August 8: After a day given mainly to attending the church services of the village’s dominant Catholic and Lutheran congregations and enjoying their hospitality, we go back to work today.
At the Dareda Kati Town public health clinic, Dr. Sadock Wilson tells us about the death in June of one of his fifteen HIV patients, Emanuela Laurian, at the age of forty-eight. Emanuela left behind three children, the youngest of whom is twelve, but all are HIV-negative.
As we sit for hours with Dr. Wilson and share a light lunch with him, our discussion of his clinic’s needs jumps all over the place, as my notes do below. Marianne and I and Dr. Susan Hughmanick, a Karimu Board member, and Dr. Art Dover are present throughout and Joas Kahembe, our Board member in Tanzania, joins us midway.
Many more HIV patients than the fourteen whom Dr. Wilson continues to treat since Emanuela’s death seek the more expensive treatment given by the Catholic hospital because its distance of several miles from Dr. Wilson’s clinic in the village center makes them less conspicuous. More still, according to Dr. Wilson’s five nurses, refuse treatment. Some resort to witchcraft, believing that a spell cast by an enemy has caused the illness. Some men think that if their pregnant wives are HIV-negative, then they must also be HIV-negative. Some men also believe that they can get rid of their HIV by having sex with virgins or that they can avoid contracting HIV by having sex while standing up.
An HIV-positive woman who becomes pregnant will sometimes seek an untrained birth attendant because she does not want Dr. Wilson and his nurses to know that she might have spread her infection–and she knows that her sexual partner will not appreciate the consequent discovery of his own probable infection.
Because tuberculosis is an opportunistic infection, HIV patients are tested for TB while TB patients are tested for HIV.
Dr. Wilson also tells us that many villagers believe that birth control causes cancer and that condoms carry infections. A lot of the men worry that vasectomies will ruin their sex lives. Only one man in the area accepted vasectomy last year from an Arusha-based NGO which visits periodically to offer the procedure for no charge.
Dr. Wilson’s clinic has no toilet and must therefore depend on the hospitality of nearby homes or businesses. For clean water the clinic relies on another Arusha-based NGO for deliveries of disinfectant, but sometimes the clinic runs out between visits. (Arusha is a few hours’ drive away and Dr. Wilson has no car.) The primitive conditions damage prenatal care by preventing urine-testing of pregnant women.
The Catholic Church might charge a pregnant woman ten dollars–a huge sum to many of the villagers–for transportation to its hospital for safe delivery of the child.
After two or three months an infant’s breastmilk diet is likely to be supplemented with cow’s milk and/or maize porridge. These are of course fillers or worse, taking the place of the far more nutritious breastmilk and, in the case of cow’s milk, often causing constipation.
Female genital cutting was, in the recent past, performed on almost all women and girls in the area in order to keep them from “looking like men” and to prevent desire for sexual pleasure from distracting them from household work, or in some cases from their studies. Genital cutting is down somewhat now because women have gained better understanding of the health risks. But there is still too little understanding because the Tanzanian government’s campaign against genital cutting is mainly punitive and involves little education. And now, increasingly, infant girls are circumcised since they cannot tell anyone.
When I ask Dr. Wilson about the safety of albinos, he says that sometimes they are murdered in the area so that magic–ostensibly bringing success in business–can be performed using their body parts. (Sifaeli Kaaya, our translator, has told me more than once that he worries about a young albino man named Frank who sometimes works on Sifaeli’s farm in Dareda Kati.)
Finally, Dr. Wilson admits that the town center has electricity only five days per week because the regional power company supplies electricity that often. (The company’s power lines extend to neither Ufani Primary School nor Ayalagaya Secondary School, nor to the land between them, hence there is no electricity at all where Karimu performs most of its work.) The company relies on hydroelectric generation, but this has been a dry year. Many of the blackout days fall when the clinic is open.
Tomorrow we will meet again with Dr. Wilson as well as with the nineteen local nurses and midwives of KAMM, the Mother and Child Health Care Association. Soon they expect to receive official certification as a nonprofit by the Tanzanian government. After today, I value more than ever their potential to bring health education to the community.–Don Stoll