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DOOR TO DOOR APPROACH SAVIOUR TO BED RIDDEN PEOPLE!

A STORY OF KOMOLO WARD, SIMANJIRO DC

It was on the afternoon of Wednesday, 5th of September 2018 when a team of Community Health Workers visited one of the Maasai household (Boma) at Komolo ward in Simanjiro DC, Manyara Region and met JOYCE (not her real name). Joyce is a married woman aged 35 years old, who has been experiencing recurrent period of sickness since the beginning of the year 2018 and since they are living far from health facilities she could not receive proper medical care hence her main therapy was local herbs, which only provided her with slight improvement and  the situation continued to be recurrent.

Upon arrival, the team found Joyce laying on her bed, weak, and speaking with difficulties. “I have suffered a lot, I have been experiencing recurrent fever, general body weakness, recurrent diarrhoea, cough and weight loss and when we go to the Dispensary for treatment they only give me IV Fluids and then they discharge me”, said Joyce.  “We tried hard to care for her health both in modern and local medicine without success, the near Dispensary (about 15km) doesn’t perform many laboratory tests, hence they end up giving her IV fluids and some oral medication and we come back home. Our big Hospital which is the District Hospital is very far from here, so it really needs huge preparation especially finances”, added Mr Shabala, Joyce’s husband (not his real name).

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The photo above shows a team of CPC providers in Joyce’s household (Boma) during the campaign at Komolo ward in Simanjiro DC

After physical examination, Joyce was found to be severely pale on her eyes conjunctiva, tongue and palms. HIV Testing Services were also conducted on site, whereby  Joyce was found to be infected with HIV. Index testing was also conducted but none of her 10 siblings (6 males and 4 females ) and other 9 relatives (4 males and 5 females) tested HIV positive. We also conducted couple counselling to Joyce and her husband. Due to her critical condition the team decided to escort Joyce to the District hospital which is about 150 km far. Upon arrival to the District Hospital, she received various laboratory tests including Haemoglobin (Hb) level which was found to be low at 4 gm/dl. Among other treatments, she received blood transfusion and few days later she was enrolled into care and treatment services and discharged.

“Am very thankful to Mkapa Foundation to bring these HIV testing services especially this “boma to boma approach”,  as majority of pastoralists wish to know their HIV status because we are hearing that this disease (HIV ) has entered into our society, but they don’t get the chance because services are very far from them. Today, these services helped us to know our HIV status including my wife which I now understand that all these suffering might be related to her HIV status. But also after receiving counselling I am now aware that after starting medication (ARVs,) she is going to get better.” Said Mr Shabala. “I sincerely plead to  the Foundation, Government and other implementing partners to make these HIV services constantly available in the remote areas like this of pastoralists, because pastoralist societies have many risk behaviours and cultural practises which puts them in risk of acquiring HIV infection, so they are highly in need of these services and other health related services in general”, added Mr Shabala.

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The photo above shows Joyce boarding the BMF vehicle ready to be taken to Simanjiro District Hospital for further management

Kitiangare Village Chairman Mr Joseph Lekele also expressed his gratitude to BMF and Tanzanian Government for bringing health services particularly HIV testing services close to the Maasai society one of the tribes in Tanzania which lives in rural areas. “On behalf of people of Kitiangare Village which is in Komolo ward, I would like to thank this Mkapa foundation for considering us and bringing these health services not only too close to us, but even to our households as some of the providers are passing through the bomas to provide these services to those who could not able to come here at the village centre. I also congratulate the approach you have used as you have integrated the services such Blood pressure check, Blood sugar check, weight measuring, TB screening etc, this gives people opportunity to know other health status in their bodies”, said Mr  Lekele.

“I am asking the foundation and the Government to make this exercise sustainable as people are really in need of these services and they are not only living in hard to reach areas but also health services are very far from our village, it is about 30kms from here in a very rough roads, just as you have witnessed. But am also very  pleased to hear that those who are found HIV positive are being initiated on treatment immediately at the government health facilities, therefore I encourage all the people to use this opportunity to know their health status”, added Mr Chairman.

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The photo above shows Mr Joseph Lekele, Kitiangare Village Government Chairman in Komolo ward in Simanjiro DC.

Before commencement of CPC initiatives at Komolo ward, people from remote Villages like Manjanga, Lemshuku ,maduka sita, Kitiangare  were necessitated to travel about 20 to 30kms to go to the Dispensaries which costs a person about 30,000/= to 50,000/= tsh for transport only, which excludes other related costs. “it is not easy for a normal Tanzanian to incur such cost just to come and test for HIV or any other medical check-up or treatment, unless the person is in a critical condition”, said Dr Deogratius Mazengo, District Aids Control Coordinator(DACC). “The District has few partners implementing HIV community initiatives and most of them are located in the town areas like Mirerani, thus we are grateful to have Mkapa Foundation reach those remotest areas of the district”, added Dr Deogratius.

The Komolo ward is located 160km from Simanjiro District headquarters and 60km from Arusha. The ward doesn’t have HIV/AIDS Care and Treatment Centre (CTC) so people on ART have to travel either to Terat Dispensary which is in Terat ward 20km from Komolo centre or to Mirerani Health Centre in Mirerani ward, which is about 80km from Komolo centre and the major means of transport is motorcycle in rough roads.

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Dr Deogratius Mazengo DACC for Simanjiro DC

In the quarter of April –June 2018, the three Dispensaries in Komolo ward (Komolo, Nadonjukin and Sukuro) managed to test about five hundred people (500) compared to 2191(male 1498 female 693) people reached with CPC approach just within five days. Komolo ward has a population of about fourteen thousand people (14000).

Benjamin W. Mkapa Foundation (BMF) with financial support from Global Fund to fight against AIDS, TB and Malaria under AMREF as the principle recipient of the grant, will be implementing a 3 years (from 2018 to 2020) TB/HIV initiative in 8 districts of Tanzania in 4 Regions. Amongst the beneficiary sites are the two Districts of Simanjiro and Mbulu in Manyara Region whereby the Project is expecting to cover 46 wards. According to the Tanzania Health Impact Survey report in 2017, the prevalence of HIV in Manyara is 2.3%.

 

Among other activities the project is expected to conduct is the Combination Prevention Campaign (CPC). This is a right based, evidence-informed, and community owned program that use a mix of biomedical, behavioral, and structural interventions, prioritized to meet the current HIV prevention needs of particular individuals and communities, so as to have the greatest sustained impact on reducing new infections.

The campaign is being conducted from one ward to another with full engagement of the Regional, district and wards leaders and community. Together with HIV testing other services like family planning, Voluntary Medical Male Circumcision, cervical cancer screening and vaccination, Non-Communicable diseases, STI, TB (include structural interventions) are being conducted depending on the availability of Implementing Partners in the respective campaign areas. Cinema shows and performance from theater groups are amongst methodologies being applied together with testing as a means of educational provision but also community mobilization.

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The three photos above show health care workers providing health services during CPC at komolo ward in Simanjiro DC

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