Tanzania Solo

I ventured alone to Dar es Salaam in Tanzania after our ship docked in Mombasa, Kenya to meet with folks from several HIV/AIDS agencies. I had been listening to many excited conversations about the plans 645 members of our community had for safaris in east Africa. I felt out of phase but having both work to do and several previous safari experiences, I pressed ahead with my divergent agenda. I was rewarded with lessons both professional and personal. And, despite much angst, I easily made it back to the ship in time to depart for South Africa.

Not many of you, I’m fairly certain, are interested in the details of what I learned about HIV/AIDS in Tanzania, but a few observations might be worth sharing. If you’ve come to this site looking only for travel color, skip down a couple of paragraphs.

As I’ve read and tried to learn about HIV/AIDS in the developing world, I have noticed a progression of preoccupation with different components of the issue as a country attempts to respond to this horrific pandemic. The first stage seems to be recognition of the problem and its extent. Russia, former Soviet states and Eastern Europe appear to be at this point now. The second stage is to formulate a coordinated response in each country, usually done by the Ministry of Health, often with the help of other partners such as the Clinton Foundation and/or universities like Harvard and Columbia – the process China and India, for instance, are now involved in. The third step centers around finding huge sums of money to address prevention, testing and care and treatment of people living with HIV/AIDS (known as PLWHA). The Global Fund for HIV/AIDS, TB and Malaria, PEPFAR (President Bush’s program), NGO’s of all sizes, faith-based organizations, and donor nations such as former colonial powers all have a role to play in funding these enormous efforts. Once the extent of the problem is known and money has been promised, the focus shifts to rolling out plans that have been made that entail resources such as drugs, labs, information and tracking systems, distribution systems and, my personal focus, health care workers in adequate numbers with appropriate training. These components of a country’s response are both crucial and exceedingly difficult, not that the previously mentioned ones aren’t as well. Problems get highlighted such as brain drain of newly trained workers to other, more developed countries (there are more Malawian doctors in just Manchester, England than there are in all of Malawi) and the disparities of health care facilities between urban and rural areas. These are not new problems but they are demanding new solutions if this pandemic is going to be addressed. All this I was aware of before I came to Tanzania.

Now I have seen firsthand the next stage: the intersection between solving the problem of HIV/AIDS and the complexities and intransigence of poverty in the developing world. At two agencies I asked what was the single largest impediment to addressing HIV/AIDS and the answer came without hesitation and identically in both: food. At Pathfinder International, we talked about their home based care program in which volunteer community health workers visit AIDS patients in their homes, taking basic medical supplies like gloves and bandages but also providing teaching, support and caring. We would think of this as hospice care. They kept reporting on the starvation of these patients due not only to the wasting of the disease but also to their social isolation because of stigma. So Pathfinder started sending food to the patients as well. But, of course, much of it never made it to the patient. The volunteers and their families were also very hungry. Now they send food for both the patient and the health care worker. I visited PASADA, a model program run by the Catholic Church in Dar and spoke with a small group of nurses there. I love connecting with these talented, creative, tireless, and caring sisters of mine who are on the front lines of this enormous battle. They said that adequate nutrition was the single largest barrier to starting their clients on anti-retroviral treatment. This large, well-funded program has only 100 people on ARV’s. One reason was that people could not demonstrate an ongoing food supply necessary for successful treatment, often because they were too sick to work and, again, cut off from their families. In the developing world, huge amounts of food are needed for these patients, their dependent families and even the volunteers. The World Food Program is working to deliver food to Tanzania but only to a few geographic areas that are in the worst shape. Unfortunately, poverty and HIV/AIDS are everywhere.

That’s probably more than you wanted to hear about HIV/AIDS in Tanzania and it was only a tiny fraction of what I learned there. It was a very professionally productive trip. I also had a few personal experiences that have been rolling around in my mind ever since, trying to fit into my concepts of myself and the world. Traveling alone proved to be more of an obstacle than it has before. My tentative explanation has to do with a new realization about my attitudes in this post 9/11 world: I feel more uncomfortable in Muslim cultures – and I hate that feeling. I could see four mosques from my hotel window in Dar and I enjoyed the rhythms that periodic calls to prayer gave to my days. When I heard them, I began pausing in whatever I was doing and just spending a couple of minutes reflecting, nothing elaborate or ritualistic, just a moment to refocus. What a wonderful tradition. But then early one morning, looking out my hotel window, I saw a group of about 30 young men running down the street, chanting, carrying a flag and being joined by a few other pedestrians. My mind went immediately back to the embassy bombings and the anti-American demonstrations of a few years ago. Two explanations occurred to me: either this was some kind of demonstration or a running group taking advantage of the cool of the new day. The ordinary logic of the second explanation was overwhelmed by the small undercurrent of fear in the first. If it was a demonstration, why would I feel in any way threatened? Instead of some anti-American, radical Islamic group, it could have just as easily been local plumbers rallying for better wages. I had a day on Sunday in which I thought about going to Zanzibar on the local ferry. I’ve done that kind of thing many times in plenty of developing countries. But there were no other tourists around and I just felt like I stuck out too much. We had had an onboard briefing by diplomats from the American embassy in Nairobi who told too many horror stories and advised us to do our best to blend in. I wanted to go but my gut was telling me not to, so I didn’t. My loss, my lesson.

One delightful consequence of my traveling alone was getting to meet Jumani, a wonderful cab driver in Dar. My colleague, Ed Wood, the clinical director of the Clinton Foundation HIV/AIDS (CHAI), had recommended him to me before my December trip; they have become great friends. Edwin Macharia, the assistant country director for CHAI who facilitated my time in Dar, mentioned Jumani again so I engaged him to drive for me for two days, one working and one exploring the city. Jumani is a treasure. He has a brand new, three-week-old baby whom he named Ed. I asked Jumani if the baby was keeping him up at night and he said, “Oh Mahjorie, that baby he cry and cry!” At the end of our time together, he said, “Oh Mahjorie, you’re leaving. That makes me soooo sad!” I wish Jumani could have driven me to Zanzibar.

I went to a cultural village museum that had recreated about 15 different types of houses lived in by the various peoples of Tanzania. It was a very low tech place and I was the only tourist on a sweltering Saturday afternoon. About 150 secondary school kids were also there, all dressed up in their school uniforms complete with navy blue jackets and ties. We all gathered on wooden benches under a large leafy tree for a drumming and dancing performance. I’ve come to love this African tradition I’d seen in Zambia and Rwanda as well of choosing the space and shade under some wonderful tree to hold public meetings and celebrations. I felt welcome there, if something of an oddity. A few girls came to sit with me and shyly answered my questions in fairly good English. Most of these children are trilingual, speaking their tribal language, Kiswahili and English. Their first question for me was, “What tribe are you from?” They didn’t pay a lot of attention to the dancing, giggling and talking behind their hands. But they loved the skits that followed, laughing uproariously and trying to translate the jokes for me. They told me they wanted to be accountants and teachers, doctors and lawyers. They made me want to work harder, to keep on trying to make my small contribution to the gargantuan task of ensuring a healthy future for them and for baby Ed.