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There are 1.1 million AIDS orphans living in Tanzania. Less than 7% of all the children in Tanzania can go to secondary school. The GNI (gross national income) per capita of Tanzania is 340 US dollars. It costs at least 100 US dollars a year for a child to go to secondary school. The life expectancy of a Tanzanian is 46 years, and decreasing each year because of the AIDS epidemic. An estimated 18-22% of the young adults in Arusha, Tanzania, are HIV positive.
Arrival
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I am now entering Tanzania! |
I arrived in Arusha from Nairobi, Kenya on March 18. Being the only non-African at the bus terminal, I was immediately surrounded by people asking if I needed a taxi, a hotel room, or a safari tour. Every foreigner here is assumed to be a tourist. My friend Sarah rescued me from the situation. She pulled me out of the crowd, saying “Hapana, asante” (“No, thank you”) to the people engulfing me.
Sarah is a volunteer from Los Angeles. She joined an organization in Washington DC, which connects her with a local NGO here in Arusha. After spending her first month studying Swahili, and the second month working for a local NGO, she did not want to work for local NGOs any more.
There are a lot of problems with the local NGOs. Some are well funded by foreign governments or organizations; their staffs are typically expatriates living in fancy western style apartments, getting paid high salaries, and spending time mostly with other expatriates. Most NGOs are severely underfunded. Sarah’s roommate, Judy, works for an NGO whose staffs haven’t been paid for nearly 2 years. Yet they still go to work every day because at least that gives them a sense of “working”. In case the NGO gets funded again, they will, probably, be the first to receive the money.
The reason why I said “probably” is because of what happened to the NGO that Sarah worked for. The director of the NGO simply cleared its bank account and vanished, leaving over one hundred people living with HIV/AIDS and sixty-three orphans in her wake. As a result, Sarah had been working on her own with people who need help.
The same afternoon as I arrived, Sarah took me to an orphanage, “Malaika,” or “Angel” in English. The orphanage was run by the wife of a Canadian diplomat. There are 17 orphans; some of them are HIV positive. We spent the afternoon there playing with the children.
“These children are not receiving enough attention,” said Sarah, “but they are extremely lucky.”
Why? I couldn’t comprehend what she said.
“Because their lives are taken care of,” Sarah explained. “I will show you other orphans. They are not so lucky.”
The evening was simple and charming. The whole world became quiet after dark. We went to bed at 9:30. Eight hours later, the roosters woke us up, and there began my second day in Arusha.
Mt. Meru Hospital and the U.N
By 8 o’clock in the morning, Mt. Meru hospital was already very busy. The waiting room was full of patients, and the guards at the main gate were busy blocking people from entering. Mt. Meru is the only government hospital in Arusha. Going to a hospital is, of course, not free in Tanzania; nor are the people here covered by medical insurance like in the western world. I was immediately shocked by what I saw when I entered the hospital. People sat randomly on the grass, on the sidewalk, or on the stairs. Laundries, patients’ and hospital’s, were randomly hung in the yard or laid on the grass. Trash was burnt at the far end. By the way, Trash is burnt everywhere in Tanzania, since that is the only way to get rid of it.
Sarah told me that a lot of the workers in the hospital are prisoners, possibly because the hospital cannot afford to hire more regular employees.
Sarah needed to speak to Sister Mao, a nun who is also a surgeon, to find out more information about becoming a volunteer at the hospital. We went from ward to ward looking for her. We ran into crowded wards where at least 12 patients shared one room. We saw broken mattresses that looked like they had not been cleaned for at least 10 years. We witnessed a father who had his two sick boys share one bed.
After speaking with Sister Mao, we went across the street to visit the U.N. tribunal for the Rwanda genocide.
It was a completely different world. Our passports were needed to pass the security check. In the air-conditioned courtroom full of the latest technologies, the attorneys were questioning a witness about very specific details from 1994, when the genocide took place. More than half of the people in the courtroom were westerners. I read from the handout that the case had been going on for more than five years. Sarah told me that many attorneys in the courtroom were paid at least six digits a years in US dollars.
Our main meal of the day at the immigration canteen was simple. Everyone was getting more or less the same food—small portions of beans, carrots, spinach, cabbage, and beef, and a large portion of rice or ugali, the local’s favorite rice product. The meal also came with a banana. In Tanzania, almost every meal is served with bananas. Many Tanzanians have two or only one meal a day.
Home Visit
We started the home visit day with a trip to the market. There we stopped by a small shop called “Jambo Store.” The shop owner was very nice. After learning that we were buying goods to visit AIDS patients, she offered to give us a good price on whatever we needed. In Tanzania, one needs to bargain on almost everything he or she buys. This is particularly necessary for us who look obviously from a different continent because we are assumed to be wealthy.
The price for eggs has gone up significantly this week, so we are only bringing one kilogram of rice and a bar of soap to each family this time.
As usual, Sarah looked for Mama Rose first. Most patients that Sarah visits live in villages, where there are no streets, let alone any systematic way of identifying each shelter. Sarah is not familiar enough with the villages so she still needs someone to guide her.
Mama Rose cannot go today; her daughter is sick with malaria. Mama Rose has to stay home to take care of her. She introduces us to another woman, Nembris, who will be our guide this time. Nembris herself is HIV positive. The virus has not progressed to AIDS yet. She is still working to keep herself alive and support her two children.
Nembris first took us to Ally’s home. There are total of three pieces of furniture in the living room: a couch, an end table, and a gas stove. Ally found another chair from the bedroom, so all of us could sit. I noticed a calendar of 1964 on the wall. The upper half of the calendar is a painting of a snow covered hut surrounded by pine trees.
Ally has AIDS, and so does his wife. Ally has four children; the two older ones are in their early teens. When the couple dies, the children will become AIDS orphans.
We continued our journey across a field of banana trees. The road was very muddy because of the heavy rain the night before.
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Sarah speaking to Ally |
The second AIDS patient we visited was Hamida. Ally’s house did not prepare me to witness Hamida’s home. It was dark and small. Seeing us entering the room, Hamida struggled to sit up from her bed to open the curtain to shed some light. The bed and a couch occupied almost all the space in her home. The house, if we may call it that, is made of wood, adobe, and a rusted zinc roof. There is no electricity or running water.
Hamida is 28 years old with a young son. She seems to be much better this week. She was coughing badly last time Sarah visited, and looked as if she was about to die. Thus Sarah gave her some money to take a dalla-dalla (a kind of local transportation usually run by using junked Japanese minivans) to the hospital. Hamida told Sarah that thanks to the money, she was able to get medication from Mt. Meru hospital. Sarah was delighted to hear that.
The last family we visited was Moses and his wife Halima. Moses has AIDS and Halima is HIV positive. They live in Nembala, a very remote village. After getting off at the last stop of the dalla-dalla, Sarah and I had to walk another hour to reach the place.
Sarah described her first encounter with Moses in her journal:
“I was instantly struck by the appearance of Moses who was only thirty-one years old. His body was simply skin covering bones; his eyes portrayed determination mixed with shame; his legs no longer enabled him to walk and he urinated with the assistance of a catheter. […] During my conversation with the couple I learned of their fears; it had been eight months since Moses had been examined by a doctor as whenever he had been able to make his way to the local clinic the doctor had not been there. Moses felt like he no longer mattered and that this world had given up on him. It was obvious that his musculature was wasting away and this caused him great pain…”
Moses used to be a police officer. His police cap is placed at where he can see it from his bed. Moses had been taking ARV (an antiretroviral drug for the treatment of HIV) medication for 3 years. What Sarah cared the most was if he had been eating regularly lately, as food consumption is pertinent for the effective metabolism of ARV medication. A few weeks ago Moses had an infection at his throat which was interfering with his ability to eat; he also had a lump on his lower back.
Through a network that Sarah had established in Arusha, she convinced a medical doctor to go with her to visit Moses. The faces of Halima and Moses were filled with joy, disbelief, and sheer amazement when Sarah and the doctor showed up at the door. The doctor examined both patients and left Halima and Moses the medicines they needed. He also told them that with physical therapy Moses might even be able to regain his ability to walk, and thus now Sarah’s next mission is to find a physical therapist.
The most important lesson I learned from Sarah is that one can live a long time with HIV, if he or she is provided with adequate medication, plenty of food and compassion.
Hope
As in many other developing countries, education is the only hope for children in Tanzania to get out of poverty. Education in Tanzania is divided into primary and secondary systems, which together last for 13 years. Primary education, which lasts for seven years, is free and compulsory. Students must write a national examination at the end of primary schoolings. Many children leave school at this point and go to work.
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Sarah and Moses |
Secondary education lasts for six years. There are few secondary schools in Tanzania and enrollment is less than 7% of all children who have completed primary school. Students must pay fees to attend secondary school. Secondary school fees range from $100 to $400 a year. Many students who have passed the national examination at the end of primary schooling cannot attend secondary school simply because they cannot afford the fees. For most of the girls among them, the only option left is to get married.
In an interview last year, when asked to prioritize the country’s most basic needs, President Jakaya Kikwete outlined the following: more schools, universities, hospitals; more roads; more access to drinking water. Clearly, education and medication are Mr. Kikwete’s top priorities. That fills the hearts of many people with optimism, including those of Sarah and me.
Many development economists believe that Tanzania is East Africa’s best hope; so do I. I left Tanzania with hope for the country, respect for its people who never give up with their lives, admiration for the volunteers such as Sarah, and determination to help.
Sarah has decided to join CHAWAKUA, a small grass-roots NGO that focuses on women’s AIDS control in Arusha, which she has come to know and trust. She will continue to visit Ally, Hamida, Moses, Halima, and many other AIDS patients. She also plans to raise money to send as many poor teen-aged girls as possible to secondary school.