Tag Archives: ifakara

The sheikh is my best friend

“The sheikh is my best friend,” shotus Father Mpinge. My site-partner Hafsa and I smile, too. The sheikh-in-question is actually the imam of the largest mosque in town. Mpinge is the parish priest of St. Francis, the largest Catholic congregation. We didn’t expect such a statement from him.

As it turns out, the priest and the imam met after a town meeting some years ago. Father Mpinge offered to drive the imam home afterwards. Since that day, they have been fast friends, meeting regularly and even seeking each others’ advice about community issues. We see many of these friendships in Tanzania – they’re what I call “de facto interfaith” – people here work and interact with each other because it’s a religiously-diverse area.

It’s strange, really. When we ask about religions working together to educate their followers about malaria prevention and treatment it’s like we’re describing something completely foreign. The idea is always met with excitement and affirmation. We want churches and mosques in sub-Saharan Africa to collaborate towards eradicating malaria deaths. The real test of our work will come when faith communities here move from “de facto interfaith” to “interfaith action for the common good”.

Bed net + mosquito = malaria?

Asma and AbdallaAsma is sitting in front of me on a hospital bed holding her son Abdalla’s hand. He’s lying down, semi-conscious, with a chloroquine drip in his arm. She’s wearing a black abaya with gold feather trim at the sleeves. She’s absolutely beautiful.

Abdalla was sick – vomiting and in pain – so she took him to the doctor. He’s two years and three months old; children with malaria don’t tend to have very high fevers, so any illness has the potential to be malaria in disguise.

The medical officer I was with asked some questions of his own and informed me that she didn’t understand where malaria comes from. Or rather, she did, but could not connect the vector (mosquito) with the disease. She and Abdalla sleep underneath a bed net every night, yet he still has malaria.

“How is this possible?” she asks. This is a story that I’ve heard before. People are told that bed nets will protect them from malaria, but unless you are completely vigilant about when you travel and how you conduct yourself in the evening hours, mosquitoes can find you. It’s a contradiction that causes people here great confusion. Health education, in Asma’s case provided through her local mosque, could explain that contradiction and help people like her learn proper prevention methods.

I asked what made her happy, or what she looked forward to. She is still mourning the death of her husband this past April, but she is excited for the future. He left her with ownership of a small plot of land. It stands empty now, and she plans to save money until she can build a home there for her and her son. She says she knows that in that home, she will be very happy.

Leprosy and “Kingdom work”

kingdom workFor the last two weeks, one particular session for the Tanzanian portion of our training program had been in the back of my mind, waiting. The itineraries we received in London listed a “Visit to leprosarium,” and we were informed that it was, indeed, a home for those affected by leprosy. I know what you’re thinking, “What does leprosy have to do with malaria?” I’ll address that in a later post. I think the question that is more likely to pop into your head might be, “Leprosy is still around?”

In short, yes. Leprosy is still around, and it still causes much suffering in the world. Not a whole lot, mind you – the World Health Organization estimates that 2 or 3 million people worldwide are permanently disabled by leprosy. The good news: new cases decline with each year. It’s a disease that is on the way out, but it’s not out yet. For that reason, there are communities located around the globe where people with leprosy can seek treatment and, fortunately, solace from a world that in many cases attaches social stigma to those affected by the disease.

We were invited to tour the Nazareth leprosarium, essentially a modern-day “leper colony”. This place wasn’t so much a colony as it was a collection of buildings in Ifakara town here in south central Tanzania, one of the few countries with enough cases of leprosy to necessitate the presence of such a place. We met Enoch, the proprietor of the joint, and he explained to us the various epidemiological features of the disease, the tests employed to diagnose it, and the treatments necessary to cure it. He’s a very funny man, and we learned a great deal about leprosy from him.

Nazareth was built by the local Catholic diocese many, many years ago. Enoch (who’s been there for 25 years) is paid by the district government, but he’s also the only real staff-person; all the other workers are volunteers or employed by the diocese. It has a small chapel on the campus, and is visited twice a month by the local parish priest, Father Mpenge, whose home we had dined at a few days previous. It’s a beautiful example of “faith in action” for reasons that may or may not require explanation.

As we began our tour of the facilities, I knew what we would encounter. Leprosy is a bacterial infection that essentially devours the peripheral nervous system and then starts on the skin. It’s not a pretty illness – opportunistic infections often lead to finger and toe amputation (perhaps even more bones) and massive skin lesions. The facial nerves stop responding so the eyes can’t close. Dust and other debris attack soft optic tissues, causing blindness. We were told to steel ourselves.

The first resident we met, whose name I did not learn, had no fingers or toes. Enoch asked him to join us on the patio and he shuffled over holding a bag slung over one of his destroyed hands. The bag contained a fork, spoon, cup, toothbrush, and comb. Enoch demonstrated the ingenuity of the Sisters at Nazareth – he wrapped a velcro strip around the man’s hand and showed us how he could feed himself, brush his teeth, comb his hair, and drink water by attaching the tools to the strap. The man smiled the whole time and laughed with us. It was a happy encounter.

We spent the next hour visiting the wards and speaking briefly with the people who were staying there. In every new room, I felt welcomed. This was not a place of suffering or worry, it was a home for people who might not have a place to call home. Many of them were severely disabled – imagine having no fingers or feet. But the residents weren’t really helpless. They engaged with us and laughed and opened their home to us. They don’t get many non-family visitors, so we must have been a welcome break in any case! We visited a large garden that provides fresh and healthy food, and we found that many of the volunteers were themselves disabled in one way or another by past encounters with leprosy.

As we walked across the courtyard, an odd thought popped into my head. “Kingdom work” is a phrase that my evangelical friends use to describe a variety of their activities: mission trips, soup kitchens, drug counseling, etc. The idea is that in ministering to those less fortunate, they can hasten the coming of Jesus Christ and the Kingdom of God on earth. I might say that until that day in the leprosarium known as, of all things, Nazareth, I hadn’t found an example of Kingdom work that resounded deeply with my own drive to help others.

Watching Enoch interact with the residents and seeing them smile as they greeted us brought me to a place of great peace. I can’t accurately describe it; I think I was spiritually excited that Nazareth existed, and I was actually sad to leave. There’s a story in the Bible where Jesus heals a leper by touching him, something that in his age would have been unthinkable (lepers were considered unclean). I’d prefer to let Jesus pick his own timetable for returning, but I’d also like to think that the folks at the Nazareth leprosarium are doing a bit of Kingdom work in creating a safe and healthy place for those who may have nowhere else to go.

Mosquito Poop

Village mock-upI am looking at a small village. It’s about 70 feet on a side, complete with a variety of mud and brick homes, trees, grasses, and dozens of mosquitoes. And a technician with a slew of interesting gadgets.

Oh, and no people.

This “village” is actually a mock-up; a to-scale version inside a greenhouse (itself a massive 700 square meters) on the grounds of the Tanzanian Training Centre for International Health (TTCIH) in Ifakara, Tanzania. Folks, this place is an international nexus for malaria research. Not only do they know almost everything there is to know about Plasmodium falciparum, the scientists here have nearly three decades of longitudinal (and latitudinal?) data about mosquitoes. They know when they feed, how, what direction they face, and which condiments they employ when taking a blood meal. I visited a room where technicians were breeding mosquitoes by the thousands.

They study things here that I would have never thought of. In the greenhouse, I watched two technicians pouring water from one little vial into another, placing it in a machine, and recording a number. I asked “Unefanya nini? (What are you doing?)” and they responded, “Measuring the feces.” I didn’t immediately connect the word “feces” with excrement – I assumed that it was a Kiswahili word that I had misheard. I asked for clarification.

The technicians capture mosquitoes from the mock village or other testing areas and segregate them. They then allow them to digest their meals and excrete. After applying a solution of lithium carbonate, which effectively stains the feces brown, the technicians measure them. The weight of the feces determines what kind of blood meal (human or animal) the mosquito has taken.

Mosquito poop aside, TTCIH is making, and has made, some serious strides in the fight against malaria. My team is considerably lucky to be learning alongside the scientists and researchers here in Ifakara.

Ours is a brand new game

Meeting with the village elder

Meeting with the village elder

Our team rolled out of Ifakara town this afternoon heading…some direction – I’m not sure where – and drove more than a few kilometers out. We headed down another very bumpy road to a small village hidden in something approximating a small forest. The homes were very scattered, and almost all were underneath very tall trees. It reminded me a bit of being in the state park back home where my Dad works.

We met with the village elder, a fellow who I would estimate to be around 45 years old. Apparently this is a recent development. Village “elders” are often younger than they would have been a generation ago. They are voted into office by the residents, in this case something like 300 people. Until I find out the actual name of the place, I will refer to it as Ginger Village, since we were greeted by a woman who had just returned from her plot with a handful of crops: fresh ginger root.

We had come to Ginger Village to ask its residents how they were affected by malaria. We are trying to collect stories of malaria and faith communities here in Tanzania, so speaking to a wide variety of people is important; earlier in the day we had visited with a great many secondary school students, for instance. Meeting with the elder was important – we had to seek his permission to interview the residents of his place. He was very gracious and happy to have us. He answered many of our questions and then led us on to visit other families.

And so it went. We stopped in, exchanged pleasantries, chit-chatted a bit about malaria, and moved on. The stories were eerily similar. Government voucher programs, some funded by western aid organizations, provide free bed nets to pregnant women and children 5 years and younger. Anybody else is, for lack of a better word, screwed. No freebies for them. A proper net with permethrin will cost around 5000 Tanzanian shillings (a little less than $4). Needless to say, families like these don’t exactly have such disposable income. Many of them had bed nets, but not enough to cover the whole family. Some weren’t treated, and others were very old.

Aside from the stories of bed net woe, which we expected in one form or another, we also made sure to inquire about the role that religious communities might play in helping educate the faithful and distribute nets and medicine. No one that we spoke with seemed to think this could happen. Ginger Village seemed to be more or less Roman Catholic, but they could have been any religion, really.

In explaining our work with the Faiths Act Together campaign and the work of the Faiths Act Fellows in Africa, we pointed out that we want to inspire and connect faith communities to each other and to their constituents in the context of friendship and cooperation to eradicate malaria deaths. This idea, when translated into Kiswahili, is generally well-received, but only insofar as it seems to be a practical solution to a severe problem. Churches and mosques and temples working on malaria, let alone across faiths, is a foreign idea. The hopes and plans that we bring are brand new. And while we don’t expect to fully flesh out an interfaith collaboration scheme in the nine months that we’ll be working as Fellows, we certainly expect to build the framework.

The fact that this endeavor is brand new actually might work for us. We’re not going to have to fight an uphill battle against entrenched, inimical views that will turn local populaces against us. We’re not airlifting a tractor to a remote village and showing people how to use it. We are trying to develop existing community-based assets that will be fully owned by Africans. And in starting from Square Zero, we can define the parameters of our work and truly involve the people for whom malaria is a constant threat.

On the Kilombero River

On the Kilombero RiverAfter a quick breakfast, our team headed out this morning to the Kilombero River, the body of water that separates Kilombero District from its neighbor. One of our friends from the Tanzanian Training Centre for International Health came along to find some river guides; we made a deal and climbed into two massive dugout canoes. They were ships, really – probably 20 feet long and more than 2 feet deep. Our whole team plus the four river guides fit quite comfortably. We set off on a slow cruise upstream.

I got to chatting with a man named Hatari, asking him lots of questions about the river and the Kiswahili words for things that I saw around the boat. I pointed to a small white bird called “nyange-nyange” and Hatari explained its place in local mythology. If I understood him correctly, the nyange-nyange is considered off-limits for eating. The practical reason is that the bird removes and eats ticks and other parasites from the area livestock. But the other, and probably much older reason, is that it is believed that the nyange-nyange provides the impetus for the growth of human fingernails – these fingernails in turn provide the bird with its brilliant white feathers.

Hatari, one of our river expertsIn time, Hatari came to ask me questions about what I was doing in Tanzania. I explained our work with the Interfaith Youth Core and Tony Blair Faith Foundation and how we were there to learn and observe. I asked him (in Kiswahili, which I am very proud of) if he thought that malaria would always exist. He paused and laughed, saying, “Malaria is…like a runny nose. It is very not rare!” He went on to explain that there are types of malaria that can linger in the body for decades, making it very hard to completely eradicate.

Hatari was adamant that real reductions in malaria deaths were only capable through increased education. I stressed that our team saw the importance of religious communities in dispensing this education along with bednets and medicines. I pointed out that the eight Fellows with me would be joined by twenty-one others who would scatter themselves across the US, UK, and Canada in order to promote interfaith cooperation on malaria. Hatari ended up asking me far more questions about the Fellowship than I asked him about Kiswahili vocabulary. I was quite happy with this turnaround; it meant that he found our work interesting and useful. And when I explained our push for interfaith cooperation on the ground in sub-Saharan Africa, I could tell that he saw the very practical nature of the program.

Still, his answer to my question about eradicating malaria was unexpected to say the least. I had anticipated such an answer to be an adamant YES, but Hatari was saying that malaria was a fact of human existence and would likely never disappear. It reminded me of a maxim that we heard often during our training in London: “Dying of malaria is like dying of a broken arm. There’s no reason why it should happen.” The real struggle for the Faiths Act Together campaign will be combating the perceived banality of a disease that affects millions.

Welcome to Tanzania!

Tanzania Road

After a very long day of travel we touched down in Dar es Salaam and made our way to a guest house for the night. The accomodations were comfortable – always a good thing to have as you adjust to a new place. In the morning we took off for Ifakara in the south central part of the country.

It took us around seven hours to make the trip. The last ninety minutes or so was a long slog down bumpy, dusty roads. Luckily, our Rovers had good suspension systems. We rolled into the Tanzanian Training Centre for International Health (TTCIH) right as dusk was falling, which was surprisingly early. I think we had gotten used to the day stretching past 9 pm when we were in London. We unpacked the trucks and met Joyce, the administrative specialist, and Dr. Pemba, the Director of the Centre.

After a wonderful dinner to welcome us, we retreated to our bungalows to rest. Sleep was welcomed.