My Canadian NGO, CACHA (Canada-Africa Community Health Alliance, www.cacha.ca) partners with a rural hospital named Kilema Hospital, which is located on the slopes of Mt. Kilimanjaro. Our biggest initiative with the hospital is the construction of a building that will house numerous HIV-related services, including the distribution of anti-retroviral (ARV) medication to HIV-positive members of the community. Those taking this medication on a daily basis will enjoy a life incomparably longer and stronger than those who do not, and will continue to work and support their families for years to come.

But the building we are constructing will be more than an HIV testing and treatment facility. It will provide office space and meeting rooms to three of the most impressive groups of people I have ever come across...

1. The first group is called the Home-based care (HBC) team, and is a collection of around 30 volunteers from the village communities surrounding the hospital. Each home-based care volunteer has been trained in basic health care and pays weekly visits to a handful of clients, many of whom are HIV-positive. The HBC worker educates the patient in simple things such as diet and sanitation, treats any minor ailments, and makes sure the patient gets to the hospital if he or she is experiencing any severe problems. Increasing the capacity of these HBC teams is an effective and efficient way of improving rural community health, since it devolves health care responsibilities from the centralized hospitals that are over-burdened, to a network of individuals embedded within communities.

As I mentioned, all the members of the HBC team are volunteers. Every week, these people walk many kilometers through the dusty mountainside paths to reach their patients, all simply out of the goodness of their hearts. At each monthly meeting they even make a contribution into an emergency fund, which is used anytime small amounts of money are needed to ensure a patient's well-being (for example, when a patient needs transportation to the hospital). These are very poor people contributing their own money and energy to ensure that those even less fortunate can receive basic health care services.

At a recent HBC meeting, it was announced that a donor had provided three bicycles to the group, which then decided that these three bikes would go to those team members that travelled the furthest to reach their patient. Equipping the entire home-based care team with bikes would increase the number of patients a volunteer could visit, and the frequency that these visits are made. Here's a picture of the group.



2. The second impressive group that should benefit from the new building is known as the "Tumaini" group, The Tumaini Group is also based at Kilema Hospital, and it consists of about 30 members who are all HIV positive. At one point each of the members was on death's doorstep, with the frequent opportunistic infections and weight loss that are associated with HIV/AIDS having reduced them to frail, hollow versions of their former selves. Then each of them began anti-retroviral therapy, and regained their strength and weight. But they regained much more than that: the Swahili word "Tumaini" means 'Hope'.

This support group of People Living with HIV/AIDS (PLHA) is dedicated to ensuring that its members have a network of friends and information to rely on while they come to terms with their disease and begin the difficult anti-retroviral regiment with its many side-effects.

There is still a great deal of stigma in Tanzania about HIV. Those known to be positive can be looked down upon or discriminated against, with the result being that people are generally reluctant to get tested. Those that test positive may remain quiet, fearing shame, and fail to seek treatment. The Tumaini group educates their communities about HIV in order to reduce stigma, and increase the number of people being tested and receiving anti-retrovirals (the joy that comes to me when new members join the Tumaini group on anti-retrovirals is balanced only by the sadness when it is announced that a member has passed away). Each group member brings a sheet of paper to the monthly meeting summarizing the small groups they have spoken to about these topics, with each member usually having spoken to a half dozen small groups of 3-10 people. Although the title "hero" can be used a little too loosely sometimes, that is certainly not the case for these people who are living openly with a dreaded disease and saving lives in the process. Here's a picture of those wonderful people.

In order for anti-retroviral medication to be truly effective, the patient must receive a nutritious diet and visit the hospital for testing on a regular basis. Many members of the Tumaini Group are extremely poor, and have great difficulty meeting these requirements. I recently spent a day with the chairman of the Tumaini Group, Eric, who told me a number of members cannot even afford more than 1 meal per day.

Instead of being provided with ongoing monetary assistance for food and transport (which they currently do not receive), the group is keen on starting a sustainable project that will provide small amounts of income to its members for years to come. Eric took me to visit a small pig shack which the group had pitched in to build, complete with 2 female pigs. The idea is that when these pigs have piglets, a number of the piglets can be sold to pay ongoing costs such as pig food and medication, while a couple of the piglets are given to another team member. Slowly, with each generation of new piglets, every member of the Tumaini Group will begin raising pigs until everyone has some. Thereafter, they will use the profits from the pig project to support their livelihood. Here's a picture of the Tumaini pig project.





I must be honest when I say that I have not studied the feasibility of this pig project in much detail. It is possible that the group will switch to raising chickens or goats, or begin some other business altogether. Regardless, it would be nice to empower this group to begin some sort of sustainable income-generating project that will give both the individuals and the collective strength to live and grow.

3. The third (but hopefully not final) group that will benefit greatly from the building we are constructing at Kilema Hospital is orphans and vulnerable children (OVCs). Tanzania is home to over 2 million orphans, which when you think about it is a really startling number. The total population of Tanzania is around 35 million, which means that over 5% of Tanzania's TOTAL population is made up of orphaned children. Breaking the figures down another way, 22% of all the children in Tanzania are orphans.

Now it must be mentioned that the definition of an 'orphan' around here isn't exactly what we're used to: around here a child is considered an orphan if he or she has lost either parent or both parents. As for 'vulnerable children', these are children whose parents are both living, but fail to adequately provide for the child, perhaps due to some chronic illness such as the usual suspect, HIV/AIDS. Regardless, the main point is that there a whole lot of children living in Tanzania and around sub-Saharan Africa that are gravely lacking both the material and non-material support that are generally needed for a society to produce healthy, happy and productive new adult members. A few months ago Kilema Hospital had some of the OVCs produce paintings of what HIV/AIDS represented to them. Here's an example of what they came up with.





By material support, I mean the basics: enough food to eat, proper shelter with access to clean water, books, pens and uniforms for school, reasonable sanitation, and so forth. By non-material support, I mean adult supervision, guidance, mentorship, and well let's face it, the most important one, love. Every child's situation is different, with some receiving a decent amount of support from nearby relatives or neighbours. But on the other extreme you have those living completely on their own in a mud house and responsible for every aspect of their lives from food to school to washing even to taking care of their younger brothers and sisters. The new building at the hospital will house an orphan and vulnerable child support program that will empower Kilema to vastly increase the level of support it can provide to those children most in need; the following pictures are a couple example of what can be done.


                                             Delivering foodstuffs in the villages


                                                       An orphan house before...


                                                    ...an orphan house after



If you have read this far, it means a lot to me. But due to ongoing and increasing work and pleasure related commitments, I'm afraid this will be the last formal update to the Mzungu Days blog. I would like to thank those of you who have read my postings, especially those who have been encouraging me since the beginning and those who have tried to spread the good word about Mzungu Days (or "MzD" as I often refer to as in my scribblings).

By now, if you have been following Mzungu Days on an ongoing basis, you have seen a somewhat representative picture of the work that I have been doing with a number of Tanzanian organizations, much of it in association with my NGO, CACHA (Canada-Africa Community Health Alliance, www.cacha.ca). I wrote about St Francis School which caters especially to blind and deaf children. I wrote about Imani Vocational Training School where an ever-increasing number of income-generating activities are on the go to support core activities. Finally I wrote about Kilema Hospital, our biggest partner, with whom we are expanding facilities and shaping programs that will provide enormous benefits to community health, especially children, women and those HIV-infected. I would like to stress that there is no pressure here whatsoever. But if anything that I have written about has resonated with you and you want to help some great local partners do some great things, I would invite you to make a donation to CACHA. Donations can be made online at www.cacha.ca/donate.html, or by writing a cheque out to "CACHA" and sending it to CACHA, 100 Marie Curie Suite 300, Ottawa, Ontario, K1N 6N5. A heartfelt thank you to any who have donated in the past or plan to in the future.

Thanks y'all! See you in April '07 (probably). I leave you with the following picture...me with a praying mantis on my arm! (taken Nov26)