14
June
2009
Here in Kongwa, it’s the time of the year when girls and boys are ushered into adulthood. Drums, whistles and songs can be heard at all hours as everyone practices and celebrates for the festivities to come. Despite how brown and dusty everything has gotten, everyone’s in a good mood. The rains have long finished, all the crops have been harvested and the locals have more time and money on their hands than at any other time of the year. Yesterday, led by the sounds of the music, I wandered down to the enclosure built for selling off surplus corn and found that several vendors were set up selling goat meat and alcohol made from every conceivable substrate: milk, bamboo juice and hibiscus to name a few. People were happy, friendly and pretty drunk for the mid-afternoon. I was welcomed to the community by a number of older men and women in typical fashion:
“We are your parents; this is your home.”
“Let me know when you get married so we can throw you a party.”
“You are a Tanzanian now.”
“Can I have 20 cents for some moonshine?”
For the new, youngest members of the adult community (ages 12+), this is the time of their lives when they learn about their tribal history and traditions and are physically marked out as being adults. Among the Wagogo (the dominant tribal group here) this often includes facial scarring, cirumcision for boys, and (all too often) genital mutilation for girls. I remember my first Swahili teacher, Jumapili, telling me about his own initiation ceremony and circumcision. After being cut, he and the other boys were led into lake Victoria where small fishes, drawn by the blood, came to feed on their fresh cuts. Any boys that tried to flee were driven back into the lake by the older men, armed with sticks. At least here in Kongwa town, it is typical for boys to be brought to the district hospital for circumcision. The level of hygiene in this practice obviously deteriorates as one travels further out into the villages. One of the reasons I was told this was an ideal time of the year for circumcision was that the weather has finally cooled down. However, it seems to me a slight consolation to feel a pleasant breeze as your foreskin is getting chopped off.
As for the girls, the practice of female genital mutiliation is illegal and therefore there exists a great deal of reluctance to talk about it. However, in all of Tanzania, it is most widely practiced from this area of Central Tanzania up to the north towards Arusha. Traditionally it was quite common among both the Wagogo and the Masai, still highly populated in those areas of Tanzania today. One NGO associated with battling this practice is the African Medical and Research Foundation (AMREF) in Tanzania. Although the organization’s programs in Kongwa are quite limited, they are the only group doing anything here on this front.
In our own project on the ancillary benefits of Azithromycin, we are looking at sexually transmitted infections (STIs), among other disease categories, and are therefore asking women about pain with urination. Given not only the existence of female genital mutilation but the taboos against its open discussion, this naturally poses a research challenge. Finding out more about the prevalence of this practice and its disease consequences would be both important and logistically-challenging medical research. It is a topic long overdue for study here and one that ought to be implemented in the context of a broad-based series of preventative, educational, women’s empowerment programs.
Posted: Kongwa Trachoma Project, Tanzanian Society & Culture
13
March
2009
I met the nicest witchdoctor last week. I was spending the day in one of our study villages, supervising village health workers, biking around to points of interest and taking GPS coordinates. It started out as a joke when Steve Schachterle and I agreed to write a paper on “Distance to Witchdoctor” as part of our analysis of relevant variables correlated to different disease categories: Malaria, Acute Respiratory Infections, Diarrheal Disease and Sexually Transmitted Infections. The more I thought about it, however, the more I felt it was actually important to include witchdoctors among our identified local resources, since they justifiably serve as dispensers and repositories of traditional medical knowledge.
First, I suppose I should say something about the term “witchdoctor.” Although not the sort of thing that anyone would self-apply where I come from, Tanzanians often use the English word “witchdoctor” in a completely neutral sense. Like the word “half-caste” for people with mixed race heritage, it sounds much worse to the American ear than to the Tanzanian. As for the far more unfortunate tendency of Tanzanians to use the N-word as a label for black Americans, well, that’s painful to hear for many reasons – not the least of which being a lack of consciousness that anyone would find it offensive. In any case, for the sake of propriety, perhaps I should substitute “traditional healer” for “witchdoctor,” although I am not entirely sure whose sensibilities I would be protecting in this instance. Maybe they have decided to take back the word “witchdoctor.”
Despite the freedom available in English usage, I have found it more important to be careful with my terminology in Kiswahili. In looking around the village for traditional healers, I explicitly used the term Mganga wa Kinyeji (village doctor) or Mganga wa Asili (traditional doctor) in my search. While “witchdoctor” may be a neutral term, Mchawi (witch/wizard/sorcerer) is not. To make matters a bit complicated, Tanzanians generally consider the terms Mganga and Mchawi to be synonymous, the former a nicety disguising the underlying malevolent reality of the latter. “Is it possible to be Mganga without also being Mchawi?” I asked some Tanzanian colleagues. “If an Mganga only helps people,” I was told in the tone of voice suggesting the concession of an unlikelihood, “then he is not Mchawi.”
Medicinal elements of traditional beliefs and practices can be touchy subjects to broach, especially coming from a white American. Among the more harsh criticisms I have heard Tanzanians level at one another is the claim that some tribe/ethnic group (Kabila) is barbarous or unchristian, as evidenced by their traditional religious/magical/spiritual practices. I hear gossipy backbiting about who wears amulets, buries good luck charms, or talks to their dead ancestors along with the typical denunciation that such people are not real Christians. Of course, the longer I stay in Tanzania the more convinced I am that most people have not so much given up traditional beliefs as they have incorporated them into Christianity, Islam or modern science, as the case may be. “I don’t believe in witchcraft since as I Christian I believe all power comes from God,” a primary school teacher friend told me, “therefore God protects me from the witchcraft.” If this quote leaves you a bit confused, trust me, it’s better to just embrace the paradox.
Taking GPS coordinates at the homes of local healers, I made sure to sound a positive note about what I was doing. “I am using this computer to identify important locations in the village so we can make a map,” I explained to the kindly old man, the fourth and final of the villages’ Waganga. “We are marking the village government office, school, churches, water sources, dispensary, drug store, and the homes of the Waganga,” I continued as he looked at me somewhat worried, “places where people can get local medicine” I added in my best nonchalant tone. “We would also like to see some of your medicines,” one of the village health workers added, anticipating my interest.
The old man immediately struck a pleading if defensive note. “All of my medicines come from tree roots,” he insisted, “I am not Mchawi.” I emphasized that his work was important and that I was only interested in knowing where people could get medicine in the village. “People just pay me with food,” he continued, “I only work to help people, not to make money.” In addition to being known for their ability to get rich from their spells, Wachawi also use sinister ingredients in their medicines: blood, bones, hair, skin – often requiring a brutal collection. In my former village, a local man was found dead in the woods with much of his skin missing. Witchcraft was the universal suspect. Albinos are in particular danger on this account, as many Wachawi agree that their skin possesses magical properties. White, European skin, I was assured by everyone, has no magical benefits, though some regard European hair as potent. The old man said he used only tree roots to distance himself from such practices.
As the Mganga took me and the other village health workers to his shaded treatment area, he continued to plea his case. “If my medicine doesn’t work,” he continued, “I tell people to go to the dispensary. If that doesn’t work, then they need to go to the hospital in Kongwa or even Dodoma.” I was impressed. By the far the biggest problem with local healers is their potential opposition to western medicines. Especially given much of the widespread skepticism regarding AIDS and the western powers (“Americans put HIV into condoms,” I have heard from suspicious Tanzanians on more than one occasion), there are plenty of Waganga who implore their HIV+ patients to take traditional medicines in lieu of Antiretroviral medications. Obviously this Mganga was concerned with the health of his patients, not his medical market share.
“I only have one medicine right now to show you,” the old man apologized. I assured him I was happy to see whatever was on hand as I took the proffered gourd-bottle. “What does this medicine treat?” I asked. “It is a topical oil,” he explained, “for injuries, pain, malaria,” he gave as examples. I had to admit that I was hoping for a slightly less grandiose claim, given how circumspect he had been up until this point. Nevertheless, I understood him to be sincere and thanked him for his work. I am not inherently opposed to placebos, especially when accompanied by the appropriate referral for serious cases.
Undoubtedly much of the magical approach to illness stems from an inherent sense of powerlessness in the face of disease and uncertainty. When a patient comes to you clearly suffering, it feels like doing something, anything, has to be better than admitting defeat. There is little consolation in telling someone to just get bed rest and let nature run its course. I can relate to the witchdoctor’s woes, as I get asked for medical advice on a regular basis these days. I am not a medial doctor, nor do I have at my disposal any diagnostic tools other than a rapid malaria test kit, a thermometer, and the knowledge gained from countless, paranoid hours spent reading my Peace Corps issued copy of Where There is No Doctor, analyzing my mysterious skin inflammations and unpredictable digestive cycle.
During the course of our current study, our village health workers are dispensing Coartem and Quinine for malaria, Amoxacillin for acute respiratory, ear and some skin infections, oral rehydration salts for diarrhea, Azithromycin for chlamydia, Ciproflaxin for gonorrhea, Paracetamol for non-malaria fevers and cough syrup for coughs without rapid breathing. Naturally the villagers have come to expect us to have a medicine for every illness and have expressed feeling neglected or cheated if we cannot provide them with such. It is in fact the reason we are giving out limited amounts of cough syrup. Our initial treatment regimen called only for treating coughs accompanied by rapid breathing. Mothers were getting annoyed at reporting their child’s persistent coughs during the health workers’ twice weekly visits without getting anything for it.
As I continue to talk with villagers about their symptoms, I find it is often the case that the best treatments are simple, common and throroughly unexciting. In this arid environment with limited access to clean water, most people are not drinking enough. Even for those with better than average access to water, this still seems to be a common problem. I have had several people tell me about muscle soreness and headaches at the end of the day. These same people are reporting that they often drink less than a half liter of water per day. Additionally, the local diet is dominated by starches and other carbohydrates with limited fresh vegetables. Telling people to drink more water and get more vitamins in their diet feels a bit like a brush off – to me and to them. It would be nice if I had my own tree root oil to dispense.
The most common requests of Waganga/Wachawi in this area appear to be exorcising demons and producing rain. Being bothered by demons seems to be a common complaint and one for which the local solutions are viewed as rather reliable. The bad news for my work is that the first requirement for the demon-afflicted is cutting out all western medicines. Apparently they are contra-indicated for the local stuff. A trip out into the wilderness for up to a week commonly comes next. Finally, local medicines, prayers, drumming and dancing generally finishes things off. As for rainmaking, and I swear I’m not making this up, the local spiritual and meteorological practitioner climbs up onto the roof of a house with a mud-baked roof, takes off his clothes and moons the sky. I guess I shouldn’t knock it until I’ve tried it.
Further reading:
Newspaper article on witchcraft and the law in Tanzania
Insightful commentary on witchcraft in Tanzania by a public health worker
Posted: Kongwa Trachoma Project, Tanzanian Society & Culture
26
January
2009
Dear colleagues, friends and family,
It has been over two months since completing my service with the United States Peace Corps. To those of you I got to meet and reconnect with in Baltimore, Denver and Tampa during the month of December, it was truly a pleasure, though all too short. To those of you I did not get to see, I hope to be back in the states sometime in the Fall and again for all of December. Otherwise, Karibuni Tanzania!
Jessica and I are now back in Africa and busy transitioning from the cool, rainy southern highlands to the desert foothills of Central Tanzania. We are living in Kongwa, Dodoma and spending most of each day immersed in the work of the Kongwa Trachoma Project (KTP). A registered Tanzanian NGO in partnership with researchers from the Johns Hopkins School of Medicine and the Bloomberg School of Public Health, KTP is the principal Tanzanian partner involved in the international Partnership for the Rapid Elimination of Trachoma (PRET).
A bacterium in the Chlamydia genus, C. trachomatis is the leading infectious cause of blindness worldwide and affects hundreds of millions of people. In conjunction with the World Health Organization’s goal of fully controlling trachoma worldwide by the year 2020, KTP’s activities follow the SAFE guidelines to trachoma eradication: Surgery, Antibiotics, Facial cleanliness and Environmental improvement. There are currently projects underway which screen at-risk populations for trachoma and implement mass treatment with Azithromycin for villages with 10%+ infectious rates (following international and national standards of treatment). My current project builds off of this work.
Since Azithromycin is known to be effective against a host of pathogens, the ancillary benefits of this drug against malaria, sexually-transmitted infections (STIs), acute respiratory infections (ARIs) and diarrheal diseases are being studied. My own work has involved training village health workers and their supervisors, who are conducting health-surveillance of our study population and providing community-based treatment. Now that training has finished, I am continuing to monitor the course of the data collection process and implementation of treatment regimens, both in the study villages and in the KTP offices in Kongwa.
As a historian of science and medicine, it has been a fascinating experience to be involved in a research project and to observe the factors that contribute to experimental design and implementation: scientific, historical, ethical and practical. As a former secondary school biology teacher in Tanzania, it has also been interesting to be involved in the pedagogical aspects of this work, explaining physiology and pharmacology as well as research values and methods to the village health assistants (the family, friends, neighbors and even participants in our study population) as well as to their supervisors, the direct care providers in the village setting.
On my recent visit to the US, I remember many of you expressing surprise at mine and Jessica’s intentions to remain in Tanzania for the foreseeable future. Certainly that goal is contingent on the continuing availability of challenging and meaningful work such as this. We have reason to be optimistic at our prospects, yet we are, of course, prudently planning for the next year and beyond. We are continuing to search for organizations and individuals interested in discovering Tanzania and in collaborating with Tanzanians. It is the Peace Corps’ goal to establish mutually beneficial relationships between Americans and host-country nationals. As former volunteers, both Jessica and I are committed to that goal and believe that friendship, communication and collaboration are the best forms of foreign policy. It was truly gratifying to hear from a good many of you that you followed this blog with interest. If I can ever be of assistance in connecting you with some part of this country and its truly amazing people, please do not hesitate to contact me: josh@joshualevens.com
Peace.
Posted: Kongwa Trachoma Project
