of the easier tall mountains to climb. Maybe so, but climbing it was the most physically challenging thing I have ever done in my life. A mountain, whether ‘easier’ or not, is still a mountain and there was 5895 metres of this one that took six days of camping in the cold and dealing with the effects of low oxygen to climb.

I am writing about this not to emphasize how hard it was or even how beautiful the view was every step of the way, but because of what I saw up there that I didn’t expect to see. I thought that climbing the mountain would be like stepping out of Tanzania for a moment; that above the cloud-line there would just be nature and some scattered trekkers from around the world. That was before I realized the small army of porters, cooks and guides necessary to get people up and down this thing. In climbing with them as well as watching them work for those six days, I was able to observe in a more distilled manner what I had been observing for the past seven weeks on level ground. First of all, the hospitality and kindness of the Tanzanians became even more evident to me in our uphill struggle. The support that these men provided got us to the top of that mountain. Our guide made sure that every step of the way we were well hydrated, fed, and not showing any signs of altitude sickness. The porters, in addition to effortlessly carrying all of the equipment, food and water for us, would help us out by carrying our day packs if they saw that we were particularly struggling. On the way down when we were clumsily trying not to fall while willing our legs not to collapse, they would offer their hand to run us down the mountain safely. There was also something very collegial about the atmosphere created by constantly trading smiles, greetings and chit-chat. As on the ground, I felt supported and welcomed even in this remote location.

In addition to unexpectedly seeing this Tanzanian spirit so far above the clouds, I witnessed another reality true to Tanzania: how much hard work is necessary just to survive. For six days as we wheezed and struggled to take painfully slow steps reminiscent of an astronaut on the moon, the porters would race by us with heavy packs, tents or even chairs balanced on their heads. On the way down the mountain they would run by us with the same incredible weight on their heads while we gingerly chose each step. As I mentioned, this was the single most physically exhausting thing I have ever done in my life and these men, who carried much more and moved much faster than we did, did it for a living. In many ways it reminded me of scenes I had seen often in Arusha. For example, a young boy pulling a large, weight-laden cart uphill, or perhaps a woman in the middle of nowhere carrying a heavy bundle of sticks on her head to an unimaginably far destination. Simply put, Tanzanians know what it is to work hard, and likely for very modest wages. This reality was just as visible above the clouds and this is something I was not expecting to see.

Climbing Kilimanjaro was one of the most painful yet one of the most rewarding experiences in my life. More than just a physical or personal challenge to see just what I was made of, it was a journey to observe what Tanzanians were made of and there is an undeniable strength there.

Learning AIDS and Teaching AIDS

            In the last half of our program, MedOutreach spent a lot of time working with AIDS organizations or observing AIDS in the hospital setting. We also spent a week in a handful of secondary schools teaching about various health topics that included HIV/AIDS. This gave us a very insightful view of the HIV/AIDS situation in the country.

                Compared to my preconceptions, Tanzania has some remarkably advanced programs in place as a response to the epidemic. In Arusha, antiretroviral (ARV) drugs are provided free of charge to anybody who has tested positive and qualifies for treatment, and to prevent mother-to-child transmission. This program has been running for just over a year now. Medicine for many opportunistic infections is also supposed to be provided for free. Various counseling and education programs are available to people. Tanzanian health workers are working very hard to increase knowledge, condom use and decrease misconceptions and stigma. Though some of the initiatives are still in their infancy, much of the framework for fighting HIV/AIDS has been set up in Arusha.

On the other hand, there is still a long way to go in order to adequately respond to the approximated 8.8% adult infection rate in the country. Though ARV’s are theoretically available to everybody, proper medical attention may not be because of too few doctors for too many patients. In particular, many patients go untreated for various opportunistic infections because medical attention is too difficult to attain or the drugs may be out of stock. Also, stigma is still a massive deterrent for people to get tested, treated or even to take appropriate precautions. Stigma scares people away from hospital waiting rooms, it prevents them from using condoms for fear that they would appear as HIV positive, and it keeps families from accepting their loved ones. The result is that many people with HIV do not know that they have it because they are reluctant to get tested. They often do not find out until they wind up in the hospital with the clinical signs of AIDS. The internal medicine wards are filled with such cases. In one visit to the women’s ward at Mt. Meru hospital, I observed that more than half of the inpatients were women newly diagnosed with AIDS. Keeping in mind that from the time of infection with the HIV virus it can take as much as 10 years before the clinical manifestations of AIDS appear, these women had gone a long time without ever having been tested.

                Even once people have taken the step to get tested and they have been diagnosed as HIV positive, there seems to be a barrier keeping them from coming into hospitals and clinics for appropriate medical treatment. Perhaps it is still the stigma of appearing publicly to seek treatment for complications of HIV. Perhaps it is the long waiting periods to see a doctor and then to get medication. Or maybe it is that, though ARV’s seem to be readily available, other medications that are supposed to be free are simply not on the shelves and this means that people have to pay out of their own pockets. Many people simply cannot afford to do so. Compounding their already difficult financial situation, some individuals may be facing additional costs due to HIV. Some may have lost their jobs when it was found that they were infected or some may have been forced to quit because of illness. Not to mention that people facing illness may have increased or more strict nutritional demands, and taking ARV’s is known to increase appetite. In addition to medical treatment or medications for opportunistic infections, food was one of the most common requests that we received from HIV/AIDS patients. Programs do exist that address this demand for food. For example, there is a United Nations initiative that provides people with bare necessities like rice and oil approximately once a month. A local group that we worked with called UHAI has a more sustainable project that provides individuals with goats that they can raise themselves. Many international groups similar to MedOutreach also come in and help relieve some of the demand for food. During our time there, we distributed care packages containing items like rice, sugar and vegetables to the Upendo HIV group that we worked with as well as to some individuals being assisted by UHAI. As a group, we agreed that this was a temporary solution to a long-term problem and we will be trying to help the Upendo HIV group put together more sustainable projects that would allow them to have a dependable source of income and food.

                The strength of the barrier that prevents people from getting testing or treatment seems insurmountable at times. The internal medicine wards in the hospital were proof of this, but we were even more shocked by the reluctance of the people who already knew their HIV status. One man in particular provided a dramatic illustration of this barrier. We first met him when we were doing basic medical and dental screenings on the Upendo HIV group (this is the neighbourhood group of 55 HIV positive individuals that was organized for the purpose of mutual support and ease of health care delivery). We were doing so in order to figure out the magnitude of the medical problems not being addressed by the public system and to flag any individuals that required more urgent medical attention. When this man first walked into the exam room, we noticed right away that he was extremely disoriented. He had a fever, chills, decreased consciousness, laboured breathing, a heart beat of over 200, diarrhea, dehydration, a left leg that had swollen twice the size of his other one and the worst ear infection we had ever seen. We sought Dr. Mhando’s assistance immediately and the man was admitted into the hospital for urgent treatment. We learned that he died only a few weeks later. Of course I expected that some people would die of AIDS, but I do not understand why this man who knew his status, was in a support group, was on ARV’s and who at least theoretically had free medical treatment available, could have gotten to such a point without having sought medical help. Whatever that barrier was, it killed him.

                This is just an example of why, along with Dr. Mhando, we decided to set up a sort of back-up medical plan in Dr. Mhando’s clinic where we have provided the money and resources for the care of the Upendo HIV group. Hopefully they will come here if they feel that they cannot get the full medical attention they need in the public system or if they want to have a little bit more anonymity than they would have in the busy waiting room of a government hospital. Any treatment that they receive from Dr. Mhando will of course be free of charge to them. We do not know how far the money and resources that we have provided will stretch, but we hope that it can alleviate some of the burden for these individuals.

                We also got an opportunity to work with an AIDS organization called the UHAI group. It is a community based organization in Arusha that provides many services to HIV positive individuals including education, treatment, funding for AIDS orphans, and various other financial and social support programs. One of their projects is to visit HIV positive individuals that live in remote areas in their homes and make sure that they have the medical, financial and social tools to deal with their illness. We were lucky enough to have the opportunity to join them for a day for several such visits. Six of us piled in the back of a pickup truck and took a very bumpy and equally dusty ride outside of the city to the hilly area surrounding Ngaramtoni village. The setting was rural but each individual that we visited lived in a unique manner. In our first visit, we arrived at a traditional Maasai hut made of cow dung and sticks. We were met by a skeleton of a woman who greeted us weakly from her bed. She was a 38 year old widow with 7 children. She was one of three wives. Her husband had died of AIDS 6 years ago, and the other two wives followed soon after. On the day that we met this woman, she had not eaten and her ARV’s had run out. She had not gone to get more ARV’s because she could not afford the bus fare to Arusha and back. It would have cost her less than a dollar to do so. Though we had brought care packages to leave with each individual we visited, we suddenly felt how meager the offering was and so we gathered up the money we had in our pockets to give to her as well. It still didn’t seem like enough but we also knew that it wouldn’t take simple money to help this woman.                

The stark image that we saw on this first visit was in sharp contrast to some of the other visits. For example, another woman that we went to visit lived in a rented home in the village. She was young, plump, cheerful and in good health. The ARV’s she went on three years ago when she found out her status had improved her health dramatically. The UHAI program additionally provided her with some goats and chickens that helped her maintain herself. The volunteers at UHAI also helped her to deal psychologically with her illness. At the time of our visit she was quite open with disclosing her status. Her neighbours were aware of her situation and they seemed to be quite accepting. The volunteers explained to me that a case such as hers was quite hopeful for reducing stigma in the community because it allowed people to see that there was life after HIV.   

                The home visits were extremely educational in terms of showing us a range of ways that people’s lives could be affected by HIV. What we learned from the home visits complemented what we learned from our time working with other organizations, clinics and hospitals. However, our experience of teaching secondary school classes about HIV was educational in a completely different and unexpected manner. It revealed to me the assumptions I had made coming to Tanzania without even realizing it. When you hear that a country has such an alarming number of HIV positive individuals, it is easy to assume that the infrastructure is lacking somewhere along the way in the healthcare and educational systems or that financial or social barriers stand in the way of prevention and treatment. In many ways, some that I have already discussed, this is true. But in many ways, the Tanzanian government and Tanzanians have made incredible progress that it is condescending not to recognize. The free antiretrovirals provided by the government or the programs provided by the UHAI group are just a few examples of this. The education that the new generation is receiving in schools about HIV is undeniably impressive as well. When we went in there, I think most of us expected to be picking up where maybe the school system had dropped the ball or it was just hesitant to approach. But the young audience that we got was a highly educated one with sharp questions that touched on social as well as scientific aspects of HIV/AIDS. At the beginning of the sessions we handed out scraps of paper so that students could ask questions anonymously. What we got back was extremely thoughtful inquiries and comments like this one:

“We know that HIV/AIDS is only educated in towns because we watch the TV. Many people come to us, but how about the villagers who tend to be more affected because of polygamous family. They don’t have even radios. I know you are not our government but please help us.”

Where I think that MedOutreach really helped in the education of these young minds is in providing a judgment-free forum for them to ask any question they wanted to ask. Like any adolescent, they were bound to have questions about sex that they were likely a bit embarrassed to talk about. And in addition to the solid knowledge that they had about HIV/AIDS, there were still some intermingled rumours from unreliable sources that had to be dispelled. For these reasons, I think that teaching HIV/AIDS in the schools, far from being redundant, was a very valuable exercise for both the students and for the MedOutreach team. I will also come away from the experience being reminded that it is important not to make cultural assumptions. This is something I have always known, but it is a mistake that is especially easy to make as an international volunteer; to feel like you are the helper and they are the helped. This is largely a myth. We provide money, resources and a spare set of hands where they are lacking, but that does not mean that Tanzanians have not already put in an incredible amount of hard work into improving the situation in their communities. I am touched by the dedication of the individuals that we worked with while we were in Tanzania and I would like to thank them for allowing us to join them in their efforts for a brief while.

The education that we have gained from our experiences this summer could not be replaced by any classroom or textbook. As I settle back into Canada and my school routine, I am appreciative of how lucky we are to have had this kind of education. 

Olga

Posted by owrezel2009 on September 6, 2006 | Permalink | Comments (0)

Comments