George was able to travel to Canada in the winter of 2011 and met with representatives of a number of Highlands Hope supporting organizations including the McGill School of Nursing, Bishop’s University, and St. George’s Elementary School in Westmount.

George will act as a mentor to the first peer health educators at the the two pilot sites as well as developing a plan to implement peer health educator training in several other area schools.

Students from the first peer health educator training session in 2011:

A peer health educator in training:

Many of their songs are original material, written by their own members. The members of the choir traveled to Mbeya to a commercial studio to record the choir’s first CD and tape, for release in early 2012.

I just want to send you an email to give you an update on the project and also share a small story about an event that happened at the clinic that made my heart happy. I am sorry that it took this long to write, but I have been so busy here with preparations for the project, making materials etc…I am really enjoying Njombe and the community is so wonderful. I really understand why you wanted to continue work with this community.

So, just an update on the project. We started teaching our youth peer health educators yesterday (Saturday the 15th, October). It was really nice. It was about 9 am when we started and the session took place at Nyumbanitu school. We started by personal introductions and introduction of the topics we will cover over the next few weeks, we did the pre-test questionnaire and played a few introductory games to get everyone acquainted. We made classroom rules for the teaching sessions and handed out our packages to the teachers and students, which contained out two books, a ruler, exercise books and pen and pencil.

I introduced some teaching about peer health education. We talked about roles and responsibilities of being a PHE, etc. We made it very interactive, asking the student’s lots of questions, for example: what they think peer education do and why they want to be and educator. They all took turns reading from the book and discussing. We wrote down important ideas on our flipcharts and had some pictures as well.

Betty did some nice teaching about reproductive health and reproductive organs of males and females, so that they will prepared to get teaching about HIV/AIDS in our future sessions. They were very good at answering questions and naming male and female body parts. I was very impressed with them and think we have a nice group of youth peer educators.

Everyone participated, the students, teachers, CHAKUNIMU, Betty and myself (in my broken Swahili). We had tea in the morning and lunch in the afternoon was provided for everyone. We finished at about 3:30 when we could tell that the students were getting tired and had enough teaching for one day. It was really a nice introductory day. Everyone worked hard and was involved.

I also just want to share one more story which is an example of how incredibly humble and wonderful the Njombe community is, how good the care is at this particular CTC and how incredibly lucky I feel to have the opportunity to be here at this time. Aside from my miscommunications, occasional frustrations and time recovering from illness, really it’s all so worth it, and feel like a part of this community as the people here have been incredibly welcoming since the day I got here.

So, as you know, the CTC is a small clinic at the TANWAT hospital. All the clients wait together outside on the benches for their appointments. Most of them come early in the morning. You can always here them talking, sharing, laughing and reminding each other if their name is called for their appointment. As for the facility, sometimes water and electricity can be a problem, even at TANWAT, which has a separate supply usually more reliable than the town’s.

However, one particular week (I think 2 weeks agao), there was no running water for a few days at the hospital. Without anyone noticing, one of the taps in the CTC clinic was left in the on position, so during the night when the water supply had returned, it started to flood the clinic. When Betty came in the next day saw that there was water streaming underneath the clinic door. So, she went outside to tell her clients that they will be opening late today, as they had to clean up the mess before they could resume and see clients. However, the clients have known Betty a long time, and knew that she had surgery the previous year. So, to her surprise, they quickly got up and got to work to help with the cleaning, saying, “We will do the work, you are ill and you should not be bending like that.”

“We are healthy, we come here and take our pills, we are not ill. We are perfectly healthy and we can do the work.”

And they did.

It just shows the collaboration, rapport and partnership that exists between the clinician and clients at the CTC. They have known each other a long time and the care is reciprocal. The clients care about their CTC and the healthcare workers who treat them. They also care much about each other, and their own health and they will continue to come back for their care and treatment. They know that they are living healthy and productive lives, even with HIV and they know that they medications and care they receive keep them healthy, on top of that they are happy!! They are happy with their care and with their lives.

This clinic is an example of not only how other clinics and health facilities in Africa should be run, but how healthcare should be delivered worldwide. The openness and vigilance and care delivered at this small CTC in rural Tanzania in my opinion is first class, and beyond anything I would have expected before coming here.

Attached is a photo of Saturday’s sessions with the students. Hope all is well back in Montreal.

Vesna

I spoke with Betty Liduke yesterday and McGill nurse Vesna Papuga’s work is going very well - they were just at a village awareness and testing event on the weekend where 300 people showed up and 160 were tested.

The new, two volume training manual in Kiswahili for the elementary school peer health educators has been completed and the young people who will be peer educators are being chosen.

And local health and education facilities are using the results of Ryan’s awareness and attitude survey to plan a roll-out of enhanced teaching in all district schools, perhaps using the HHUmbrella/CHAKUNIMU/McGill approach with young peer educators that we’re piloting at Ramadhani and the other village school.

The McGill-Highlands Hope “virtuous circle” of care, research, and advocacy continues to bear very nourishing fruit.

Also wanted to note that the Kibena Women’s Association is implementing a new accounting system that will be extended to the other Highlands Hope Umbrella organizations as they work out the kinks to enhance financial reporting and accountability. This is being done with the assistance and support of the new accountant/comptroller at Tanwat Hospital

And just to let everybody know, we’re moving forward on editing Kristin’s home-based care training manual into a handy reference version for volunteers that we hope to have designed and printed for March.

Hope everyone’s well,

Royal

Introduction of Youth Peer Health Education project to the Njombe Community Advisory Committee

Introduction

My name is Vesna Papuga and I am a nurse and graduate student at McGill University in Montreal, Canada. I am here to work with your community to do research project to help youth in the Njombe learn more about HIV/AIDS. I want to thank you for taking the time to meet here and for participating as the community advisory committee for this project. The advisory committee will be involved with all of the decision making and planning along the way. This project will take place over the next 3 months from September to December. There will be three parts to this project that will be explained in greater detail following the background of this project.

Background of project:

Last year one my colleagues from the McGill University collaborated in a project with your community to try and figure out what knowledge, attitudes and practices youth in Njombe have regarding HIV/AIDS, surveying over 800 students in the primary schools. Now to continue with the collaborative work established between Njombe and McGill University’s School of Nursing, we want to continue our research and help children learn more about HIV/AIDS. The idea for this project is to create a youth program involving children, by learning through their own peers, to help them develop life skills and knowledge to enable them make better health choices regarding HIV/AIDS. So, now our question we are looking to answer is: Can a peer health education program regarding HIV/AIDS in Njombe’s school-aged children improve their knowledge and attitudes towards HIV/AIDS?

Because CHAKUNIMU is already volunteering in the community to share their knowledge about HIV/AIDS through peer education, we think they would be very useful to help us teach the children to do something similar in their schools.

To try out this idea we will start with two schools in the community. (Nyumbanitu and Mlevela). One class from either standard five or six in each school will be selected to participate in helping us develop and teach a youth peer health education program around HIV/AIDS. However, we will first need CHAKUNIMU volunteers to participate in the role of adult peer health educators (APHEs) to help us teach the children about HIV/AIDS and help them become youth peer health educators (YPHEs) in their schools. This is the part of the project.

Explanation of the three phases of the project.

Phase 1:

Introduction, planning and training the APHE’s
The first step is to identify two female and two male CHAKUNIMU volunteers, who will be the adult peer health educators (APHEs) who will be teaching and working with the youth peer health educators (YPHEs). The APHE volunteers will need to sign a consent form prior to participating (Appendix G). An assessment will be completed with the Adult Peer Health Educators by completion of the knowledge and attitudes (KA) questionnaire (Appendix J). The Advisory Committee will also identify an educator partner to assist with teaching the Adult Peer Health Educator volunteers and help set up the workshop sessions. This week we will also present the project to the teachers of the preselected classes to reaffirm their participation and the directors involved at the school level.

The Adult Peer Health Educators will get teaching to cover any data gaps identified through the results of the KA questionnaire and additional training through a workshop created on how to teach and work with the YPHEs by input from the student researcher, Mrs. Betty Liduke and a local teacher.

The next step will be to introduce the project to the selected classes in the two primary schools (Nyumbanitu and Mlevela). The purpose and the methods of the project will be described to the classes in detail by the Adult Peer Health Educators. The classes will nominate Youth Peer Health Educators through an electoral voting process by placing the nominations of students in a ballot box. Five female and five male students will be selected. The students will then get a more detailed explanation of their role as Youth Peer Health Educator. The children will be given assent forms and consent forms for their parents/guardians to be completed and brought back prior to initiation of the project. To test whether this program will work we will do a questionnaire of the students before and after the teaching program (similar to the one they completed during last years project).

Phase 2: Development of the YPHE program

We will assess the knowledge of the YPHEs through results of the primary questionnaire. They will then receive focused education from the Adult Peer Health Educators. Our curriculum will be partly guided by the “Mema Kwa Vijana” curriculum for standards 4, 5 and 6 in Kiswahili. The length of sessions and location will be decided upon by the Advisory Committee and input from the schools and parents. Roles of the YPHEs and APHEs will be established, as well as goals and objectives for the program. We will take field notes during the training sessions to document the process and evaluate the project’s process.

Once the education training session is completed, the planning of the youth HIV/AIDS peer health education program will take place. The Youth Peer Health Educators will work with the Adult Peer Health Educators to decide the curriculum to teach to their peers whether it is through skits, role playing, games, etc. The female APHEs will work with the female YPHEs from the schools and the male APHEs will work with the male YPHEs as it is thought that boys and girls may not feel comfortable and may not ask questions if the opposite sex is present (Obasi, et al.). The Assessment of their training will be done with the post-knowledge and attitudes questionnaire (Appendix J). They will also practice the program and get feedback from the Adult Peer Health Educators.

Phase 3: Implementation of YPHE program

The final phase of the project will be for the YPHEs to teach the program to their classmates. The female Youth Peer Health Educators will teach girls and the male YPHE’s will teach boys. Adults will not be present during the YPHE teaching sessions except for a volunteer notetaker, so that discussion can occur freely amongst the peers. After completion of the teaching program by the YPHEs, a post-test of the knowledge and attitudes survey will be conducted of the students in the class to evaluate the effectiveness of the peer health education program (Appendix J). There will also be an evaluation form for the program and YPHEs (Appendix L). The students will be able to express what they did and didn’t like about the HIV/AIDS peer health education program and what improvements could be made. The YPHEs will have a chance to fill out an evaluation form about teaching their peers after the program (Appendix K). Finally we will evaluate how effective our program was and share these results with the community and other schools for further development.

Last year, two McGill nursing students, Kristin Gagnon and Ryan Lomenda, undertook projects developed by local activists led by Tanzanian nurse Betty Liduke that trained volunteers in basic home-based care for AIDS patients and which undertook an exhaustive investigation of awarenss of HIV among primary school stucents in several Njombe area schools.

The preliminary results of that major study (to be published in a peer-reviewed journal in 2012) revealed low levels of awareness and knowledge. As a result, the local activist group that sponsored the research, CHAKUNIMU, has asked the McGill School of Nursing and Vesna Papuga to work with them to train selected primary school students as peer health educators, an approach that has worked very well with adults in village and workplace settings in Njombe.

The effort is being coordinated by associate director of the School of Nursing, Prof. Madeleine Buck, and the Coordinator of Highlands Hope Umbrella, Betty Liduke.

A four-course, African-inspired meal was served and entertainment provided throughout the evening. Prof Betty Kreuger’s photos from her study trip to Ilula and Njombe in the summer of 2010 were displayed on screen. The theme of the evening was “Teachers for Hope”. A powerful presentation on the power of hope, especially in the context of the helping professions was provided by the Dean of Students from Bishop’s.

Two Bishop’s School of Education students will be going this summer to volunteer at Hope School in Ilula to assist with the teaching of English as a second language. George Sanga from KYOFE (member organization of the Highlands Hope Umbrella) will work with them as well.

Nurses, orphan supporters, peer health educators, and youth AIDS activists have come together to form Highlands Hope Umbrella, a new administrative and support focus for efforts aimed at people living with the effects of HIV-AIDS in the Njombe district.

This is the profile that was approved by the Board of Directors of the new entity which will act as a fund-raising and accountability mechanism for its members’ programming.

HIGHLANDS HOPE

PROFILE
Highlands Hope is a non government umbrella organization that brings together Community Based Organization and Professional organizations to address the Challenge of HIV/AIDS and related social problems in Njombe Region Tanzania.

Their member group includes a network of Community Based Organization and health workers from local Health facilities.

Highlands Hope consists of dedicated team of friends, health care professional and Community organizations as follows:-
1. Highlands Hope Tanzania Nurses (HHT) – who are involved on Prevention of HIV and Care and Treatment programs.
2. Kibena Women Association (KWA) – is a professional women group involved in Orphans and Vulnerable children, Human rights programs.
3. Njombe Youth Development Association (NYDA) – is a youth organization involved on youth drug abuse, environment and youth employments programs.
4. CHAKUNIMU – Peer Health Educators community organization involved in awareness of HIV/AIDS, Malaria eg, Home Based Care and Men’s As Partner on the prevention of HIV.
5. PIUTA – a group of People Living with HIV – involved on follow up of HIV clients on adherence of ART and Home Based Care
6. Kibena Youth Fellow (KYOFE) – group of youth choir and drama team that builds awareness of HIV, Malaria, Children abuse e.g. among young people in the area.
7. Highlands Hope Friends and Volunteer activity that supports the network to go smoothly.

Highlands Hope Vision
Better quality care and services to the society in the targeted area (Njombe region)

Highlands Hope Mission
Highlands Hope umbrella a model to building confidence and ability to its members (NGOS and CBOs) in order to improve quality life to people at the targeted area.

LOGO
Highlands Hope carries a green umbrella with green ribbon tied to the handle with the means of Unity together to build strong community, life and Hope.

AIM
The main aim of Highlands Hope umbrella is to bring together and organize teams of professional, NGOs and CBO of Njombe region into corporate body.

Louise and I traveled to Dar, Ilula, and Njombe in early November to meet with Tanzanian and Highlands Hope partners. This is a brief update on the people and projects we visited.

We met Muhingo Rweyemamu in Dar. It was a very busy time for him – he ran communications for President Kikwete’s re-election campaign and was immediately tasked with analyzing why the ruling party shed so many seats to the opposition on election day (October 31, 2010). Nevertheless, he was able to take two days to drive with us to Hope School (which he established with his wife Fatma) for discussions about partnering to improve ESL and science teaching in local schools at Hope School and more generally in Iringa District. We met with several teachers and with students from Forms 1 and 3 (Form 2 was in the midst of national exams and Form 4 – the first graduating class at Hope School – was on a study break getting ready for finals). We made a great deal of progress in our discussions about how we could proceed in partnership with a Canadian university and we will pursue this along with new connections made with Dodoma University and the World Bank’s office in Tanzania.

We traveled on to Njombe. Two McGill nursing students are there working with Betty Liduke – Ryan Lomenda and Kristin Gagnon. They are doing great work on home based care with peer health educators as well as researching awareness of HIV among students in schools in an area served by our Highlands Hope partner group CHAKUNIMU.
We met with the Managing Director Tanwat, Bram Goswami, and discussed with him the benefits of the McGill School of Nursing partnership. Betty Liduke explained in some detail the critical role that our students and their research played in the Tanwat Hospital securing permission to establish an HIV care and treatment centre as well as ongoing contributions to the quality of peer health education in the work place. He assured us of his ongoing, enthusiastic support.

We were then guests at a special event at Ramadhani School (where St. George’s and Bishop’s have been developing a partnership) to mark the building of a new computer lab and library by the local community. Canadian donors had contributed some resources to the school, but the new lab was built using money raised in the local community (about 5 million shillings or $5,000) by school and village leaders. Two new desk top computers were also presented to the school thanks to donations by a Canadian patron of Ramadhani. District officials were also present and seemed surprised (shocked, even) that the local community had accomplished this without government or large donor involvement.

We sat down with representatives of Highlands Hope of Tanzania Nurses. They have elected a new executive and hope to re-establish programming in the coming year. They still have more than 20 members, but they have had problems gathering for meetings and for professional discussions. They pledged to keep us informed of their efforts to get things rolling again. We presented them with the next instalment of the nursing scholarship from the Mosher family and reminded them that we needed their support to select future candidates.

We attended a supper meeting with the Kibena Women’s Association. We have worked with them over the years on issues touching orphans and vulnerable children in Njombe. Their work continues with three of the children they sponsor about to begin “O” Levels or high school. They are also actively planning for the next annual Boxing Day event for orphans in Njombe Town that they sponsor. Unfortunately, I had to bring the news that Bishop’s University’s Political Studies Department has cancelled the student exchange program that had brought four Canadian students to Njombe. In spite of my explanations to the contrary, several members expressed concern that their actions might be responsible for the end of the effort.

We traveled the next day to Nyambanitu to meet with CHAKUNIMU and PIUTA, peer health educators and HIV activists who work in close collaboration with Highlands Hope of Tanzania. We had a very warm and affirming meeting with them, reviewing the great success of the home based care kits and training events that McGill nurses have been developing with Betty Liduke. This effort is an overwhelming success from the perspective of the community. Kristin Gagnon is doing a more objective evaluation as part of her research and early indications are very positive. Thanks to all the Canadian sponsors who got behind this effort – it’s really making a difference and is effective and sustainable with local resources alone. CHAKUNIMU is going from strength to strength – they showed us the land they have been given by the village council to begin construction of their own office and training space, to be built with their own resources.

We had also invited representatives of the PIUMA village chapter from Mwakauta (Mwakauta NM) to come to Njombe to be with us. Their two representatives led a very lively discussion with the CHAKUNIMU and PIUTA members concerning their impressive micro-credit program. We had a chance later to sit down with them for an update (we have made a small grant to the program) which was very positive; their capital fund continues to grow (currently at 2.7 million shillings) and they have just completed roll out of a 390,000 shilling fund to their 26 members to encourage chicken and egg production. We also concluded a deal with them to roll a loan given to their micro-credit project into a grant/ investment in a piece of land for dry season production of green vegetables for members and for income generation. We were also very pleased that Jackson Mbogela was able to come from Makete to be with us for these discussions.

We had a brief meeting with the Kibena Youth Federation (KYOFE) at a local church. We exchanged gifts and met with their musical director George Sanga who is to visit us in Canada in 2011 (if he is able to get a Canadian travel visa).

With each of the groups in Njombe, we presented a proposal to restructure Highlands Hope into an umbrella type organization that brings all the professional and community groups together and coordinates relationships with donors and government officials for them. This was positively received in principle by all groups. We will keep moving ahead on this in 2011, formalizing a structure and putting systems in place.
We returned to Dar, met with Vicky Ntetema, now media coordinator for the albino rights organization Under the Same Sun, and finished preliminary planning with Muhingo Rweyemamu on the ESL and science teaching project. Then, after a too brief hop across to Zanzibar, we returned to Montreal.

November 21, 2010.

In addition to this I have also been performing more thorough physical assessments, which has been a wonderful learning experience for me and the clients usually are very appreciative. If necessary we will then make referrals to the health dispensary or hospital as necessary.

The time I have spent in the villages has been challenging, amazing and at times extremely moving. During my first weekend I was welcomed into a home to find a woman with a condition that caused her extreme pain.

Her husband said that she had been diagnosed in February, 2010, and that the pain had been worsening over the past month. I recommended that she be taken to the hospital so that she could be prescribed a stronger analgesic, however, the family wanted her to remain at home. Three days later the pain became unbearable so the family decided to take her to the government hospital.

I stopped in to see her a few days later on my way to the villages. She was still fully conscious and tried to speak when I took her hand to greet her but was unable to. I received word that night that she had passed away in the evening.

The following day I was invited to attend her funeral. Before the funeral I went to her home to pay my respects to her family. Her female family members were all huddled around her bed where her body lay. They were so vocal with their pain, crying, screaming, and singing songs of sadness. I was so moved that I couldn’t help but break down myself and share in their pain.

The funeral took place in the catholic church and the burial immediately after. At the burial the men stood around the plot whereas the women of the village sat off to the side. People seemed to be very grateful for my attendance, and it was amazing for me to share in the experience, as difficult as it may have been.

Ryan’s project has been continuing successfully as well. He has spent several days in the villages administering his questionnaires to primary school children in six schools to assess their knowledge, attitudes, and practices of HIV/AIDS. His questionnaire was very well received, and he finished with more than 800 completed questionnaires.

Now begins the fun task of data entry and analysis. Everyone here is eargerly awaiting the results.

Thanks and look forward to seeing you soon,

Kristi

A note from Krisitin Gagnon, currently spending a term of study in Njombe with colleague Ryan Lomenda as part of the M.Sc. (Nursing) in Global Health at McGill’s School of Nursing:

Ryan and I arrived in Njombe on September 2nd and things have been going very well since our arrival. We first met with the PHEs on September 11th and Betty presented them with the computer that had been donated to them by Highlands Hope (editor’s note: the group CHAKUNIMU purchased the computer on a shared cost basis, raising half of the budget required locally). Everyone seemed very excited and grateful for the donation. Ryan and I will be helping the PHEs to learn how to use it while we are here.

My project with the home care kit training got off to a very quick start and the training took place on September 16, 17, and 18th. I had been working on the curriculum throughout the summer so the training was based around that. The PHEs learned about infection control, basic personal hygiene, common AIDS related conditions (e.g. skin conditions, pain, dehydration, diarrhea, worms, nausea and vomiting), how to give medications, wound care, burn care and using forms to make referrals and document their home care clients and activities. Betty and I did the teaching together and everything went quite smoothly. I will begin follow-up evalution of how the PHEs use the home care kits during their home visits in two weeks time.

Ryan will begin his project in two weeks time as well administering a questionnaire to primary school students in 6 villages to assess their knowledge, attitudes and practice surrounding HIV/AIDS.

Thanks,

Kristin

Kristin Gagnon and Ryan Lomenda from McGill School of Nursing with Highlands Hope PHEs.

Ms Gagnon will be focusing on Highlands Hope peer educators and a special project to create training and resources to allow peer educators to provide very basic first aid and care to HIV+ patients in remote village settings.

Mr Lomenda will undertake an evaluation of awareness and knowledge of HIV-AIDS among older primary school students in Njombe District.

Both students are working under the supervision of Betty Liduke R.N. and will also spend time in the Care and Treatment Centre of the TANWAT Company Hospital. Thanks are due to the Managing Director of TANWAT for his partnership and his welcome of the McGill students and to Njombe school authorities for their commitment to research into youth attitudes to HIV-AIDS.

Kathryn Hansen, Ariane Desmarais-Michaud and George Sanga interview a student at Ramadani School in Njombe.

Hi from Njombe!

So it is already our last week in Njombe. Time has gone by so fast. It seems surreal that we’ve already been here for 5 weeks!

Now all we have left to do is some home visits and we have also started to teach some of the teachers how to use the new computer.

So, that’s about it, we’re just trying to appreciate these last few days and make sure all the work gets done!

We have included some photographs as well,

Best Regards,

Kathryn and Ariane

Last summer, Bishop’s students Lucie Imbeau and Micah Orr investigated home living conditions of a group of orphans who receive support from the KIbena Women’s Association (with contributions from a number of Canadian donors including St. George’s School in Montreal and the Buck family from Magog).

The Bishop’s students’ travel is sponsored by TD Meloche-Monnex.

Below is the latest note from Ariane and Kathryn outlining the community support that their work on the situation of orphans has attracted.

Hi Royal!

Just a quick update. We have almost completed our student interviews and we are looking forward to meet with the community. On the weekend we accompanied Betty and Aspen on to a small village for HIV testing. It was very interesting to observe the work that Betty does on a daily basis. Also in the news, we are apparently recieving an award for community service in Njombe tomorrow, for the research that we are conducting. Which makes our work seem all the more worth while, because we have the entire community behind us! Alright so we have 1 1/2 more weeks to finish our research, and we are quite optimistic about finishing everything on time. Hope that everything is going well in Canada!

Kathryn and Ariane

We are finishing up our second week at Ramadani School and our project is progressing along at a great pace. We have almost interviewed half of the OVC’s we have selected to interview (about 50 so far) and have also started several home visits.

These visits have been difficult on an emotional plane however, we feel that the information that we gather will greatly help us in understanding the data that we have already collected from the children.

On a lighter note, the students at the school have taken a great liking to us, and you will often see us playing football or skipping with them on their lunch hour. Needless to say it is valuable time spent well!

Next week we hope to complete student interviews and move out into the community.

That’s it for us this week! Hopefully we will have more exciting news to report next week!

Ariane and Kathryn

So this week has been awesome.

We were able to interview all the teachers at Ramadhani School, many community leaders, and members of the school board as well as some students (orphans).

The research project is really interesting, as well as giving all the information to the Kibena Women’s Association, we’re going to work hard to make it a very comprehensive academic research project, possibly even trying to get published? But we’re not sure.

We met with the two teachers from Bishop’s and St. George’s School who arrived in Njombe yesterday and we discussed it a little bit. (editor’s note: Hannah Hershman from St. George’s School in Montreal, a long-standing partner of Highlands Hope and the Kibena Women’s Association, and Prof. Betty Kreuger from the School of Education at Bishop’s University are on a study tour in Iringa region; more reporting on their project is to come.)

In any case, Ariane will send you a rough draft of the project so that you’re a little more informed.

But we are really enjoying our time here and hope to be efficient this week and interview more children as well as do some home visits, which will certainly be critical to fully get an idea of the quality of life of these vulnerable children.

Anyways,

Take care!
Kathryn and Ariane

This is the second year in an ongoing partnership that links Highlands Hope affiliated groups with the Political Studies department of Bishop’s University (www.ubishops.ca) in Canada. In 2009, Lucie Imbeau and Micah Orr did a baseline study of the home living conditions of HIV orphans supported by the Kibena Women’s Association. George Sanga from the Kibena Youth organization was also a critical researcher in this effort.

This summer, the Bishop’s students will be evaluating the sources of support that orphans and vulnerable children at Ramadhani School in Njombe can count on to survive.

These efforts are designed to inform advocacy efforts with local officials and to ensure that children needing support receive it from all sources currently available in Njombe.

The month long study will lead to ongoing representations on behalf of orphans and vulnerable children by the Kibena Women’s Asscoiation who are co-sponsors of the study effort with TD Bank, Meloche-Monnex.

While there, she will be the guest of the Tanwat Company. Special thanks to Tanwat Managing Director Bram Goswami for supporting this visit.

Visiting the Villages…

We are sitting in a living room, on the wood framed couches that are identical to the wood backed seats that adorn each of the more prosperous of the fifteen houses we have visited today. Though structurally identical, the chairs come alive with their distinctive coverings; some use brightly colored Tanzanian fabric; others white cloth delicately embroidered with a care and skill that would make my grandmother smile with recognition.

The door is open and through it I can see chickens pecking and roosters strutting under a pale blue sky. This house has walls made of concrete painted a pale yellow and behind me there is a cartoon poster detailing the ABCs of safe sex. Otherwise the walls are bare except for a lonely gecko statuesquely defying gravity in a corner by the ceiling.

We are here to conduct Amy’s field research which involves asking families about their health care needs in order to improve the services that local volunteers provide to people living with HIV/AIDS.

Over the course of the past month we have visited over 40 families in remote villages. We have been confronted with generosity in a context we commonly contextualize as lacking riches. We have slept in a mud walled, straw-roofed hut, lulled to sleep by the sound of scurrying rats and the dancing rhythm of hungry bedbugs.

We have learned to kill a chicken and been amazed at the ability of women and girls to handle metal pots burning over the heat of a smoldering fire with bare hands. We have observed that soccer can be played by twisting a number of plastic bags into a somewhat circular shape and kicking it around a mud courtyard with a lazy chicken acting as a goalpost.

We have come to understand that what is described in academic papers as ‘rural and remote’ in practice means walking 40km in a single day, over dusty rutted roads through fading and at times charcoal black fields, in order to visit people that are otherwise unreachable.

We have often felt, at times acutely, that what is trying for us; walking seemingly endless distances on an empty stomach, waiting for someone who may or may not ever arrive, is routine for the Tanzanians accompanying us.

Our visits take on a pattern. We arrive at a house and move into the “sitting room” to conduct the interview. Most of the houses we visit are made of earth; earth walls and earth floors, sometimes a fire smolders in the center and when not used to this, it is difficult not to scrub the eyes like a tired toddler beleaguered by the unfamiliar. Often there are not enough seats for everyone and this typically causes a brief delay as our hosts hurry over to a neighbor’s house in search of an extra stool.

Once seated, there is the inevitable five minutes of personal greetings and salutations that are the prelude to any interaction. It is customary here to greet everyone: from the stranger you pass on the street, to the taxi driver, to the workplace colleague. These exchanges sometimes seem to teeter on the brink of the absurd: How are you? Good, how are you? Good, how is you family? Good, how is your family? Good, how is your work? Good, how is your work? Good, sorry you have to work. Thank you, sorry you have to work, and so on until every possibility has been exhausted. And it is not politeness per se but more like humanity shining in a way we seem to have forgotten about back home.

The questions we ask are always the same and the surprise lies in finding that the answers we receive are, in kind, uniformly similar.

We ask how far people have to travel to access drinking water. For most, it is at least a half hour walk away, for many, over an hour to make a trip. We see them often, women and girls walking with stately grace their heads supporting plastic buckets containing 20 L of water. According to the WHO, access to clean drinking water means living no further than a 1km or 30 minute walk to a water source; this means that almost 40% of the families we interview live without access to safe water.

All of the families we visit have at least one member who is HIV positive, most families have multiple members living with the infection. Some families are housing orphans, the son or daughter of a brother or sister, aunt or uncle who has died from the disease.

We enquire how far it is to the nearest hospital or local dispensary and how they get there. The vast majority walk; it is anywhere between a 6-8 hr round-trip, over dusty pitted roads, through rolling corn and potato fields to the closest dispensary. Old women, young men, the sick and the healthy, everyone must make this monthly pilgrimage to receive basic HIV care, treatment and most importantly, medication.

A 66 year old woman told us about the time she walked 4 hours to her local HIV clinic only to find that the CD4 machine was broken (CD4 counts are used to establish disease progression and help determine treatment), at which point she turned around and began the 4 hour walk back home. We ask people what the health care volunteers can do to better assist them with their day to day health care needs. The answer is always: we need money. Money to travel to the hospital, money to buy food, clothes, fuel, medication, money to live. We need an income generating project, we need a pig project, a pottery project, we need money.

Today is our final day of interviews and we are sitting on the wood-backed chairs- this time adorned with cloth delicately embroidered with apples, of all things- finishing an interview with a woman in her mid thirties who is living with HIV. The interview draws to a close and we ask if she has any questions for us. She looks at us with tired eyes and says: “You come here and asks about our problems. Everyone always asks after our problems, but what can you do to help me? What will you do?” Amy replies that she will write a report and that the results will be used by the village volunteers to provide better care to people in the surrounding communities.

Still, the woman looks skeptical and I can’t help but share her sense of uncertainty. What will I do- what can I do? I am confronted by a sense of powerlessness and a sea of apparently endless contradictions. Ninety percent of the approximately 33 million people infected with HIV/AIDS live in Sub-Saharan Africa and yet, the technology, infrastructure and drug development required to effectively manage and treat HIV infection is overwhelmingly located in the west.

Tanzania is one of the poorest countries in the world and yet, it has been the darling of the aid community, receiving billons of dollars worth of foreign aid from 1960 to the present. Tanzanian has an appalling shortage of healthcare workers and yet, western universities send an abundance of students like myself over for a few short months potentially straining an already fragile system. While it would be naïve to think that development work is inherently good or that the best intentions lead to progress, the contradictions are nevertheless unsettling, as is the look in the woman’s eyes as she thanks us and leads us out of her house.

It has been said that the way in which a problem is framed inevitably affects the response. I have been here for 3 months and though I will soon be on a plane returning home, I am still searching for a way to frame the problem in a way that makes sense. What can I do in the face of poor access to drinking water, broken equipment and lack of medication? What can I do for people who need income, who are too sick to travel to the hospital? What can I do to target the structural inequalities that contribute to the poverty I am confronted with in the houses I visit every weekend? What can I do where billion of dollars of international aid money have failed?

I know there are no easy answers, but perhaps, more so now than before, I am confronted with the complexity of asking the right questions. I hope that if nothing else, studying global health will allow me to better understand the problem and the next time someone asks me “What can you do?” I will be able to look them square in the eye and give them an honest answer.

Veronique Fraser

HIV testing by CHAKUNIMU in a village setting

It has been quite a journey and we have learned much about the friendliness and caring nature of the people of this region. We have also learned of the desolate conditions in which they diligently perform their work with the limited resources they have.

After spending the month of September working in the hospital, where we were confronted with the scarcity of supplies and medications, we went out to the surrounding villages to engage in participant observation of the home-based care services offered to the community by the CHAKUNIMU organization.

This organization offers home-based care services to HIV/AIDS patients and by word of mouth, they also offer care to any other patients in the community that may have conditions needing medical treatment. They operate solely through the use of volunteer peer health educators and service six villages in the Njombe district, encompassing a total area of approximately 40 sq. kilometres (or more).

It may not seem like a large area to cover, but as the road conditions in these villages are deplorable and access to motorized vehicles is close to non-existent, most peer health educators provide these services by walking over 20km a day to reach their patients. Those who have the resources have access to a bicycle, however as the area is hilly and ditches carved by the rains punctuate the paths, they still easily spend half their time pushing their bicycle up hills or through muddy valleys.

We spent 5 weekends in the villages collecting data based on these home-visits for a patients’ needs assessment. While the results have not been finalized yet, the preliminary results show that the most pressing need in this community is financial assistance and transport help.

Some patients spend up to 8hours a day walking to the hospital because they don’t have the money for bus fare into town and the medications they need (HIV antiretroviral drugs) are not available at their village dispensary. They then get to the hospital only to find out that the CD4 machine needed to assess their HIV status is “broken”, and spend another 8 hours walking home.

A day of work lost, with no results to show for.

Other patients are looking for income generating projects because they don’t have the money to send their children to school or buy food to supplement their diet of subsistence farming. Some houses are “lucky” to be located within 20 meters of a water supply, but many others walk up to 1 hour to get a single bucket of “clean” water.

In addition to collecting water, the children and women of the household also collect fire wood to fuel their mud stove. It is not uncommon to see in the early morning or late evening, women and children transporting either buckets of water or stacks of firewood neatly arranged on top of their head on their way home.

My experience here has been unlike anything I have ever experienced, and I do not know if I will ever again get to experience such genuine kindness and hospitality as I have experienced living with my host family in the villages. My short time here has taught me that despite the many needs of this community, there is a willingness to share and that we have much to learn from each other.

Amy Low

Amy Low and Veronique Fraser with CHAKUNIMU partners

CHAKUNIMU, PIUMA AND PIUTA PROJECT

Title of the project: Home Based Care

Participants: Peer Educator from CHAKUNIMU, members of PIUMA and PIUTA

INTRODUCTION
CHAKUNIMU is a non government organization situated at the rural area in Njombe district near Tanwat Company limited. Members of the organization come from six villages surrounding the company. They are devoted to work with the community in several areas such as environment care, HIV/AIDS, HBC etc.

PIUMA (Pima Uishi Kwa Matumaini) is a non government organization situated at rural area of Makete district. Member of the organization are people living with HIV (PLHA) who are devoted to help the community of Bulongwa Makete on Counseling and Testing, Home Based Care and fighting on human rights.

PIUTA (Pima Ujitambue Uiishi kwa Tahadhari) is non government organization situated in rural area of Njombe district near Tanwat Company limited. Members of the organization are people living with HIV (PLHA) who are devoted on sensitizing men’s on involving in the HIV response, community sensitization and campaigning on voluntary counseling and testing and Home Based Care.

The objective of the project was:
• To build a strong bridge between the three organization
• To increase Knowledge and skills through exchanging ideas, skills etc
• To help each other and the community at large.

Duration of the project: was ten days (10)

Activities carried out:
• Home Visiting
• Community education on HIV/AIDS, Voluntary counseling and testing, services of care and treatment, use of ARVs etc.
• Campaigning and sensitizing people mainly men on Voluntary counseling and testing

Home Visiting:
Together (Kwa Pamoja) we:
• Reached six (6) villages of Chakunimu
• Attended eighty four (84) clients at their male 15 and female 69
• Referred some cases to hospital for further care and investigation

Problem found during the visiting:

• Most of men don’t help their family
• Most of men don’t show up to the counseling and testing
• Shortage of care givers as the area is very big
• Clients fail to attend CTC due to long distance to walk to get the services
• Children are not involved on HIV testing

FUTURE PLAN
• To strengthen the exchange program
• Plan on how to help those clients who fails to reach the CTC services

Needs:
• Transport
• HBC kits or first aid kits

Last but not list thanks to all who gave the idea of the project and other help, special thanks to:
• Canadian HHT friends
• PIUMA leaders and board of advisory
• Tanwat Company Limited
• Village leaders

Prepared by:

CHAKUNIMU, PIUMA AND PIUTA
15th September 2009

We pile into the hospital jeep/ambulance and begin the two-hour drive over the bumpy road to Ikonda Hospital. The sky gradually begins to clear and the windshield wipers are put to good use chasing away the dust which, when stirred up by other cars, becomes a veritable fog and hazard.

Having arrived safely at our destination, we proceed to walk down the road to the little village of near the Hospital. Until this moment, there has been little, if anything, I have encountered in Tanzania that I would describe as quaint. Rustic maybe. Bucolic, perhaps. But nestled in amongst rolling blue and green hills, Makete stands apart.

Little dukas (stores) proudly display their multi-colored wares, thermoses stand to attention beside rows of oranges. Children in blue slacks and white shirts mill about, waiting for the school bell. Our party moves into a little restaurant where the waitress brings us Chai and mandazis- a sort of deep-fried-bun that is typically served for breakfast here. The mandazis are sweet but the Chai is sweeter and Evangelista tells us about how she used to own the restaurant we sit in, back when she practiced as a nurse in Makete.

Breakfast finished, we return up the hill for a tour of Ikonda Hospital. It is bright, clean and efficient. It smells like bleach and clean laundry. It has western toilets in every room, it has incubators, it has working CD4 equipment, and it has a well-stocked and organized pharmacy. It is a marvel.

In addition to offering all HIV/AIDS related services for free, it provides pro bono care to children under the age of ten. Unsurprisingly, it is a busy place: though they have 45 beds they are currently treating 60 patients, and it is funny how much this reminds me of home; seeing hospital beds turning hallways into impromptu hospital rooms.

The tour over, we settle in a sunny courtyard to wait for the meeting to start. Because time is slower here, or maybe just measured differently, and so waiting an hour, maybe two, is the inevitable precursor to any event.
The meeting begins, oddly enough, with a discussion as to whether or not it should proceed. Of the fifteen members scheduled to attend, only eight are present, and so there is debate as to whether to even hold the meeting. It is decided that we will continue, though hold off on the more important points until December.

Discussion centers on the need to increase membership. It is decided that on October 14th, representatives from Highlands Hope will make the three-hour journey to Lukalawa Hospital to disseminate information about the group and hopefully recruit new participants. Funding for this, as well as other activities, is critical and becomes a major topic of debate. The treasurer is absent and though the exact amount available to the group is unknown, the chair is confident when she stresses that money is tight. Yet expenses from the apparently slight- purchasing the paper on which the minutes are written- to the more obvious- transportation to and from meetings, are adding up. It is concluded that there should be enough in the treasury to provide for the trip to Lukalawa.

We return to TANWAT and a troubling sight. The hospital is located at the top of a small valley. About half a kilometer away and directly across the valley is the TANWAT Wattle Factory. We join a group of nurses and a doctor who are standing in the open hospital hallway that is also a balcony of sorts, staring with grim fascination across the way.

A fire set some time ago has grown out of control and flames the size of a small house dance dangerously close to the factory. Fires are not uncommon here; they are routinely set to regenerate the land, to burn garbage, really, if something gets in the way you just set fire to it – very cathartic and the air often smells like November at a cottage.

However, today a strong breeze is enabling the fire to gain strength and is pushing the flames towards the buildings. Had there been a fire extinguisher it would be too late to use it and there is no fire department waiting for a distress call. There is nothing to do but watch and wait. We stand together, mostly silent, and watch the flames grow and subside until our eyes become tired of the display and one by one we go back to our respective tasks.

The next day, we stand together once again overlooking the now charcoal black patch of land that is still lazily smoking. The factory is intact but TANWAT has nonetheless suffered a heavy blow. The fire managed to destroy a cache of lumber that had been treated to act as electrical poles. Valued at close to 100$ US apiece, this presents a significant financial loss to a company already burdened by economic setbacks.

Still, the day moves on like any other. And perhaps this is what I am learning more than anything else here, resilience. There is a KiSwahili word: “pole” that means “sorry for your suffering.” It is poetic in that it is said to all patients, simply and without pity. People acknowledge hardships without dwelling on them; perhaps because the suffering here is more immediate there are no histrionics and there are no maybes. You take what you have and you make do and that may sound ridiculously trite and hopelessly unjust, but it is true. Whether it is finding the money to buy the paper on which to print the minutes of a meeting, or finding the necessary materials to improvise a splint for a patient, it is these little steps that people make everyday that allows for forward momentum.

Have a nice week and I hope to send some pictures soon,

Nicky

Her work will focus on re-establishing high quality HIV care for PIUMA members and other people affected by HIV in the Bulongwa area (see www.piuma-simba.org for more information about PIUMA).

She was welcomed to the Highlands by Betty Liduke of Highlands Hope and the Katibu of PIUMA, Anna Mwinuka.

http://www.canada.com/health/Nurses+from+Canada/1954620/story.html

You can listen to it at http://www.rcinet.ca/rci/en/emissions/archives/archivesDetails_1952_31082009.shtml (second hour of the show).

While at Tanwat Hospital in Njombe, Veronique will be observing on the wards and undertaking an approved study, “Barriers and Facilitators to Voluntary Counselling and Testing in Njombe , Tanzania.” Amy will also observe in the Tanwat Hospital and will work on her MSc study, “Exploring the needs of clients using community home-based care (CHBC) in Njombe , Tanzania.”

The students will be supported and supervised onsite by McGill instructor Betty Liduke and Highlands Hope Chairperson, Evangelista Koyombo.

Both student studies build on work already undertaken by McGill graduate students in Njombe that issued from priorities set by Highlands Hope of Tanzania members for enhanced knowledge. Both studies have been approved by McGill as well and follow all University guidelines for ethical academic investigation.

The McGill students have begun their four month stay with two weeks of intensive language training in Kiswahili.

Watch for updates from Veronique and Amy!

QUARTERLY MEETRTING OF HIGHLANDS HOPES TANZANIA ON 07/07/09

THE AGENDA
1. Opening
2. Reading past minutes
3. Issues rose from past minutes
4. A report from members who visited Canada
5. A report for opening of Bank account
6. Transport fee to members to attend quarterly meeting
7. Issue of increasing memberships
8. Secretarial uses
9. A lesson on ARVs drugs
10. Other issues
11. Closing

1st OPENING

The Chairperson opened the meeting by greeting to members then she introduced the new members who joined with HHT from Kibena Wattle Company Hospital . This was at 10.30 am.

2nd READING PAST MINUTES

The past minutes were read and the members agreed upon the minutes, when they were asked about the validity of it.

3rd ISSUES ROSE FROM PAST MINUTES

A chair person wanted to know what shall we do to that member who does not attend secondary education sessions? The members responded that “the responsible once they will inform us when are ready.”
Also we wanted to know about the annual contribution, how far we are, they are only 9 members who are not yet contributed up to now.

4th A REPORT FROM MEMBERS WHO VISITED CANADA

A chair person who was among of member who visited Canada she reported that “We are proud to say we met our friends who welcomed us very nicely and they arranged a lot for us to during our stay actually we enjoyed a lot.” We succeeded to visit several health services areas, also we are attended several presentation with Canadian students which was a good learning to us. Betty also thanks the Canadian people for their voluntarism of hosting them for that period of time with good protection from cold and other donation the donated to HHT members like Nursing Books, one Laptop and Canadian 430 Dollars. Both the informed the HHT members that we shall have a certain learning visit of at list three months to Canada just when thing are due.
The members thank a lot the friends of HHT (The Canadians’) for their spirit of helping us in that way. It is a good struggle that wants to us step up but the problem may to our employers if they will allow us to go and stay for three months.

5th A REPORT FOR OPENING OF BANK ACCOUNT

HHT cashier reported to open an account at CRDB Njombe Branch, which was opened on 09 May 2009. We opened with Tshs 317, 000/=, during banking there were a regulations that was made and are suposed to be followed when we need to take the money. We were 4 members who signed the account, we four we were grouped into two groups A & B, group A one from Njombe and one from Ikonda as well as group B.

6th TRANSPORT FEE TO MEMBERS TO ATTEND QUARTERLY MEETING

A chair person asked the members to see how can help in transport fee to members who will be traveling from one place to another for attending the meeting.
Members discussed the importance of helping donating transportation fee for those members who are traveling to the meeting area. This will start next meeting by each member donating according with the present cost.

7th ISSUE OF INCREASING MEMBERSHIPS

We need to increase the coverage of membership. The members contributed the idea by agreeing the idea, but we should be very keen without forgetting our aim of starting the organization. We are going to accept members from Non Governmental organization only by the time. In that case Ludewa District will be included esp. Lugarawa Hospital , they said the members. For doing this we better finish our annual contribution so we can higher a car for going to Lugarawa to sensitize them on the need of joining with HHT.

8th SECRETARIAL USES

There is a need of having papers and ink (cartrage) for producing minutes

9th A LESSON ON ARVS DRUGS

This lesson was not done

10th OTHER ISSUES

A chair person insisted that the organization is for all medical personnel and Paramedical so the new members they shouldn’t be demoralized herring of Nurse colors, this just because we started with Nurses colors.

12th CLOSING

The meeting was closed by the chair person thanking the members to attend the meeting and their good contribution for building the organization. The meeting was closed at 1.00 pm by not arrange the next meeting until we get the date of coming Our friends from Canada .

Secretary signature ————————–
Date ——————————————–
Chair person signature ———————–
Date ———————————————

Things are getting busy here. I met with the Kibena Women’s Association on Wednesday and we started to visit the families yesterday.

Some houses are fine and we see that the children are happy there, but it is harder in others. This is really a great experience and it’s making us realize how privileged we really are.

On Sunday, two other choirs are coming to Kibena to spend the afternoon with the Kibena Youth Fellowship choir so Micah and I are learning the songs in Kiswahili so we can sing with the group. It’s not easy but we are practicing everyday.

Here are 2 pictures so you can see what it looks like around here. The first one is a picture of Hope School and the second one is a picture taken from a village near by.

We hope everything is going well in Canada.

Thanks,
Lucie and Micah.

Hope School in Ilula where Micah and Lucie spent a week

Kids on a playing field near Njombe

As part of the University’s innovative International Studies program, they are assisting two volunteer groups in the Njombe area. Their solidarity visit has been made possible by Canadian Friends of Highlands Hope, TD Meloche-Monnex, and the Political Science Department of Bishop’s University.

The Kibena Women’s Association supports orphans and vulnerable children, many made vulnerable by the death of parents from HIV-AIDS. The Kibena Youth Fellowship does outreach and builds awareness on HIV issues with young people and villagers around Njombe, mostly through the efforts of its very fine choir.

Lucie and Micah will be sending occasional updates and reports that will be published here from time to time, starting today:

Hi everyone

Lucie and Micah.

Pearson Canada Supports Highlands Hope Nursing Consortium in Tanzania

Author Madeleine Buck Donates Royalties To Help In Fight Against HIV-AIDS

Montreal, Canada – April 21, 2009 – Pearson author Madeleine Buck, co-author of Fundamentals of Canadian Nursing: Concepts, Process, and Practice, 2nd ed., and an Assistant Director at the McGill School of Nursing, recently announced that she would donate her share of royalties from the textbook to the Highland Hopes Nursing Consortium in Tanzania, which works with HIV-AIDS patients in that country.

Pearson Canada, which sponsored a speaker event in Montreal for nurses from the Consortium, is donating copies of Buck’s textbook to the organization. Visiting nurses included Highland Hopes Chair Evangelista Kayombo and Coordinator Betty Liduke.

Highlands Hope of Tanzania and the McGill School of Nursing will create a Center of Excellence for Best Nursing Practices in Rural Africa at TANWAT Company Hospital, a McGill clinical teaching site in Njombe, Tanzania. The partnership is also developing training resources for Highlands Hope nurses, including basic computer skills and pain management techniques for resource-limited health care systems.

“Pearson has a deep commitment to supporting projects in our own community and communities around the world that make a difference in people’s lives,” said Steve O’Hearn, President of Pearson Higher Education Canada. “We’re glad to support the generosity of our nursing author Madeline Buck and the important work of the Highland Hopes Nursing Consortium in Tanzania.”

About Pearson Canada
Through our Higher Education, School, and Penguin divisions, Pearson Canada distributes and publishes acclaimed fiction and nonfiction as well as leading educational resources in print and digital formats across the full Canadian curriculum. We are proud to publish bestselling and renowned Canadian authors in literature and children’s books, computers and business, as well as elementary, secondary and postsecondary education. Our innovative digital products, ranging from multimedia learning applications to interactive media, have made us leaders in value-added technology. For more information, visit http://www.pearsoncanada.ca/index.html

Contact:
Rod Granger
Pearson
212-641-6114
rod.granger@pearson.com

Betty and Evangelista will meet with nursing students and faculty at the School of Nursing of McGill University as well as making presentations to a number of donor partners including St. George’s School and St Lambert United Church.

They will also travel to Bishop’s University in Lennoxville to meet with two student interns who will be working with children and youth in Njombe this summer, thanks to a grant from TD Meloche-Monnex.

Notice of a presentation by Betty Liduke at McGill University can be found at:

http://www.mcgill.ca/channels/events/item/?item_id=105613

Finn’s Facts: End the monopoly of Becton Dickinson at Ministry of Health

FINNIGAN WA SIMBEYE
DAR ES SALAAM

VENERANDA Sanga, an orphan who lived with HIV/AIDS from Bulongwa in Makete District in Iringa Region succumbed to death last February. According to medical doctors at Bulongwa Lutheran Hospital where the girl was being treated, she died from opportunistic infections resulting from her deteriorating CD4 count which could not be detected on time.

Activists from ’Pima Ili Uishi kwa Matumaini� blame Veneranda’s death on poor treatment and care services being offered at BLH and specifically lack of effective CD4 counting machines as Becton Dickinson’s FACSCount machine maintains its monopoly of the local market.

I last visited BLH last year when I found out that the hospital had two non-functioning BD FACSCount machines, one of which had broken down while the other was brand new and the American company’s exclusive agent in the country, Dar es Salaam based Biocare Health Products Limited was yet to fix it.

I talked and witnessed how people living with HIV/AIDS were failing to get an update of their CD4 count due to lack of functioning machines. Makete District Hospital which had one functioning BD FACSCount machine was rendering services on a weekly basis to BLH’s patients.

Several people living with HIV/AIDS I talked to told me they had gone for over six months without an update of their CD4 count. Veneranda could have been saved if PIUMA’s CD4 count services with a German made Cyflow machine which were suspended from BLH several years ago were still in place.

The Cyflow CD4 Counter was allegedly ordered off BLH when PIUMA activists questioned loss of millions of shillings from Evangelical Lutheran Church in Tanzania’s southern and central diocese coffers meant to assist HIV/AIDS activities in the country worst hit district by the virus.

Experts blame Veneranda’s death on BD FACSCount Counters’ failure to detect deteriorating CD4 count in infants hence expose them to risks of getting opportunistic infections and possibly death. The sad story is that some officials at Ministry of Health and Social Welfare have crafted an unholy alliance with BD’s local agent, BHPL’s owner, Bharat Rajani.

The relationship between Rajani and some senior MoHSW officials were described by former Chief Government Chemist, Dr Salum Madati, as questionable. These learned health experts at MoHSW who have used their knowledge and expertise to sabotage other imported technologies such as Cyflow not to be used in the country’s public health centres, are comfortably relieved when they hear death of innocent children like Veneranda.

With a new Permanent Secretary in Blandina Nyoni at MoHSW, hopes are high that sanity will finally reign at this sensitive ministry being led by one of the country’s most distinguished medial doctors, Professor David Mwakyusa.

The monopoly which BD and BHPL are maintaining in the country’s health sector particularly in the area of HIV/AIDS is not a normal thing and it needs to be probed by Fair Competition Commission and Prevention and Combating of Corruption Bureau (PCCB).

Last week, the government of Venezuela’s anti-monopoly unit imposed a fine of $ 1.6m on the local unit of Becton Dickinson and Co. for abusing its position in the Venezuelan market. The International Herald Tribune reported that the office for the promotion and protection of free competition, Pro-Competencia, said Becton Dickinson Venezuela had refused to sell to its local authorized distributor, Inmunolab Lab C.A., chemical reagents used in its medical testing kits for HIV and AIDS patients.

The report said since the US Company controlled a 100- per cent local market share for the FACSCount diagnostic systems used in the treatment of AIDS in Venezuela, the move by the US company put the local patients at risk.

Indeed in Tanzania and as can be testified by Veneranda’s death, BD’s monopoly is putting tens of thousands of Tanzanians living with HIV/AIDS at risk because apart from delicate use of FACSCount machines, its reagents are also becoming more expensive and rare.

Authorities at MoHSW should urgently address this issue of giving BD monopoly of supplying CD4 counting machines and reagents which is causing unnecessary death of toddlers such as Veneranda Sanga. We must borrow a leaf from Venezuela’s anti-monopoly unit and end FACSCount exclusivity by allowing competing technologies to be purchased and used by public health centres.

During their visit, the Highlands Hope representatives will plan for next steps with the School of Nursing at McGill University for the extension of a partnership that has already seen five representatives of the School work in Tanzania including two McGill Nurses for Highlands Hope Fellows and two students from the School’s Global Health MSc program.

Evangelista and Betty will also visit Bishop’s University in Sherbrooke and meet two student interns who will be traveling to Njombe in May to work with orphans and vulnerable children and youth organizations affiliated with Highlands Hope of Tanzania.

While in Canada, the representatives will revisit long-time funding partners at St. George’s School in Westmount and at St. Lambert United Church.

Veneranda Sanga (2005)

For more reporting (in Kiswahili) and photos, visit http://www.piuma-simba.org/site/

3:22 a.m. (EDT) I talked to Juma this morning and he sai yesterday night had a meeting with the oprhanage administration on bringing the body home, previously i had advised Juma to bring the body to the Oprhanage and then leave all the arrangement of the burial in the hands of the BLH/Oprhanage and PIUMA should attend the burial lik a close realatives to Ven. Juma told me that the Oprhanage admin did not agree with this idea and they have asked PIUMA to tke reposnsibilities of transporting the body and the burial. It has been very difficult for Juma he had been in this meeting to very late in the night.

The Orphanage will send some staff to represent them in the burial, I think may be some older children would like to be there. She was very loved by children in the centre.

The teachers and student from the Bulongwa secondary school are in Iniho already. Wema and Herode are in Iniho already, Juma, Anna, Witness are in Ikonda, Anna was with her in the hospital when she died she spent a night there. PIUMA members who are living in Iniho village has yesterday promised to show their support to Veneranda by attending the burial.

Bernard and friends in Ilolo are arranging themselves on the road to wait for Juma may be they will match with the body to Iniho.

It is real a sad moment. jm

5:15 a.m. (EDT) Juma says that they are approaching Bulongwa now on their way to Iniho. Pillar and some of them as jackson said are waiting by the side road to join Veneranda’s journey to her resting place. vn

7:49 a.m. (EDT) Juma called to say that they are in church for the mass. When they arrived with Veneranda, the coffin was being made and the grave was being dug. He says a lot of people are attending the funeral in tears. My heart goes out to PIUMA. They must be very distraught. vn

1:30 p.m. (EDT) I have just spoken to Witness and Wema this evening. Juma is understandably knuckled. He is resting.

This is what they told me: Veneranda has finally been laid at her final resting place in Iniho. There were more than 200 people at the funeral. This shows how her life touched hundreds in and out of Makete.

At 1930 hrs they arrived in Lupaso from Iniho and were still in the office comforting one another before going to their respective homes.

Many PIUMA members who could be reached by phone attended the funeral, the majority from Iniho. As the vehicle that carried her body approached areas where some of the members live, some locals expressed their condolences and others joined in on foot escorting Veneranda on her last journey home.

From the orphanage the Head, assistant head and 2 carers were accompanied by four older children from Mwakauta Secondary School to the funeral. They went with the center’s vehicle which also carried the Lutheran Pastor of the Diocese. The Yatima Center donated 20 kilos of rice, 5kg of sugar, 5 packets of salt and a burial cloth.

Veneranda’s Bulongwa Secondary sent to the funeral about 50 students, 5 teachers and two cooks in a hired vehicle to pay their last respect. It was devastating for all of them. She was very popular! Students helped Iniho village leadership in digging the grave. The school donated 20 kg of rice, 5kg of sugar, 20kg of beans, cooking oil and a burial cloth.

Apart from the vehicle that carried Veneranda two more hired vehicles ferried people and food stuff to Iniho.

Sister Anne was informed about Veneranda’s demise last night. She said, “Pole”.

No representative from BLH and Bulongwa local authority.

PIUMA also got a burial cloth for their youngest member in the group. All three pieces were used to cover after she was dressed up in one of her favourite attires.

Witness said that Veneranda’s death has reminded PIUMA about the importance of having their own dispensary. It has made them even more determined than ever to do whatever is in their power including spending more time on voluntary work to speed up the completion of the building. “She died because she was late in getting the much needed treatment,” Witness said. “If we had our own dispensary Veneranda could have been with us today.” vn

For an earlier report on Veneranda, see http://www.highlandshope.com/2005/12/11/veneranda-a-16-year-olds-life-history-experiences-difficulties-and-dreams-2

Veneranda is not another statistic!

28th February may be last day of the second month of year 2009! But regrettably, it is also the last day of Veneranda Sanga’s life, who since her childhood had been battling with the virus that causes AIDS. She passed away today at 1930 hrs in Ikonda Roman Catholic Mission Hospital while undergoing further tests to ascertain the illness that had weakened the once very energetic teenager. May her soul rest in eternal peace! Amen.

It is hard to believe that I will not see that happy, tough, caring and ever smiling girl whose short life had touched many in Bulongwa, the village where she lived and Makete District in general, in the Southern Highlands of Tanzania. The area is one of the districts in the country with the highest rate of HIV prevalence at 20% and the highest number of orphans (at 20,000 out of a population of 105,000) whose parents died of the scourge.

Veneranda did not behave like an orphan at all! She was always happy and ready to help other orphans and even adults who she thought needed assistance more than her. When in 2005 I met her for the first time at the Bulongwa Hospital orphanage, I could not believe that she was one of children who had HIV. She was bubbly and full of vigour and laughter and she would go round the dormitories reminding other children to take their medicine.

She carried and looked after the youngest orphans as if she were an adult. She did some chores in the premises without being asked to do so. She was the first to wake up and the last child to go to bed ensuring that everyone was safely tucked in bed. That is the Veneranda I know!

It is very difficult for me to speak of her in the past tense.

The little girl from Iniho village who taught many in the area and further afield patience, resilience, tolerance and showed love and care for every human being is NO MORE!

As the youngest PIUMA member (a Bulongwa-based self help group of People Living With HIV and AIDS), she joined the rest of the group on the grounds of Tandala Teachers’ College to ask Honourable Jakaya Kikwete who was campaigning for presidency to ensure that they get proper treatment and care. He promised to bring about changes and better life for every Tanzanian. Mr. Kikwete put on Veneranda a reassuring hand in a special photograph showing that if he came to power, he will make sure that PLWHAs get access to VCTs, CTCs and all medical services needed to treat them.

He promised to work with everybody from in and out of Tanzania to save the lives of his people because there is NO NEED TO DIE just because one has contracted the AIDS virus. That was on 2nd December 2005 a day after a German company PARTEC donated to PIUMA a machine that has the ability to determine CD4 percentage of children (an essential therapeutic test); a day after PIUMA was officially inaugurated by Dr. Kapinga the then Makete District Commissioner. He also promised to work with PLWHAs to ensure that people like Veneranda do not need to die because of lack of treatment and care! 12 days later the country went to the polls to elect their lawmakers and president. On December 17th 2005 Mr. Kikwete was declared the winner of the presidential race by more than 80%. His party, Chama Cha Mapinduzi – CCM also won by more than 80% of the votes. On December 21st 2005 the CCM presidential candidate became the youngest and 4th Head of State of Tanzania.

Veneranda and all the PLWHAs in Bulongwa had their eyes directed to Dar es Salaam’s State House, hoping that their health conditions would improve. A year later, after more than 270 million Tanzanian shillings from Global Funds was embezzled from the district coffers and the culprits went unpunished, and after more than 270 million Tanzanian shillings was stolen from Bulongwa Lutheran Hospital (BLH) and again five members of the management team went scot-free the HIV and AIDS clinic funded by Austrian EAWM was closed and its machines, including liver function machine were confiscated, its staff harassed and patients denied the right to be treated. Why? Simply because Veneranda and her PLWHA brothers and sisters in the war against HIV and AIDS and for justice and human rights had registered their protest against the thieves and corrupt system! Simply because they demanded accountability from the powers-that be!

PLWHAs like Veneranda in Bulongwa had nowhere to go for treatment and although they had ARVs, adherence and regular check-ups were problematic. BLH got another machine which does not determine the CD4 percentage for children. The clinic also did not have liver-function machines. So Veneranda and other PLWHAs were not properly treated. The machine does not work and so HIV blood tests had to be sent to Ikonda or Makete and TANWAT hospitals miles away. BLH does not provide transport for its patients because there is no ambulance. When bidding the foreign medical staff goodbye after the 12th April 2006 lockout, Veneranda told one of her doctors, “Please do not go, because without you I will die!” The doctor reassured her that she will not die because of HIV if she got proper treatment and care! Did she predict her death? Was she being realistic knowing that the management and the government of Tanzania and politicians would not deliver their promises?

More than 45 people with the virus died in a period of one year and more continue to die in Bulongwa because of lack of proper treatment and care following the closure and expulsion from the hospital of qualified medical staff including foreign medical volunteers. Where are the promises that President Jakaya Kikwete made to Veneranda and other PLHWAs? What will he and the ruling party CCM tell Makete PLWHAs when election campaigns start all over again before the 2010 general elections?

Mr. President and First Lady Salma Kikwete on 14th July 2007 set a good example in the war against HIV and AIDS by being the first to be counseled and tested. It was the beginning of the campaign titled, “ Tanzania without HIV and AIDS is Possible!” The Minister for Health and Social Welfare, Prof. David Homeli Mwakyusa told Tanzanians on February 27th 2008 that the response to voluntary testing is now picking up as a result of the campaign of the same launched by the president. That was less than 24 hours before she lost the battle to the unnecessary death. From her deep sleep, Veneranda and many who have lost their lives not to the virus but because of corruption, lack of proper treatment and care would surely ask you “what is the point of testing and knowing your HIV status if in the remote areas of Tanzania you cannot get the right medication?” How will they be better treated if they do not know their CD4 Count? Veneranda was born with the infection and lived her short life with ARVs and there was no reason for her to die today!

Where is the Makete CCM Member of parliament Hon. Dr. Binilith Mahenge who promised to improve the health services among many other things for his voters? Where is Honorable Lediana Mafuru Mng’ong’o, Member of Parliament who hails from Makete and who is a member of a parliamentary committee dealing with HIV and AIDS issues? Where is the Evangelical Lutheran Church of Tanzania - ELCT and the South-Central Diocese - SCD of Makete which claim to care for the poor, the needy, the sick and the dying? Do they know the qualifications of the medical team they have employed at the Bulongwa Lutheran Hospital ?

When Veneranda fell ill last year while in her second year at a secondary school, she was taken to Bulongwa Lutheran Hospital . Her condition did not improve. Attempts to save her life took her on a hired vehicle to Ikonda Hospital . And now that sweet, ever smiling and caring young girl is gone!

Veneranda is one of many people living with HIV and AIDS in Tanzania who did not have to die! How many more Venerandas should continue to suffer and die as a result of corruption and lack of political will to save lives of PLWHAs? When will the Ministry of Health realize that some HIV and AIDS kits are not suitable for rural Tanzania and also are not children-friendly? When will the authority realize that Voluntary Counseling and Testing is meaningless if not followed up by proper treatment and care including regular check-ups of CD4 percentage?

The authorities have failed Veneranda and many others who were not supposed to die!

The passing on of Veneranda should be a wakeup call for the Ministry of Health and the government in general to improve their HIV and AIDS clinics in rural Tanzania equipping them with machines that work and competent and qualified medical teams. Lost in her deep sleep, Veneranda’s message to President Jakaya Kikwete, his government and parliamentarians is “ Tanzania without HIV and AIDS is IMPOSSIBLE if the above are not implemented!”

Do not allow Veneranda become another statistics, Mr. President! Remember the reassuring hand on her shoulder in December 2005 during CCM election campaign!

Veneranda, you have not died in vain! Rest in eternal peace our little friend, the fighter, the carer, the guardian angel and the symbol of hope! Amen.

Vicky Ntetema
Bureau Chief

Femina HIP partners with other organization and goverments as well as individuals. Over the years, many individuals have collaborated with Femina HIP in the quest to reach out to communities with quality information about HIV/AIDS and healthy lifestyles.

Highlands Hope of Tanzania Founder and Coordinator Betty Liduke helped Femina HIP start Simchezo magazine which has become a very popular source of information in Tanzania. Since 2002, Betty has written a regular column for the publication providing advice about intelligent life choices, including issues of reproductive health and information about HIV-AIDS.

On February 21, Femina celebrated its tenth anniversary at a gala in Dar es Salaam. Betty Liduke was honored at the celebration with an Outanding Achievement Award.

We join her colleagues in Tanzania in congratulating Betty on her richly deserved recognition!

Betty Liduke at a village gathering near Njombe

McGill Nurses for Highlands Hope* - 2008 Fellowship Presentations

Jacqueline Bocking, M.Sc.(A) C

Understanding adherence to antiretroviral therapy for HIV/AIDS in rural Tanzania : Client and provider perspectives

&

Andra Leimanis, M.Sc.(A) C

The Exploration of home-based care in Njombe , Tanzania

February 11, 2009
16:45 - 18:15

Wendy Patrick Room, First Floor, Wilson Hall
School of Nursing - McGill University
3506 University
Montreal, Quebec

For further information about McGill Nurses for Highlands Hope*

Visit http://www.mcgill.ca/nursing/about/mnhh/

Or contact Madeleine Buck , N. M.Sc.
School of Nursing , McGill University
514-398-4155; madeleine.buck@mcgill.ca

* Founded in 2006 to foster collaboration and development of nursing education and practice relationships across continents as well as provide instrumental resources to support sustainable Nursing projects originating from the Tanzanian Highlands Hope Nurse-Counselor Network.

We would like to convey our greetings to you all, as we hope your getting fine. we wish you happy for new year.
Here is a report of 9/12/2008 which was held at the above mentioned dates.

HIGHLANDS HOPE TANZANIA
NURSE’S COUNSELOR MEETING 09TH DECEMBER 2008

PARTICIPANT’S MANES

No Name Title Facility
1 Evangelista Kayombo Counselor TANWAT
2 Evelina Madunda Counselor Ikonda
3 Betiseba B. Liduke Counselor TANWAT
4 Tasilo B. Mdamu Counselor Njombe Gov. Hospital
5 Onolina Mahenge counselor Ikonda
6 Jacqueline Bocking McGil Nursig Student McGil Nursig School
7 Andra Leimanis McGil Nursig Student McGil Nursig School
8 Beltina Mbilinyi Counselor Ikonda

9 Leonia Samlongo Counselor Ikonda
10 Sixbelta Manga Counselor Ikonda
11 Potania Mfuse Counsellor Ikonda

AGENDA
 Opening
 Reading past minute
 Issues rose from past minute
 Research presentation
 Other issues
 Closing

1st Agenda: Opening

A chair person of HHP opened the meeting by greeting members of the HHP with thanks for their attendance which was followed with self introduction, and then it followed with others to new comers who came from Bulongwa. But before opening the chair person reported the death of Annahilda Mtega who was among of HHP member, also informed that some of members attended a burial sermon which was done at Lugarawa - Ludewa

2nd Reading past minute

The HHP secretary read the past minutes followed asking the members about the minutes if was as how it is. The members of HHP agreed it.

3rd Issues rose from past minute

Computer training not yet to three HHP members, the problem is lack of a teacher who can complete the left programme, wile those who not yet to start they have arranged with a teacher to teach them. But we want to put extra efforts to make sure that we gate teachers to teach them. Also members were encouraged to engage with secondary subjects.
Annual contribution;

We discussed about annual contribution, for the sack of raising HHP basket Fund. This will be decided at the next meeting after reading the constitution. Also there will be a modification of some areas of the constitution to make open to every HHP member.

Topic of a day
PMTCT counseling.
The topic of PMTCT counseling was agreed at the 13th/Sep/2008 that could be tough, but the presenter presented the introduction of general counseling, especial Eclectic method of counseling was introduced.
Andra and Jack presented their summary of their study which well detailed.
The topic of use of ARVs was not presented by Dr. V. Mponzi as he was not present.
Chair person requested the HHP members to arrange the next meeting, which will be 7/March/2009 at 9am.
After all of the above the chair person welcomed use at meal of saying good bye to students from Canada. The meeting was closed at 12.50 pm

The bicycle is an invaluable means of transportation for the PHEs. The distances between and within villages are vast taking anywhere from 30 minutes up to 1.5 hours in one direction to reach a village. The terrain is also challenging with steep hills, sandy roads & paths and tough weather conditions.

Upon arrival in the village, the PHEs would gather and meet with the village mayor for introductions, explain purpose of visiting, followed by the signing of the village guest book(left photo). We were warmly greeted into the homes of the clients either sitting inside a room or outside in a central courtgiven a small stool to sit on. All family members and caregivers were actively taking part in the discussion and sharing of information (right photo). The PHEs provide substantial psychosocial and spiritual support to clients and their families. They also monitor the condition of the clients, their medications and providing referrals to local dispensaries or hospital if the need arises. The PHEs provide education to the families and play a key role in the reduction of stigma related to HIV/AIDS.

A great deal of walking occurs between homes which provides an opportunity for the PHEs to talk amongst themselves and support eachother in their work. The commraderie between colleagues is admirable and certainly inspiring to witness(left photo). As is typical in a village life – everyone knows oneanother – and the PHEs are instrumental in “connecting” with the community, and inquiring about those villagers who have fallen ill and requiring support and care.

The PHEs also support clients who find themselves in impoverished situations with income generating ideas and solutions. A group of villagers have united to develop a business in growing and selling mini avocado plants (left photo).

At the end of a long day’s work we would eat at the local restaurant (a single small room with 1-2 tables). Food was always abundant consisting of ugali (corn maize), rice, beans, meat, and vegetable with a thirst quenching soda – Pepsi, Coca Cola or Fanta!

PIUTA support group for clients with HIV/AIDS is held every Sunday evening in Nyumbanitu Village. The meeting takes place at the CHAKUNIMU office (right photo). CHAKUNIMU plans to expand this service by developing support groups in each of the 6 villages. Promotion of this service was provided in all our home visits in whi

Jacquie Bocking, Betty Liduke (Director, TANWAT CTC and Coordinator of Highlands Hope of Tanzania), and Andra Leimanis

I thought it might be interesting for me to share about my work in the Care and Treatment Centre (CTC) at TANWAT. The CTC is the clinic for following patients who have tested positive for HIV through voluntary counseling and testing (VCT). The Tanzanian government trains CTC staff and provides the antiretroviral (ARV) medications that are dispensed free of charge to patients that are eligible.

The eligibility criteria in most parts of Africa is a CD4 count of less than 200, which is very low comparative to high income countries where many more people have access to ARVs. Once a patient starts antiretroviral therapy, they need to take this medicine every day for the rest of their life. If they stop the medication for a bit, the chance is high that the HIV virus will become resistant to one of the drugs, and this has huge public health implications particularly where HIV prevalence rates are high.

There is a lot of work involved in following patients who are taking medication for life. Lab tests must be run regularly to ensure that the medication isn’t harming the patient’s liver and also to ensure that the medication is being effective (ie. improving the patients immunological status). Many patients have side effects from medications or get other opportunistic infections. These are all aspects of the monthly follow-up sessions that the nurses do with patients.

A typical day at the CTC usually has 2-3 nurses staffing it and seeing 30-50 patients. Each patient will have a check-in meeting with a nurse, who will determine if the patient’s therapy is progressing as normal or if they are experiencing any other health issues and would need to see the doctor. In their CTC training, nurses are educated on common side effects and which medications should be prescribed to manage these. This makes the clinic fairly nurse independent, with most patients only being seen by the nurses. After this interview, they meet the dispensing nurse who provides the medications they are to take and also the teaching and adherence reinforcement.

One issue that I have seen is the amount of paperwork that the nurses have to fill out at the CTC. The antiretroviral medications are provided by the government and strictly regulated. When they are dispensed to a patient, the patient must sign in a register that they are receiving them and the nurse must countersign that they are dispensing. Each patient also goes into a register of patients (no matter whether they receive ARV drugs). At the end of the day, each patient’s visit is again tracked in registers that record the history of every patient. All of this paperwork thus far is by hand, and it is the nurses who complete it.

A new addition to the CTC is that the government now wants to track the patients using a computer database. So all of the patient charts are being entered into the computer. This is in addition to the paperwork that the nurses are already doing (which usually takes at least a couple of hours at the end of the clinic day). Some of the nurses have received computer training, however most have not. Even the nurses who have had basic computer training are not used to regularly using a computer and so the speed of entering patient visits into the computer is not very fast.

For an outside observer, it seems like an unfortunate use of the highly skilled nurses time when a few hours of every day is spent doing paperwork – in Canada, these activities would be completed by a data clerk. But is also a demonstration to me of the fact that even the best of ideas for how to help with the HIV epidemic are not necessarily easy to implement. There is a lot of capacity building that needs to go along with it. The addition of a computer tracking system is adding several hours of data entry to each CTC day, and with no additional training for the nurses who have to do this process. The benefit of the computer eventually is obvious – they will be able to see which patients are attending the clinic as they should be, which have not come for several months (thus lost to follow-up), as well as more detailed tracking such as which side effects are most common, etc. But when the nurses are already over-worked and spending many overtime hours at the CTC, it seems to me that the transition to using the computer is not going to be as hoped.

Another interesting CTC-related activity that I was fortunate enough to join Betty at this week is a meeting for 3 of the local CTCs (ie. three different hospitals in the area). At the meeting, the coordinators of respective CTCs shared information on how many clients they have registered and how many of these are “Lost to Follow-up”, meaning that they have not come to appointments for some months.

The meeting was a brainstorming session to figure out what can be done to fix the situation and prevent future problems with attendance. A fantastic part of the meeting is that it was not only clinicians –volunteer groups that follow patients in home-based care as well as some of the local groups of people living with HIV had also been invited to share their perspective on what some of the issues are. This provided an excellent forum for all of the real issues to surface.

Some examples that arose are of people choosing traditional medicines instead, as well as a problem with a particular church who has been telling patients that they can heal them through prayer and thus they should stop their medicine. The plan is that this group of clinicians and community representatives will now meet regularly every few months to try to improve the care that they are providing and ensure that adherence to ARVs is as high as possible.

On a more personal note, I am finding it difficult to believe that we have already been here for almost 2 months! We are feeling very comfortable working with the health care team at TANWAT and have been made to feel incredibly welcome here. We only have 6 weeks left to go with our school work here and I’m already starting to feel sad at the prospect of leaving our new friends. That’s yet another lesson for us with Global Health work.

Fortunately, we are encouraged to know that the link for TANWAT with McGill is a strong one and that more students will be coming to learn from the nurses here.

Sincerely,

Jacquie

Home-Based Care with Peer Health Educators:
Report from the Villages

Who is CHAKUNIMU?

CHAKUNIMU is a group of Peer Health Educators (PHEs) who are actively involved in caring for their sick villagers through home-based care (HBC) and the promotion of HIV/AIDS education and prevention. The group was founded by nurse Betty Liduke at the end of 2004 with 63 PHEs in total and 20 PHEs providing HBC in the 6 villages surrounding the Tanganyika Wattle Company (Tanwat).

This grass-roots organization is very dedicated to their work as volunteers during their time-off from working in the fields cultivating crops and selling their produce. Since April of this year, “PIUTA”, a support group for persons living with HIV/AIDS has been started in Nyumbanitu village with 12 members meeting every Sunday. They are also promoting the start of similar new support groups in each of the other villages as well.

A Typical Day

As part of my student project I am spending my weekends working along-side the PHEs to observe and support the current practice of HBC in these rural villages. The overall purpose is to see what home-based activities are occurring in this region and to identify the challenges and strengths of this work to help the PHEs in developing and strengthening their capacity to provide care and support to the chronically ill at home.

Typically we arrive in one of the neighbouring villages in the morning after a bicycle ride from Nyumbanitu to be greeted by the village major/chairman, we introduce ourselves, explain our purpose for visiting, and sign a guestbook. Our home visits are spread out during the entire day with each home visit lasting on average 20-30 minutes.

The distances between homes can be quite large as we leisurely walk on little paths through forests, corn fields, across streams, through gardens, up and down many hills. We take a break at some point in the day to either eat a snack called “Mandaaz”(a big doughnut), drink sodas or eat a complete meal at a small restaurant or at the home of one of the PHEs.

“Wagonjwa” – The Sick Individuals

I have spent six full days working with the PHEs up to this point. We visited with 18 patients in Nyumbanitu village September 20th-21st, 16 home visits in Mlevela village October 4th-5th, and 14 home visits in Itulike village October 6th and 7th.

I work very closely in particular with three of the administrative leaders of CHAKUNIMU, Laurence, Amon and Vumilia, who visit a different village every weekend together with the local PHEs from that specific village.

The diseases/illnesses that I have been seeing are primarily chronic conditions such as HIV, cancers, arthritis, diabetes, tuberculosis in the past, and many respiratory complaints. One of the most frequent complaints is a cough, often a result of smoky home environments from cooking on fires in small enclosed rooms.

Long-term paralysis or weakness on one side of the body is another common problem occurring as a result of accidents, falls, and in one instance a snake bite. We also visit orphan-run homes, where the eldest teenage child is caring for five to six younger siblings since the passing of their parents from AIDS.

A large number of the villagers are HIV+, taking antiretroviral therapy and attending CTCs (care and treatment centres) on a monthly or bimonthly basis.

On a Personal Note

The work I have been doing with the PHEs has been very interesting but at times challenging to see the reality of some of these villagers with limited money for medicines and resources, and family losses due to untimely deaths. Other challenges for me have included language comprehension as all communication is in Swahili with additional greetings in the local language of Kibena.

My basic Swahili ability is growing “pole pole” (slowly) with a dictionary and phrase book always at hand! The PHEs have been very eager to learn English as I am to learn Swahili, so we teach one another new phrases and words as we walk and talk throughout the day. I have been warmly welcomed into the household of Vumilia (a 25 year-old PHE) with her 5 younger siblings, her parents and all their extended family in the village.

We eat dinner by lantern light, eating traditional ugali (maize) or rice, beans, vegetables, boiled and sweetened milk from their cow, and meat from a freshly plucked chicken. I have helped to fetch water from the nearby stream, but have not yet learned the graceful skill of carrying the bucket on my head as all the women do here!

I have attended Lutheran church services where I have been deeply moved by the beautiful voices singing hymns and have visited a family in mourning over a loss of their one-year old infant to malaria.

The sense of community and family togetherness is very palpable in this setting, where everyone greets one another passing by on the streets, by homes and workers in the fields. The sincerity of the villagers is very special especially the smiles and laughter of the children, and the young infants bundled in a traditional African cloth on their mothers’ backs.

Words of Gratitude

The PHEs have asked me to express their gratitude for the instrumental support from Royal Orr in Montreal, Canada who has helped to fund the cost of a bicycle for CHAKUNIMU. They now have a total of two bicycles which permits them to travel some distances along roads and paths to gain access to neighbouring villages.

Hello again from Njombe,

We have now been in Tanzania for one month. We are really enjoying working with the nurses at the hospital – every day we spend there we are learning about different ways of doing things, new conditions that we don’t see in Canada, and some of the challenges that our patients are facing.

We have seen a lot of malaria, respiratory infections (especially in young children), and meningitis, which is often a complication of HIV. We have also seen how the issues of cardiovascular health, which are so common in Canada, are also a burden in this setting too – managing hypertension and congestive heart failure is also something that we have seen here.

One of the most interesting learning experiences for us in the hospital is learning how to document our Nursing Care Plan the Tanzanian way. This is something that often varies between hospitals in Canada, however in Tanzania there is a structured format that the nurses learn to track teaching goals, discharge planning, and other nursing interventions.

TANWAT had another visitor from McGill University for the past few weeks, a family doctor, Dr. Guylaine Proulx. Yesterday, Guylaine gave a workshop to the hospital employees on Neurological Complications of HIV/AIDS.

This workshop gave an excellent review of HIV and how antiretroviral therapy (ARV) works, and then explained some of the different issues patients may be facing either due to their illness or to ARVs. She presented to a large audience and hopefully this will be useful for the team, especially to the nurses who are the firstline care for patients at the TANWAT Care and Treatment Centre (CTC). Some of the most common complications can come from being on ARV: the NRTIs, a class of drug that includes one of the medications that is used in the firstline treatment here in Tanzania, are the usual culprit.

The nurses at the CTC are finding that they are facing more and more neurological complications as they can appear from 1-6 months after starting ARVs. The TANWAT CTC has had ARVs available since 2006. Lactic acidosis is another neurological problem that may be occurring more frequently as it occurs after longterm use of the ARV treatment that most of the TANWAT clients are on, which is the firstline treatment provided free by the Tanzanian government.

It is important for the nurses to have the ability to recognize these complications so that they are able to refer their clients for possible changes in the ARV regimen.

More stories will follow soon as our projects are starting to get moving!

Jacquie and Andra

Andra Leimanis and Dr. Jocelyne Proulx from McGill University with Betty Liduke and the peer educator team in Nyumbanitu

Hello from Tanzania!

Andra and I have now been in Njombe, in southern Tanzania, East Africa, for two weeks. After flying into Dar es Salaam on Sept 1st, we left the next morning to get to Njombe by bus - the Dar es salaam bus station is madness in the morning; most of the bus journeys are very long distances and so have to leave very early in the morning. Our bus ride took 10 hours to get to Njombe and most of the passengers were still continuing on for another few hours to Songea.

We arrived in Njombe in the evening of Sept. 2nd. We have been put up in a house all our own that the company (in whom’s hospital we are working) keeps for longterm visitors. The house is about 200 m from the main guesthouse (the main guesthouse is where people normally stay for 1-2 weeks); our home is very spacious with 2 bedrooms, living room with fireplace…and a beautiful garden to walk through every day! We eat our meals at the main guesthouse, and so far we have already been through 3 other groups of guests that have spent some time there. Having our own house is working well for us as it gives us a quiet space for some downtime at the end of the day.

The first week was a lot of orienting ourselves to a rural town in southwestern Tanzania. Our placement is in a small, company-owned hospital, which sees mostly its own employees (they get free healthcare) and other private patients who pay. There is a government supported HIV/AIDS Care and Treatment Centre here also, which provides free services to any patients in the area with HIV (it is much busier than the hospital itself). While we are here, we are doing a placement in the hospital ~ 2 days/week, we are doing our clinical projects with the healthcare team here (both associated with the Care and Treatment Centre), and we also have another course that we are doing via internet with our classmates back home.

We are already finding the experience extremely interesting. We have spent 5 days in the hospital by now and we’re overwhelmed with 1) the severity of some of the morbidity in the patients and 2) how much more Kiswahili we need to learn if we are going to be able to communicate with our patients. Most of the patients here actually speak Kibena as their first language, and then Swahili. We have yet to meet any that speak English. We had been doing Kiswahili classes for several months before we left Canada and they are certainly helping, however it is definitely very different when you are immersed in a language! We have already caught on a lot so far, but there is much more for us to learn.

This past weekend is probably the most exciting activities that we’ve had so far. On Saturday we visited another hospital for a meeting of nurses who work at the HIV/AIDS clinics.. the nurse counselors at several hospitals in the area formed the group Highlands Hope of Tanzania a few years ago and they have meetings every 3 months to share ideas, successes and challenges that they face in their work. This meeting one of the counselors was presenting some research that he had done with mothers who had tested HIV+ prenatally and had been referred to the Care and Treatment Centre for followup.. he had explored with those who had been referred why they chose either to go or not to go to the CTC. The day was busy, as we had a 2.5 hr drive to the hospital, and then the meeting, and then back 2.5 hrs the same day, on dusty, bumpy dirt roads winding through mountains. Then on Sunday we drove with our project supervisor, Betty, to a local village where Peer Health Educators from the TANWAT Care and Treatment Centre were doing HIV/AIDS awareness raising. It was a whole day event, with dancing, singing, and a meal at the end. We also had guests in our group from an HIV/AIDS focused Tanzanian magazine, SiMchezo, who had clothing to give as prizes to participants in the day.. overall, a great adventure. Pictures from both of these outings are on the website link.

So, that’s the start of things here. I think I can say that we have mostly settled in and are now trying to focus more on our projects and clinical work at the hospital. I’ll send along another update in a few more weeks. Until then, I hope that all is well in Canada.

Kwaherini!

Jacquie

HIGHLANDS HOPE TANZANIA
NURSE-COUNSELOR MEETING 13th September 2008

PARTICIPANTS’ NAMES
No Name Title Facility

1 Evangelista Kayombo Counselor TANWAT
2 Evelina Madunda Counselor Ikonda
3 Maria Mahenge Counselor Ikonda
4 Rose Msigala Counselor Ikonda
5 Maurisia Msigwa Counselor Ikonda
6 Betiseba B. Liduke Counselor TANWAT
7 Stella B. Kilovele Clinician Ikonda
8 Aidani A. Mkalawa N/O Ikonda
9 Tasilo B. Mdamu Counselor Njombe G. Hospital
10 Onolina Mahenge counselor Ikonda
11 Jacqueline Bocking McGil Nursig Student McGil Nursig School
12 Andra Leimanis McGil Nursig Student McGil Nursig School

AGENDA
 Opening
 Reading past minute
 Issues rose from past minute
 Research presentation
 Other issues
 Closing

Our lord father prayer prayed before starting the meeting to bless us for the full participation during the meeting.
The meeting opened by the chair person at 11.25am by thanking participants for attending.

Reading of past minute
The acting secretary read the minute, the followed by corrections and additions from the participants, but generally the minute was agreed with a few corrections.

Issues rose from past minute
The teacher who was training computer has left and there is one programme not covered, that is Excel, also one counselor not yet to start the programme. Participants suggested another teacher to complete the programme while other counselors should continue with Secondary subjects as a foundation of being in a position of being accepted any where to work.
Research presentation
Chairperson informed the participants that “our fellow counselor who was at school has completed his studies and today he is going to present part of his research to us.

A research was presented that was titled Factors Contributing to low attendance of HIV positive Postinatal mother for CTC services in Makete District. Research was good because it revealed some issues that as we counselors do mistake to clients, through this research we are going to struggle on improving our services.

Other issues
After long discussion on the research chairperson told the participant on the need on having a refreshers courses concerning counseling as well as nursing practices. Participants discussed on it that it is good to keep counselors well informed and up to date with new information, but the problem is on the administration to allow them to join the courses. Other wise it was left to our hands for more discussion with administrators until next meeting.

Other issues
One participant who attended at the first time he appreciated on the way that we programme and improvement of our matters that improve the way of providing medical services to our patients, and he promised to join with HHP members.

Conclusion
Chairperson requested the participants to arrange the topics that will be learned at the next meeting, topics were selected; ARVS Drugs will be presented by AMO V. Mponzi and PMTCT counseling which will be presented by Betty Liduke. Also students from McGil University of Nursing Canada will have something to present which they will have after their stay here.

Next meeting will be held on 09 December 2008, then the meeting was closed at 1.25pm.

TANWAT Company Hospital is an official teaching site for McGill University. The students are pursuing study topics approved formally by the University as part of their degrees. The students are looking at issues involving drug compliance and home-based care with HIV-AIDS patients in rural Africa.

Andra and Jacquie will be working closely with Betty Liduke and other members of Highlands Hope.

Through a complex series of political, business, and research maneuvers (many of them demonstrably corrupt), a competing technology provider has managed to get Cyflow counters banned in Tanzania. This despite the fact that Cyflows contine to provide excellent care at the TANWAT and Ikonda Hospitals. In fact, Cylfow systems work dependably for thousands of local patients while the competing technology lies broken down and idle in other hospitals in the area.

This issues has received considerable attention by local and international media, but the problem remians unresolved. Suspicions run high that fears of corruption investigation and criminal proceedings now block reasonable resolution of the problem.

Abstract Preview - Step 3/4

Text: The demand for easy-to-use, accurate and affordable cell counting devices performing precise
determinations of CD4+ T cell concentration for adult patients and CD4+ T cell percentages
among lymphocytes (CD4%) for pediatric patients within HIV monitoring and AIDS patient followup
is rapidly increasing. Many countries especially in Africa, Asia and Latin America have started
to significantly scale up the national treatment programs for HIV/AIDS patients. CyFlow Counter
and CyFlow SL instruments have been designed for securing efficient and cost-saving operation
even under very difficult environmental and infrastructural conditions and are therefore well suited
also for use in rural areas and resource-poor settings far away from central laboratories. Since
2002, already 800 CyFlow CD4 counting devices have been successfully implemented in Africa
and Asia, covering more than 500,000 patients at cost of approximately USD 2 per test, while
using previously introduced techniques in such countries showed average test cost of USD 40
(WHO, 2002). India has an estimated population of 1.1 billion and 2,470,000 people living with
HIV - the prevalence rate is 0.36% (UNGASS Country Progress Report 2008). The National AIDS
Control Organization (NACO) under the government of India and in cooperation with the United
Nations Office for Project Services (UNOPS) has recently procured 67 CyFlow Counter
instruments for supporting the nationwide HIV monitoring program. A key issue for laboratory
instrumentation is the internal and external quality control and quality assessment which should be
performed regularly and documented well. The cost (labour and material) should be kept at a
possible minimum. It is shown that QC/QA can be performed highly economical for the CyFlow
technique using precounted control material with approved concentration (Count Check Beads
green, Partec, Germany) and blood samples prepared for CD4 and CD4% counting using
dedicated IVD approved and CE marked reagent kits with monoclonal antibodies (CD4 easy count
kit and CD4% easy count kit, Partec, Germany). For the first time ever in flow cytometry, a QC/QA
program including an evaluation of the intermachine variation was run in parallel with such a large
quantity of instruments. Within only 4 days, all 67 CyFlow flow cytometers have been installed in
India and checked for their general performance and counting accuracy using first the same
approved lot of precounted control bead material and subsequently three different blood samples
stained in bulk for CD4 analysis. The coeffient of variation (CV) was 4.7% for CD4 absolute count
results and 3.3% for the control bead material on all 67 instruments. This result evidences a high
degree of reproducibility and standardization in flow cytometry as well as instrument manufacturing
which is especially important for considerations in context to the targeted large scale increase of
national treatment programs in the global fight against HIV/AIDS.

For some of us, like me, who are hailing from Makete particularly in villages around Bulongwa we know the situation is worse than what have been stated in Thisday. The reporter has not mentioned a number of patients who are not able to access treatment in the hospital following treatment costs, walking distance. We suppose that HIV/AIDS drugs (ARV) should be free, however the OI treatment is very expensive in Bulongwa Hospital . We all understand that what kills people is NOT AIDS it is the OI. So why should the government think don’t think on another simple alternative on the best way to help these people. The MoH subsidies salaries of some staff at BLH so as to bring the running cost down, yet the treatment is unaffordable. Usually the payroll is tempered and BLH has become like a private business.

PIUMA have applied to MoH to assist in distributing ARV through its Mobile clinic, MoHSW promised to send experts to asses PIUMA’s infrastructures, this discussion was held in 2006 (by official letters) it had never been in Place no the watalaam from the MoHSW have ever visited PIUMA. PIUMA is still waiting! When I walk in Villages, I see people dying in their huts and when asked why the reason one will get is either they are not able to walk to Bulongwa, or they don’t have money for traetment. Do we all need to have PhD to understand the relationship between Walking distance and access to treatment?

I know ever since the Cyflow Counters were replaced by MoH in the year 2006, hundreds of patients have not been tested their CD4, the problem have not stated only in February this year, since that Day when Professor Mwakyusa assured People of Bulongwa that he have solved the problem by replacing the machine. I am evry worried that even this machine at the District hospital that is said to be used to test the CD4 from Makete is real working for all the CD4s from the two big hospitals. Some times in the year 2007 this machine did not run for number of months as they did not have cleaning water.

I appreciate the work of people like Finigan, they show how are our expertise and people of learnt class of Tanzania always try to run for simple solution even though they know for sure the solutions will costs the life of the majority. Hundreds of people are dying in Bulongwa not because of HIV/AIDS or the associated OI, BUT they are dying from lack of proper treatment and proper care. I wonder if Professor Mwakyusa have ever been in Bulongwa or send any one to asses the situation ever since he was there with Hon. Lediana Mng’ong’o (representing TACAIDS) when bringing the FACS counter which we here to day is destroyed by rats?.

I thought Lediana would find time in her tight schedule visit her voters in Iringa especially Makete people and see how things are moving, sit with them, discuss and come up with a proper strategies, at the end she should see if the implementation is accordingly. She is the chair lady for the parliamentarian Committee for HIV/AIDS, why NOT? Being the chairperson of the very powerful committee, TACAIDS Commissioner now she has more power and chances to help Makete.

It is sad that HIV is afflicting the peasants in Makete, but those who are deciding how should these people be helped are in Dar Es Salaam, many of them had never been in Makete, they work from hear say. That is why we always end up hearing more fund raising to help orphans and HIV/AIDS work in Makete, of which most of the cash has never been transferred to Makete (Tsh.>52 Mil 2005). If they would have come to Makete and make an assessment they would understood what is needed is not fund raising, it is commitment, transparency and corrupt free responsible community including leadership.

It is Pity!

Jackson

Rats on the rampage: Destroy CD4 counter machine at Bulongwa HIV/AIDS clinic, forcing patients to walk all the way to Makete

FINNIGAN WA SIMBEYE
Makete

RATS are reported to have damaged a US-make CD4 counter machine used to analyze the progression of the HIV virus in people and determine whether they need anti-retroviral drugs at Bulongwa Lutheran Hospital in Makete District, Iringa Region.

According to the reports, the FacsCount machine has been wrecked since January this year after rats ate parts of the electric supply cables.

As a result of the crisis, all blood samples of people living with HIV and AIDS in the Bulongwa area are now being referred to the Makete District Hospital and Ikonda Roman Catholic Hospital.

Makete District Medical Officer Dr Joshua Kapande told THISDAY that the district hospital currently each week receives between 25 and 30 blood samples from Bulongwa Hospital for HIV/AIDS checks.

’’The CD4 counter machine at Bulongwa has been out of service since last January, and I try to assist by sending a motorcycle over there every Wednesday to collect blood samples of patients to do CD4 count here,’’ Dr Kapande told THISDAY in an interview here.

The Dar es Salaam-based Biocare Health Products Limited, sole local agent of Becton Dickinson company which manufactures the FacsCount CD4 counter machines, is understood to have supplied a new machine to the Bulongwa hospital earlier this month, but it has yet to be set up for operation.

’’Biocare technicians came here to fix the old machine, but deemed it impossible. So the company supplied a new machine earlier this month although the technicians are yet to fix it up,’’ said Makete District Laboratory Technician, China Mbilinyi.

However, Bulongwa Hospital administrator Edward Masevella had a different story to tell: ’’We have two brand-new, functioning FacsCount CD4 machines here the problem we have had is not having a qualified laboratory technician to run it.’’

Masevella said the hospital’s last qualified lab technician absconded from work earlier this year but both FacsCount machines, one supplied by the Ministry of Health and Social Welfare and the other by Kenyan-based charity organization Tunajali, are functioning properly.

While the Makete District Hospital is understood to have a functioning FacsCount machine supplied by Biocare Health Products along with the Bulongwa Hospital machine back in 2006, the Ikonda Hospital uses a German-make Cyflow CD4 counter machine.

When THISDAY visited the HIV clinic at Bulongwa last Wednesday, people had not undergone their regular CD4 count this year.

’’I was supposed to have my CD4 count examined last April but it wasn’t done because they said the machine is broken down,’’ said one male patient with identity card number 1102022000381.

His card indicates that his last CD4 count was done in February 2007, when his tally was 35. He is frail and has protruding cheeks.

A female patient found at the clinic, with card no. 11220013, said her last CD4 count observation was done in September last year, when she tallied 691.

’’I am finewith me the CD4 counting isn’t a big deal. I just need the medicine,’’ said the patient as she joined a lengthy queue of people living with HIV and AIDS currently on antiretrovirals.

With a population of just over 116,400, Makete District’s prevalence rate for HIV/AIDS currently stands at 16 per cent, according to available statistics. This makes it the district most affected by the AIDS scourge throughout the country.

Mwandishi wa habari Simbeye ambaye alikuja jana tarehe 27/8/2008 katika ofisi ya PIUMA saa 5:30 asubuhi akiwa ametokea DSM.

Mwandishi huyu alisema kuwa amekuja kujua historia fupi ya PIUMA.

Kwa bahati mbaya Katibu Wema Sanga hakufika ofisini, lakini alibahatika kuonana na baadhi ya wanachama kama, John Nyihava, Amini Pilla na Apolo Mbogela.

John Nyivaha alieleza kwa kifupi historia ya PIUMA, alisema kuwa PIUMA ilianzishwa mwaka 2005 ikiwa na wanachama 5, ambao ni Kabuyu Kyando ambaye ni Mwenyekiti wa PIUMA, Wema Sanga ambaye kwa sasa ni msaidizi wa Katibu Mkuu wa PIUMA, Bernadi Kyando, Herode Fungo, Rehema Nyamule.

Aliendelea kusema kuwa shughuli ambazo zinafanywa na PIUMA ni HBC, VCT , Mobile VCT, ushauri wa lishe kwa wanaotumia dawa za kupunguza makali ya VVU ,pamoja na kutoa ushauri juu ya magonjwa ya zinaa.

Mwandishi aliuza habari za HBC, VCT na Mobile VCT.

Juma Nzige (Mganga) alisema kuwa huduma za HBC zinafanywa na wanachama waPIUMA .

Aliendelea kusema kuwa Kituo cha VCT kilisimamishwa tangu mwezi waPili 2008 baada ya Nesi aliyekuwa anafanya kazi PIUMA mkataba wake kuisha .

Baada ya hapo viongozi wa PIUMA waliandika barua ya kuomba manesi kutoka Bulongwa Hospitali kwa ajili ya kuendelea kutusaidia kazi hii. BLH walitukubalia ombi letu na kutupa manesi wawili ambao walikuwa wanafanya kazi kwa kubadilishana, manesi hawa walifanya kazi kwa kipindi cha mwezi mmoja na nusu, ndipo tulipopata barua kutoka BLH ya kusitisha manesi wao kutoa huduma katika Kituo chetu na kusema kumekuwa na uhaba wa manesi katika Hospitali yao.

Hapo ndipo Uongozi wa Afya wa Wilaya ulipokuja kufunga kituo chetu na kusema kuwa kituo kitafunguliwa mpaka mtakapoajiri manesi wenu.

Baada ya hapo uongozi wa PIUMA uliwasilisha taarifa hii kwa wafadhili wao, ndipo wafadhili walipochukua jukumu la kuajiri Nesi Potania Mfuse na Mganga Juma Nzige.

Watumishi hawa waliwasili katika ofisi ya PIUMA na uongozi wa PIUMA uliwapeleka ngazi zote za serikali pamoja na uongozi wa Afya kwa ajili ya utambulisho.

Baada ya hapo Uongozi Afya wa Wilaya Makete ulisema kuwa PIUMA tunatakiwa kusajiri upya kituo cha VCT, viongozi wa PIUMA pamoja na wafadhili wao walifanya kazi hio na kufanikiwa kusajiri kituo.

Baada ya kurudi kutoka kusajiri kituo viongozi w PIUMA walienda kwa viongozi wa Afya wa Wilaya kupeleka ripoti ya kusajiri kituo, hapo ndipo viongozi hawa walipogundua kitu kingine, walisema kuwa wahudumu wetu hawajapitia mafunzo ya VCT COUNSELOR,” kweli hapo ndipo kazi ilipoanza”, Viongozi wa PIUMA hawakukata tamaa, waliwasiliana na wafadhili wao na kuwaeleza hili, wafadhili walikubaliana nalo na kuwaambia kuwa yafanyike mawasiliano ili kupata sehemu ya kuweza kupata mafunzo, mawasilano yalipofanyika mafunzo yalipatikana AMREF na kusema kuwa wanatakiwa kuanza mafunzo mwezi wa Nane.

Lakini cha kusikitisha ilipofika mwezi wa nane DACC wa Wilaya Makete alisema kuwa mafunzo yamesimamishwa kwa sababu AMREF wanapitia mwongozo wa mafunzo ili kuufanyia marekebisho. Tarehe itatangazwa upya ya kuanza mafunzo.

Hatukukata tamaa,Tuliendelea kuwafuatilia kila wiki, tulifanya hivyo mwezi mzima. tulipoenda kwa mara ya mwisho kuwaambia kuwa Wafadhili wameamua kuja kufunga kituo chao mwezi wa kumi, hapo ndipo waliposema kuwa watatuazima nesi ambaye tutakuwa tunafanya nae kazi, na nesi huyu tutatakiwa kumlipa kwa siku sh. 20,000/= kiasi ambacho kitaliathiri shirika pamoja na wafadhili wenyewe.

Baada ya hapo Mwandishi aliomba kukiona kituo chetu cha VCT.

Hapo ndipo walipoondoka na Juma kuelekea kwenye kituo cha VCT, huko walienda kuonana na Nesi Potania Mfuse.

Mwisho mwandishi alipewa Nakala ya Ripoti ya Mobile VCT tulivyopima mwaka jana.

Ni hayo tu.

Visit PIUMA’s website at www.piuma-simba.org

EDITORIAL: Govt commitment needed to revamp health sector

EDITOR
DAR ES SALAAM

IN Tanzania, like elsewhere in Africa, we have politicians and public officers who have the penchant to seek medical care in health institutions abroad while the nation’s health care delivery system is in a shambles.

It is regrettable and shameful that Tanzanians in high offices leave the shores of this country to seek medical treatment elsewhere using our public funds. It translates to their lack of commitment to the fundamental rights of Tanzanians to gain access to quality health care as enshrined in our Constitution.

When our high-ranking government officials fall sick, even from a single mosquito bite, they are rushed abroad because of their status. If a poor man collapses on a Dar es Salaam street from exhaustion because of harsh rays of the sun, will any body fly him to Berlin, Paris or London for treatment?

Our rulers have allowed the healthcare system in the country to deteriorate beyond imagination, offering nothing to Tanzanians. The politicians are only interested in filling their pockets and bank accounts without thinking about what the people are going through to make ends meet or their health
conditions.

The politicians and their families run abroad to treat fever because they have refused to do what they are supposed to do as regards improving the health care system.

It is a shame for Africa when some of our leaders die in foreign hospitals and return in caskets when they should have made the health care sector functional so that they couldn’t leave the shores of their countries for medical check-up in London or Johannesburg. We must reverse this ugly trend.

What we are saying is that African leaders have failed to upgrade, revitalize and revamp the health care sector, which is why the hospitals and clinics are all in a shambles.

All over the world, most individuals cannot afford to pay for their full health care services and for that of their families. You need an insurance policy, especially against very serious cases because they do occur and without money or insurance policy, the person will be in a precarious situation.

Lack of basic medical services has compelled Tanzanians to flock to those ’fake’ spiritual churches and prayer houses or to the herbalists dotting the country’s landscape for medical assistance and in the process, they are being duped.

Many of our leaders think they need not worry because they feel so rich they can get the highest level of medical care from Europe anytime they get ill. They forget that they have the manpower to establish the highest level of medical care right in their home.

The government has to take almost all the blame for the innumerable maladies facing our health care system. If the government provides the tools the doctors in Tanzania need for the practice of their profession, they will do just as well as their colleagues in developed countries. Give the doctors what they need to give Tanzanians the care they need and deserve. It isn’t impossible. We only need the will and commitment from the government.

To which we can only add, “Give the nurses what they need, as well.”
RO

President Jakaya Kikwete toured the new ward facilities at Ikonda Consolata Hospital in Ikonda earlier this week.

Pictured above is the President with hospital Director Fr. Alessandro Nava. Highlands Hope of Tanzania nurses work in the hospital’s very effective HIV Care and Treatment Centre, serving thousands of patients with the highest quality care available in Tanzania.

The Ikonda success story is a model of what can be accomplished in rural Africa by focused, professional, accountable health care workers.

A feature interview with Betty is included in the latest edition of A. Magazine.

To read the full interview, go to:

http://interviews.amagazine.org/?p=115

Excerpt from A. Magazine:

Betty Liduke has been called a local legend in Njombe, Tanzania where she is a nurse and the Director of the Tanwat (Tanganyka Wattle Company) Hospital HIV- AIDS Care and Treatment Centre. Liduke is also the Coordinator of Highlands Hope of Tanzania, an association of nurses who work as HIV-AIDS counselors and caregivers in the southern highlands of the country.

According to the African Medical and Research Foundation (AMREF), more than 2.2 million people in Tanzania are living with HIV/AIDS and an estimated 2 million children have been orphaned as a result of the disease. This doesn’t seem to daunt Liduke who has been working with Tanwat’s HIV/AIDS Program since 1996. She is also a founding member of the Kibena Women’s Association, a group of professional women who provide support to women living in the local villages, and to children orphaned by HIV/AIDS.

As well as working with local community groups, Liduke has been working with McGill University’s School of Nursing. She is the school’s first International Clinical Instructor in Africa, and has traveled to Canada to meet with Canadian healthcare professionals and to participate in an International AIDS conference.

Why did you decide to become a nurse?
I really liked to be a nurse since I was a child. And my mother also wanted one of her children to be a nurse. She felt that is a very good work and she compared with God’s work. I was the only one who was interested to go into nursing. My two sisters are teachers, one of my brothers was a veterinarian, and two of my brothers were working as car mechanics. All three brothers have died and we are three sisters remaining. My father and my mother also died.

How did you get involved in working with people HIV/AIDS?
I’ve been a nurse at the Tanwat [Company Hospital] since 1994. We started the HIV program, called the Workplace Intervention Program, with the company. We worked together in cooperation with AMREF, the African Medical & Research Foundation. From research in 1996 we found that there were cases of sexually transmitted infection of HIV/AIDS. At that time the company thought that it was good to start the program so we can give awareness to workers and their dependants to let them know that they were at risk for HIV/AIDS.

At that time, I was working with workers and their dependants only. But since 2001, Tanwat extended the program to 19 villages. Our workers also are living in the villages and coming to work, so we thought it would be good to extend to the villages.

In Bulongwa, I have three village-based groups made up of people living with HIV/AIDS. One of which is called PIUMA. [Ed. According to the Highlands Hope website, the PIUMA HIV Counseling and Testing Clinic is an independent, community-based clinic with leadership drawn primarily from local people living with HIV-AIDS.]

The other groups are CHAKUNIMU and TULILUMWI. They do community work, sensitization on development and HIV/AIDS awareness.

We started with prevention and awareness, and then in 1998 we started voluntary counseling and testing. We do testing for free—people don’t have to pay for voluntary counseling and testing. In 2006 we started care and treatment with the help of the National AIDS Control Program and some international help. The government is giving us antiretroviral drugs (ARVs). This is a national program: all the care and treatment programs are supposed to give free ARVs to all the clients. Up to now, we have enrolled 557 people in our care and treatment program. Of those, 420 are on the ARVs.

What are some of the biggest issues you encounter in providing care and treatment?
For the treatment we have no problem with access to ARVs, but we have a problem with drugs for opportunistic infections. The government is not supplying them for us so we have to buy them. And people here are very poor. You can’t tell them to buy the drugs because they have been sick for quite a long time and sometimes they have used all their money. So Tanwat buys the drugs and gives them to those who are not able to pay. Those who are able to pay, they pay. But for those who are not able, they are not paying.

Transportation is also an issue. For me I travel quite a lot because I have these 19 villages to go to. The roads to some of the villages are very bad. Especially during the rainy season, it is really hard to travel.

How do people react when you talk to them about HIV/AIDS?
At first when we started, the people they didn’t want to talk about HIV/AIDS, but now they understand. And they can talk openly—we can discuss it. Even those who are HIV positive are talking too. But at first it was very, very difficult.

Have you lost anyone in your family to HIV/AIDS?
Yes, one of my close family members died of HIV/AIDS.

Are you optimistic? Do you think things will get better with HIV/AIDS in your community?
I think so. In Tanzania we have a very high prevalence of HIV/AIDS but at the villages I have been going since we started the program the prevalence is going down. People now they started to understand what is HIV. They go for voluntary counseling and testing and they get treatment and they do their work. Now we have started with schools. We have a program in primary schools and secondary schools. It is much better to make people understand before they get HIV.

You are also a volunteer with the Kibena Women’s Association. What does the Association do and how did it start?
I’m a coordinator for the Kibena Women’s Association. We are 20 members and we started the Association in 2005. We are teachers, nurses, accountants, in agriculture… all professionals. I just talked with a few women and it was my opinion that we needed to work in a group so that we can help other women, mainly in the village. Not in town because in town there are many people who are helping. In the villages they don’t get help because, you know, people don’t want to go to the rural areas.

The life of village women is tough. They are the ones who wake up early in the morning and the ones who go to sleep late. Women in the villages do all the work of the field, taking care of the family, making sure the children have gone to school, making sure the family has daily food at home, doing all daily home activities, etc.

So we decided to get together so that we can raise the voice of women and educate them on various matters including HIV, income-generating projects, empowering women to have one voice etc.. We are also taking care of 17 orphans, [several] of them in secondary school, the remaining in primary school.

It must be challenging to do the work you do. What keeps you going?
My family makes me strong every time, whenever I become tired with the work. Also I love my work and job as I feel it is a part of my life. I really like to help my community. That is my heart, the feelings from my heart.

Tumaini Swallow is tough. At 28, she has already had four children, is living with HIV and has been a member of PIUMA for two years. Despite her small stature, and that she has lost the fingers on her right hand from an accident with hot charcoal as a child, she will not let anyone call her weak. Her profession, making charcoal, ironic considering the nature of her accident, is among the toughest things one could do without machinery.

Her husband, who shares in her profession, owns several plots of forest, but they insist on working separately. “For efficiency,” she says as she picks up an axe to demonstrate her strength and accuracy, halving a tree trunk with a 20 cm diameter in just a few brisk swings. Her job has forced her to be quick.

Every day, Tumaini sets out for the section of forest ripe for clearing. Single-handedly, she levels the plot with just an axe, and then chops the fallen trees into logs of roughly eight feet length. Once her selected area is clear, she piles the logs up – sometimes as big a house. The tough manual labour is not all done though. First she must cover the pile with dried grasses, after which she digs up the area cleared and coats the wood in a thick layer of dirt, effectively building a furnace.

After she piles wood shavings and more dried grass at one end of the pile that is left open, she sparks the furnace, waits for the fire to catch within, and buries that end too. The wood may burn for one to three days depending on its size, and as soon as it stops smoking, it is ready to be uncovered and broken into the charcoal bits for sale.

Tumaini alone generates six big bags of it every week, which each sell for 3000 Tsh. Part of her job involves delivery from her home in Makwavuta to Bulongwa, on foot with her product on her head.

In addition to this business, Tumaini grows crops for sustenance – maize, potatoes and sweet potatoes – has two chickens, one of which is part of her PIUMA group project, and had a pig that she recently sold. But when asked whether she’s overwhelmed, she says that in fact, she “wants her project to grow or to have more projects.”

Gabe Maldoff
Canadian Friends of Highlands Hope

INDEPENDENT AUDITOR’S REPORT

TO THE MEMBERS OF PIMA UISHI KWA MATUMAINI (PIUMA)

INTRODUCTION.
I have examined the appended financial statements made up the balance sheet, receipts and expenditure and cash flow as well as the related accounting records of M/s PIMA UISHI KWA MATUMAINI (PIUMA), a local registered non-governmental organisation resident in Makete district for the year ended December 31, 2007.

OBJECTIVE AND SCOPE.
My examination was conducted in accordance with acceptable auditing standards for small organizations and accordingly I applied audit procedures that were relevant by examining the accounting records and books on a test check basis as I considered necessary under the circumstances.

The purpose of the examination was to form an opinion whether, taken as a whole the financial statements examined portray a true view of the affairs of the organisation for the year under review. I did not conduct the audit with the purpose of establishing the adequacy or inadequacy of the system of internal control nor with intention to discover any accounting mistakes or fraudulent errors.

ACCOUNTABILITY FOR REPRESENTATIONS.
The responsibility for the representations of the financial statements is that of the management of PIUMA and its Executive Committee which is mandated to manage all financial affairs of the organisation in accordance with the Constitution of the organisation.

REPORT THAT:

1. The financial statements and related records examined are in agreement with the books maintained and that sufficient explanations were provided to support the transactions sampled for examination.

2. The financial statements of this first year of operation have been prepared in compliance with the generally accepted accounting principles.

3. All the money received from donors and other sources was properly supported by relevant official receipts.

4. On the basis of the audit sample examined, I was made to conclude that taken as whole all payments were adequately documented and duly accounted for.

5. Physical verification of the fixed assets was done to evidence their existence. It was reported that a digital camera whose value was not readily established was stolen during the year.

6. The Piuma trustee bank account maintained in Daressalaam by Pima Associates, Accountants & Auditors was scrutinised with regard to transfers received from donors and the approved reimbursements paid to Piuma. I was satisfied that all the transactions were properly documented and an elaborate cash book maintained to record the receipts, withdrawals and payments.

OPINION:
In my opinion the appended financial statements of M/s PIMA UISHI KWA MATUMAINI (PIUMA) drawn as at December 31, 2007 present fairly a true view of the financial position and cash flow as at that date.

Signed
Valerian R. Kaijage, FCPA (158)
FELLOW CERTIFIED PUBLIC ACCOUNTANT
February 22, 2008
UDSM, P.O. Box 35091
Daressalaam, Tanzania

EDITOR
DAR ES SALAAM

RWANDAN President Paul Kagame repeated his criticism of bureaucratic red tape delaying transit cargo at Dar es Salaam port during an East African investment conference in Kigali last week.

Mr Kagame whose landlocked country depends on Dar es Salaam and Mombassa ports to ship and receive its goods from abroad blamed, among other things, poor infrastructure, bureaucracy and corruption for the delays.

This is the second time within a month that the Rwandan leader has ’hurled stones’ at the Dar es Salaam port. The first time he did so was during a presidential plenary of the 8th Leon H. Sullivan Summit held in Arusha between June 2-6 this year.

While we acknowledge that poor infrastructure, including good roads and railway network, is a major factor delaying clearing and forwarding of goods at the port of Dar es Salaam, there is enough evidence that bureaucratic red tape which aims at convincing port users bribe officials, is also a major hurdle.

Take a simple example of 40 cartons of HIV and AIDS campaign T-shirts donated by an Austrian based good Samaritan, Othman Ruf last January to a Makete based HIV/AIDS activist group, PIUMA (Pima Ukimwi Uishi kwa Matumaini), only got cleared from the port last week.

So while Kagame’s coffee, tea and apparel en-route to Europe or the Americas takes 60 days to be cleared from the port’s bureaucratic cartel, PIUMA’s donated t-shirts took close to six months! January 20, 2008 to June 24, 2008.

It’s absurd and sincerely it shows that main players at the country’s prime port have lent a deaf ear to criticism against bureaucracy and corruption. The 40 cartons PIUMA t-shirts did need to be ferried from Dar port to Makete for clearance and even if the port operator, Tanzania International Container Terminal Services (TICTS) is said to have poorly invested in infrastructure at the port, certainly a consignment of t-shirts is no heavy load.

As Kagame pointed out during the 8th Leon H. Sullivan Summit, corruption is the biggest of our undoing. In a statement to express his frustration with the bureaucratic process of clearing the t-shirts consignment, PIUMA advisor Rayben Sanga said that the original documents were reportedly lost at Tanzania Revenue Authority�s customs department forcing the group to submit a second set of documents.

But worse still, Sanga noted that even the second set of import and tax exemption request copies were misplaced again forcing PIUMA to produce yet another set of documents. This is lack of professionalism and it displays gross irresponsibility, corruption ploy and negligence by TRA officials who handled the shipment.

At the end of the day, PIUMA had to pay over 1.4m/- in handling costs for a consignment worth EUR 5,000 (approx 6.5m/-) but the activist group is still waiting for a bill on storage charges and clearing and forwarding charges. You can imagine what a group of few corrupt individuals sitting at TRA long-room can do to discredit the country’s prime port.

We urgently need action by relevant government authorities to clear this mess and ensure that Rwanda’s merchandise and other landlocked countries’ cargo as well get handled in a professional manner that will improve trade, spur regional economic growth and cut cost of doing business.

Tumeondoka Bulongwa tarehe 27/7/2008 tumefika Arusha tarehe 29/6/2008.
Tumefika Arusha 4:30, tumepokelewa na ndugu Jackson Mbogela.
Tumetafuta gesti mahali pa kupumzika.

Tumekaa kwa pamoja na kuandika barua ya kwenda Polisi na kwa mkuu wa
Mkutano na kopi kwa ofisi kuu ya Arusha kwa ajili ya kuomba kushiriki
Mkutano, na hapo hatukujua mkutano unafanyika sehemu gani mjini Arusha.
Tulitafuta magazeti ya dini toleo la tarehe 28/6/2008, tulipata gazeti
zuri sana ambalo lilitufahamisha mkutano ulipo ACC 8:30. Tulikwenda
polisi tulipokelewa vizuri na Polisi wa pale na akatupeleka kwa mkuu
wa Upelelezi, tulimpa barua yetu akaisoma tukamweleza lengo kuu
tulilokuja kwenye mkutano, tuliulizwa tuko wangapi, tulimjibu kuwa
tupo watano, kwa kweli mkuu wa upelelezi alitusaidia sana mawazo, na
muda gani wa kuingia kwenye ukumbi wa mkutano.

Tulipokwenda kwenye kituo cha polisi saa 10:12 tukaenda ofisi kuu za
KKKT tulikuta hawapo. Tukaenda sehemu ambayo mkutano unafanyika (AICC)
tukaambiwa leo ni jumapili ofisi zimefungwa, tuliondoka saa 12:30
kwenda kupumzika kujiandaa kwa ajili ya kazi ya kesho.

Tarehe 30/6/2008 tuliamka saa 12:30 kwenda ofisi kuu ya KKKT tumefika
1:20 tumeona bado hazijafunguliwa. Baada ya hapo tumeondoka kwenda
AICC ambako mkutano unafanyika tulifika AICC saa 2:7 tulimwona mama
mmoja kwenye chumba cha mapokezi tukamwambia tunashida na mkuu wa
Mkutano yaani KATIBU tunaomba kuruhusiwa kuingia kumwona Katibu.
Tulichekiwa kama tuna vitu vya hatari, tuliruhusiwa kwenda kumwona
Katibu wa Mkutano, tulisindikizwa na huyo mama wa mapokezi,
tukapokelewa vizuri, tukamweleza kwa kifupi kazi tuliyojia kutoka
Makete, alipokea barua yetu na kwenda kumkabidhi mwenyekiti wa
mkutano, tulipanda wote lifti kwenda gorofa ya saba ambapo tuliambiwa
tusubiri sehemu ya chai tulitoka saa 5:00. alitokea mama mmojas ambaye
ni mjumbe wa mkutano alikuja na mbwembwe zake alitaka tutoke lakini
tulisimama ngangali hatukumsikiliza, ndipo walipotoka kunywa chai
tulisimama na mabango yetu huku tumevaa tisheti za PIUMA tatu, mpya
moja na mbili za zamani. Mabango yote yaliandikwa kwa kiingereza,

Mabango yalisema hivi.
(i) Donor Money stolen from Makete must be returned (Pesa ya wafadhili
iliyoibiwa Makete irudishwe)
(ii) Corruption lack of account ability lack of Transparencey of the
ELCT/SCD quietness of donors, kills HIV + Makete ( Ufisadi, ukosefu wa
uwajibikaji, ukosefu wa uwazi wa KKKT/DKK ukimya wa wafadhiri unauwa
wa (VVU) Makete.
(iii) Ice is melting on Mt. Kilimanjaro PLWHI lives are perishing in
Makete due to corruption (Barafu imeyeyuka mlima Kilimanjaro maisha ya
wa (VVU) yanayeyuka kwa sababu ya UFISADI.
(iv) LWF talk on the on going state of crisis at BLH (Kongamano la
makanisa zungumzeni juu ya mgogoro wa BLH)
Baada ya hapo tulisimama na mabango mbele ya ukumbi muda wa dakika 30
tuliitwa na Katibu wa miradi anayesimamia ukanda wa Afrika, tulikaa
ofisini mwake dakika 45 naye alitutia moyo sana kwa kazi tunayofanya.

Wana PIUMA baada ya hapo tulitoka na kwenda kupata chakula ilikuwa saa
6:15, saa 7:30 tulikwenda redio 5 (five) tulitoa malalamiko yetu
tuliyojia Arusha, saa 8:20 tulikwenda TBC Televisheni huko nako
tuliwaeleza tulilojia Arusha, tukawaeleza yanayo tusibu wana Makete,
tulimaliza kazi saa 10:30 tukarudi kupumzika na kwenda kufuatilia
tiketi.
1/7/2008 tuliondoka Arusha kurudi nyumbani Bulongwa tumefika tarehe 2/7/2008.

Huu ndio mwisho wa ripoti ya safari yetu ya Arusha.

Ahsante.

Wema Sanga.

On behalf of the Planning Committee of the 2008 GANES Educating the Future Nursing and Health Workforce: a Global Challenge Conference, I would like to take this opportunity to thank you for submitting an abstract for the conference.

I am pleased to inform you that your abstract, “Canadian and Tanzanian nurses optimizing pain management: Description of a partnered approach”, has been chosen as part of the program for the 2008 GANES Educating the Future Nursing and Health Workforce: a Global Challenge Conference.

Sylvie Lambert worked with nurses and other health professionals at TANWAT Hospital in the autumn of 2007 and winter of 2008 to design and present workshops on pain assessment and management. The training focused on basic pain concepts as well as the implementation of techniques based on the latest research from McGill University affiliated teaching hospitals.

McGill Nurses for Highlands Hope will be supporting the visit of two graduate students in Nursing Sciences to TANWAT in September. These students will continue advancing the McGill-Highlands Hope partnered approach to nursing research and education.

For more information about the GANES 2008 conference, visit http://www.casn.ca/content.php?doc=147

As encouraged by PIUMA, many of the members in these villages banded together to form the Tumaini, or Hope, Group. Their focus? To educate the community about HIV, and to show that if treated properly, HIV need not hamper one’s lifestyle.

PIUMA has also encouraged its members, particularly its groups, of which Tumaini is one of seven, to use their talents to pursue economic activity, which is exactly what the group from Ilolo and Utanziwa has done. Using their flare for song and dance, they inspired a donation from the diocese in Makete that allowed them to buy cabbage seeds, beginning their self-sustaining activities.

From their humble beginnings with 11 members, they have grown to 22, now collectively owning several cabbage plots, two goats, two fish pools, and 12 chickens – soon to be 22, or one per member. All of this has been accomplished by pooling their resources together and trading up with the profits of their sales. Their activities are also designed to send a powerful message to the community: “because we are treating our HIV with ARV’s, we are strong and fit and active,” says Miandoko Kilemile, Chairman of Tumaini, as elected by its members.

In addition to their collective projects, each member still cultivates their own farm and takes care of their families. Some even have individual PIUMA facilitated projects, such as carpet or basket-making. The group meets frequently at the nearby primary school to discuss their future endeavours in business and education, to support each other, and often just to have fun. Every meeting ends with a dance, accompanied by traditional drums and a guitar. In Ilolo and Utanziwa, PIUMA Imara Kama Simba!

PIUMA has been asked to send three representatives to the committee – PIUMA’s executive officer, and two members to be chosen by the Executive Committee. The members will be selected based on their ability to speak with conviction and stand for their rights, and will be chosen when the Executive Committee convenes at the end of this month.

Among the constituents of the District Health Committee will be two District Councillors, those from Bulongwa and Kipogala, as well as the Makete District’s accountant. Starting in mid-August, the committee will visit all the villages in the district and report on the status of health care provision in each.

The creation of the District Health Committee spawns from TANGO’s fierce mandate for NGOs to participate in the making of government health budgets and to force government to evaluate their services with NGOs present. Expenses for the committee’s prospective three week travels are to be funded by the district.

PIUMA was chosen to represent Makete by the chairman of Makete’s NGOs based on the organization’s great successes over the past few years. As the NGO with the largest membership base in the Iringa region, PIUMA was the first to perform mass testing and counselling for HIV, and has tested more people than any other NGO in Iringa. PIUMA is also widely known for its promotion of patient rights and its fight against corruption.

Furthermore, these accomplishments saw PIUMA selected by all the districts of Iringa to air on Tanzanian National Television (TVT) next week. In the television interview, Taimu Sanga described the often rocky relationship between government and NGOs and demanded more government support of NGO projects. He explained that donor money filtered through government frequently disappears, as was the case with PIUMA’s huge testing campaign last year, that tested over 2000 people - a service government promised to back, yet no public money was ever allotted to the project. He also discussed the failure of government to provide CD4 counts in Makete District due equipment failure and neglect.

This honour is but another proof that PIUMA’s strength is causing a stir in Tanzania’s HIV/AIDS services sector and is recognized throughout the country for its achievements in patient rights and accountability.

Sasa wanachama wa PIUMA wameamua kuanzisha timu ya mpira wa miguu ili kupima afya zao. Timu hii imeshaanza mazoezi taraya kwa ajili ya kujipima afya na wanataka kuanza kushindana na mashirika mengine ya watu wanaoishi na VVU.

Timu hii ni ya mchanganyiko wanawake kwa wanaume , waliopima afya zao na ambao ni wanachama wa PIUMA. Tayari wameshapata barua ya mashindano ya ujirani mwema kutoka shirika la watu wanaoishi na VVU MASUPHA.

Baadhi ya wanachama wameshaanza mazoezi tayari kwa ajili ya kwenda kushindana na shirika hili la MASUPHA Makete tarehe 13/7/2008.

Na siku ya mashindano haya itakuwa ni siku ya uzinduzi wa KUZUIA MAAMBUKIZI KUTOKA KWA MAMA KWENDA KWA MTOTO (P.M.T.C.T) ambayo yatafanyika tarehe tajwa hapo juu.

Tumepewa mipira miwili na Gabe kwa ajili ya kufanyia mazoezi.

Hao hapo juu ni baadhi ya wanachama walioanza mazoezi.

Ambulance for poor patients existed on paper only

How donations amounting to Є 300,000 have disappeared in Tanzania. An insight report into why aid organizations of the German church are having a hard time fighting corruption.

By Matthias Thieme

Bishop Alex Malasusa did not mention the issue of corruption occurring in third world aid of the church during this week’s meeting with Hamburg’s senator for economic affairs in the “Turmsaal” of the city hall. The chief bishop of the Evangelical-Lutheran church in Tanzania chatted rather about city partnerships and the close ties of the various parishes in both countries.

Whether these ties might be too close for the effective fight against corruption is the current topic of a heated debate in church circles.
This pertains, in particular, to blatant cases of misguided development aid funds. Extensive documentation about such projects of German social aid organization in Tanzania is known to the FR, which prove embezzlement of donated funds in the hundreds of thousands Euro.

Among the affected missions are the Evangelical “Mission Eine Welt”, the “Nordelbische Missionswerk”, and the Saxon “Kirchenprovinz“. Nobody denies that a lot of money has simply disappeared. However, how to prevent such cases in future is currently disputed.

The Doctor

Rainer Brandl has seen a lot in his time. But the 44-year old doctor remembers one incident all too well, which makes him angry about aid workers of the church, and their ignorance and appeasements. Brandl has written hundreds of accusing e-mails about this issue.

For three years, the Austrian doctor has been in charge of a station for Aids patients in the hospital of the small town of Bulongwa, Tanzania. With the help of modern instruments and medicine he was able to help the patients in a country, where almost every other person is infected with Aids and the average life span is only 50 years.

However, when Brandl came to the hospital in the morning of 17 April 2006, 30 policemen with submachine guns were gathering before the doorway. They detained the doctor from entering the building threatening to use force. Brandl was only allowed to take along his laptop. All the valuable medical instruments, which were financed by the Austrian “Arbeitskreis für Weltmission“ were confiscated. Since then, the patients are looked after only by unqualified staff. There is no medical help. Brandl says, “I have been threatened by members of the Tanzanian church and I had to leave the country for my own protection.”

Brandl is quite sure, that the reason for him being thrown out of the hospital is related to the fact, that he suspected the former bishop of the diocese, Shadrack Manyiewa, and other church members of corruption. He puts the blame on German missions not to have taken any action against the corrupt bishop and the mismanagement of the various projects. “The children and the poor suffer more from the criminal actions of the persons in charge for managing and controlling the aid funds locally as if there would be no aid at all”, says Brandl.

Therefore he acted himself and engaged an auditor as a support for a self-help-group of Aids-patients, which was determined to do something against corruption. The auditor’s report about the financial misconduct of the persons responsible in the aid projects was unmasking. This created quite a buzz and the press in Tanzania reported this in full detail. However, some church people hated the bustling doctor Rainer Brandl. Brandl in turn regards the church as being blind towards the issue of corruption in their Tanzanian parishes and as a result, the church does more harm than good. “Patients have died as a result of the Aids station being shut down, because adequate treatment became impossible”, says Brandl. “This is, in part, also the fault of the German church”.

The Auditor

Rayben Sanga lives in the Tanzanian capital Dar es Salaam and has meticulously examined the use of funds in the various aid projects. The independent auditor has prepared endless lists with dry numbers showing a disaster. The aid has failed. Donated funds have disappeared. There is theft, corruption and triggery.

The result? Approximately Є 300,000 – mainly made up of German donations – never reached the people in Tanzania, for whom the money was intended. Instead, large amounts were siphoned off by project managers. Wages have been paid twice or salaries were transferred to deceased. Even the local bishop, Shadrack Manyiewa, helped himself and had his new 4WD-car financed for the amount of Є 60,000. In addition, he sold his “old” car – which was only five years old – and pocketed the profit.

Everyone could look into the reports of the auditor Sanga and read in detail, how aid funds have disappeared in the swamp of corruption. For instance, if donors in Germany still believed, they would have financed an ambulance in the hospital of Bulongwa, the auditor could reply: “I live in Bulongwa and have never seen an ambulance at the hospital. Where is it hidden?”

Or take donations for biogas plants or school projects: According to the Sangas report, such funds were never received. Even already transferred funds for a medical procedure of the bishop had to be collected once again by the locals. Rayben Sanga has no doubt: The aid organizations of the church were not able to sufficiently monitor the projects and the fraud was apparently clearly recognizable. For instance, the persons responsible have charged numerous dubious payments under the entry „Christmas Cake”. Even a German employee of the “Nordelbische Hilfswerk” has allegedly embezzled funds and her name frequently appears in the lists of deficiencies. According to the church, the woman has been forced into early retirement. However, no investigation has been initiated against her.

The Priest

Manfred Scheckenbach is responsible in Bavaria for the projects of “Mission Eine Welt” in Tanzania. He talks a lot about partnership and equality, whenever the issue of cooperation with the African dioceses comes up. In the opinion of Scheckenbach, any paternalistic attitude should be avoided and patience is the key. He says, “We are a church and have relations with Tanzania for 60 years”.

For Scheckenbach, development aid must be seen in the long run. Doctor Brandl – and his public fight against corruption – is regarded by him as agent provocateur and instigator. “He discovered corruption and went public. We wanted to discuss this internally in the church”, Scheckenbach says. “Brandl wanted to remove the bishop from office. We have a different strategy in the church”. The “Missionswerke” cannot be blamed. Indeed, an external investigation has confirmed, “that the charges of embezzlement are true”, Scheckenbach says. “But we immediately stopped all payments.” Meanwhile, the Persons responsible have been removed from office.

Proceedings against the persons responsible are pending, the priest says. However, no judgments have been issued yet. “This is still delayed with all possible legal tricks”. In the meantime, the corrupt bishop has been voted out of office. Scheckenbach is of the opinion, that “we have acted consequent”.

The fight against corruption should also be shouldered by the local municipalities, says Scheckenbach. Very soon, the Bavarian “Mission Eine Welt” will transfer money to Tanzania again. Receiver will be the new management of the diocese. Now, however, all moneys will be paid in installments only and everything will be audited and trusting that the Tanzanian partners intend to solve the problem.

His colleague Volker Schauer, “Nordelbisches Missionswerk”: “Locally, we do not have complete control. We are also not interested in that.” Aid to developing countries does not imply to act as a powerful financier. Shower says, “That is not our understanding of Christian cooperation. We are not the knights in shining armor”.

The Outsider

Gottfried Mernyi has only limited sympathy for such justifications and describes this attitude a “false understanding of cooperation”. Mernyi is the director of “Evangelischer Arbeitskreis für Weltmission“ in Austria. Since the German aid organizations lack any willingness to fight corruption, the cooperation in Tanzania has ended, says Mernyi. “Nothing has been investigated voluntarily, everything happened only due to public pressure”, so Mernyi. The aid organizations of the church from Germany had taken too long to demand an explanation from responsible parties of the Tanzanian partner church. Apparently there is a systematic approach to silence and conceal embezzlement by the clergy of the Tanzanian church.

Any person criticizing such conditions is charged with either paternalism or hostility against the church. The German aid organizations “knew – at the latest – since spring 2006 of such embezzlement cases, without any legal consequences”, says Mernyi. The German officials of the mentioned organizations had – to say the least – fostered such criminal actions with their decision to deal with these issues only within the church. “The public in Tanzania and Germany and, in particular, the donors were not informed about the criminal actions and the scope of the systematic corruption”, so Mernyi. In addition, the German aid organizations had refused to protest against the lockout of the doctor Brandl by police force, quoting internal political reasons.

The Member of the High Consistory

The whole thing is quite embarrassing to Michael Martin. The member of the High Consistory of the Bavarian national church says: “That is indeed a huge problem”. We do have a responsibility towards the donors”. However, corruption is an everyday occurrence in the development aid. Five bishops were removed from office in the past years in Tanzania due to mismanagement. “That is part of our continuous efforts”, so Martin. For members of the clergy in Africa it is “a giant temptation, when they suddenly receive project funds in the millions”. Often, amounts are siphoned off in order to look after acquaintances.

In this concrete case, the decision was reached not to accuse the bishop of corruption in public. “Such an attack would have caused solidarity”, so Martin. “We were counting on self-curing effects, so that people would have realized: He is ruling like a chieftain”. Now, with the new management, “the aim is to find out how to get out of this corrupt swamp”. One project is again managed by us, since the bishop only employed relatives. However, we should avoid aid paternalism. “Worlds collide, if we try to force our own ideas of aid”, Martin says. “But we can not change the people to become Europeans.”

The Mediator

Reinold Thiel is a founding member of “Transparency Deutschland” and worked for a long time in development aid. He knows the problems from own experience. Together with other experts from the development aid sector, he prepared a report about corruption in development aid and the specific problems of the various churches with their not very transparent structures. Thiel emphasizes, that the report has been prepared in collaboration with the churches and not against them. The churches agreed to discuss the report internally. But they rather not publish anything. Then, the report was published in the newspapers. That was the last straw for the churches. The main thing – according to Thiel – is the discussion of the issue. But this attitude made him not very popular with anybody.

The Hima-VCT was created over a year ago with the mission of providing members with free services, which the Bulongwa Lutheran Hospital, despite its mandate, was not offering.

The VCT was shut down on March 20th of this year when the nurses, temporarily borrowed from the Bulongwa Lutheran Hospital, were called back due to staff shortages at the hospital. Concerned about members’ access to their government-promised free treatment, PIUMA hired Juma Nzige in April to prepare the Hima center for re-opening. Last week, ten District Health Officials visited the facility and deemed everything to be in good order, the site ready to open upon the arrival of a nurse from Ikonda Hospital later this week.

Here is the report from PIUMA’s Clinical Officer:

‘’The health status of our members is a primary issue of concern. I have been caring for them day and night to help tackle their health problems.

“Currently, I have been looking at their CTC cards to assess their compliance with the medication regimen and checking that their last CD4 count was done. It is encouraging when their compliance is good, however, the majority aren’t going for the CD4 counts, sometimes even for a couple of months. I think the problem is all about lack of information, support, and about the benefit of regularly checking their CD4 counts.

“In that case, I plan to commence a routine examination on CD4 counts. Under this program, the overall condition of our members is going to get much better.’’

- Juma Nzige

Of the 15 NGOs in the Makete district, PIUMA was chosen by the chairman of all Makete’s NGOs because of its strong sense of financial accountability. With the main focus of the TANGO meeting being the use of money by NGOs in Tanzania, PIUMA’s continued fight against corruption will make for a valuable presentation at the meeting.

Taimu Sanga, Executive Officer of PIUMA, has been selected to make the presentation in Mbeya and is “feeling good and very proud to represent [his] NGO!” Among many things to be discussed in the meeting, Mr. Sanga plans to describe PIUMA’s work within the community and its continued struggle with Church and government officials. He will also explain PIUMA’s valiant slogan Pima Ili Uishi Kwa Matumaini – Test and Live with Hope.

A delegation from PIUMA, the AIDS patient activist group in Makete District released the following press release as part of its advocacy efforts with the Lutheran church meeting in Arusha:

PIUMA Demands an End to Corruption in the Lutheran Church

Arusha, Tanzania (June 30, 2008)

The HIV-AIDS patient advocacy group in Bulongwa PIUMA has denounced the Lutheran churches of Tanzania and of Europe and North America for their lack of transparency and accountability in the use of money for international development and to combat HIV-AIDS at the a meeting of the Council of the Lutheran World Federation in Arusha. PIUMA has also demanded that the Lutheran churches address the ongoing state of crisis at the Bulongwa Lutheran Hospital and its HIV clinic.

“The people of the Bulongwa area of Makete District are suffering because of the corruption and lack of accountability of the South Central Diocese of the ELCT (SCD), its hospital, Bulongwa Lutheran Hospital (BLH), and the Lutheran donor agencies that support them,” says PIUMA spokesperson Wema Sanga. “People living with HIV and AIDS (PLWHAs) have been among those most directly and most negatively affected by this fraud and theft.”

At least 272 million Tanzanian shillings are known to have been lost or stolen from the Bulongwa Lutheran Hospital and from donor-supported development projects since 2003. This theft has been confirmed by a number of independent audits, but the ELCT and international Lutheran donors have done virtually nothing to reclaim or replace money that was raised by northern churches for the benefit of the poor and needy but lost due to incompetence.

“Hundreds of millions of shillings were stolen by local hospital and church officials,” says Ms. Sanga. “There are professional audits that show this clearly. This money was stolen from the people of our area and must be returned. The Bishops of the ELCT and their foreign partners meeting in Arusha must address this lack of accountability in their system and its negative impact on the poor. Our people are dying from lack of decent care caused by theft and corruption in the Lutheran church. ”

PIUMA is bearing witness that the people of Makete are suffering and PLWHAs in the District are dying because of the Lutheran Church’s incompetence and corruption both in Tanzania and in Europe. PIUMA believes that since the lock-out, hundreds have become infected or died for lack of decent services and HIV follow-up testing and care from BLH. The Church must accept responsibility for the ongoing crisis and change fundamentally its approach to partnering with Tanzania and with the SCD.

“Basic health care is a human right,” says Jackson Mbogela, senior advisor to PIUMA. “Helping PLWHAs in Makete is a matter of justice, not charity. It would be better if no money came from European churches than for it to end up in the pockets of local church elites who use the power and influence it gives them to oppress the people.”

PIUMA held a day-long vigil outside the Arusha International Conference Centre where the Lutheran World Federation was meeting and presented three demands to church officials:

- That the northern partners of the ELCT, specifically the Mission EineWelt (Evangelical Lutheran Church in Bavaria), NMZ (North Elbian Centre for World Mission) and KPS (Lutheran Church in the Province of Saxony) of Germany, recognize that they have failed the people of Makete through financial mismanagement and lack of transparency and accountability, including the contravention of their fundamental human right to receive basic health care;

- That the ELCT and its donor partners pay the people of Makete District the money that was supposed to have been invested in the District in health care and in development projects but that was stolen due to their mismanagement;

- That the ELCT, SCD, and its partners immediately restore services for PLWHAs to the level that was available in April 2006 at the BLH HIV Care and Treatment Centre prior to the expulsion of PIUMA and the professional staff working with them.

Founded in December, 2005, PIUMA is a self-help and advocacy group for people living with HIV-AIDS. It is committed to educational and service outreach and to democratic activism against corruption and bureaucratic indifference to the hundreds of people it represents. Its actions are deeply rooted in proud Tanzanian traditions of democracy and justice for the poor. Last year, PIUMA counselled and tested more than 2,000 people in outreach clinics to villages in Makete District, the poorest region of Tanzania with one of the highest prevalence rates of HIV infection in the country.

For more information, contact:
Jackson Mbogela, +255 787 410 315 (English and Kiswahili) or
Wema Sanga, +255 783 099 324 (Kiswahili)

PIUMA Wanataka Ufisadi Ukomeshwe katika Kanisa la Kilutheri

Arusha, Tanzania (Juni 30, 2008)

Kikundi cha wanaharakati wa Watu Wanaoishi na Virusi Vya UKIMWI huko Bulongwa PIUMA kinapinga vikali hatua ya kutokuwa na uwazi na kutowajibika ya makanisa ya Kiluteri ya Tanzania, Ulaya na Amerika ya Kaskazini kwenye mkutano wa Baraza la Jumuiya ya Dunia ya Waluteri mjini Arusha. PIUMA vile vile wanataka makanisa hayo ya Kiluteri kutatua tatizo la Hospitali ya Kiluteri ya Bulongwa (BLH)na kliniki yake ya Kupimia VVU.

“Wananchi wa Bulongwa kijiji kilichopo katika Wilaya ya Makete wanapata mateso kwa sababu ya ufisadi na kushindwa kuwajibika na kuwa wawazi kwa Dayosisi ya Kusini Kati ya KKKT (SCD), Hospitali yake ya Kiluteri ya Bulongwa (BLH), na wafadhili wa Kiluteri wanaowaunga mkono,” anasema Msemaji wa PIUMA, Wema Sanga. “Watu Wanaoishi na VVU (PLWHAs) wamekuwa kati ya wale wengi walioathirika moja kwa moja na ufisadi huo.”
Takribani Shilingi milioni 272 million za Tanzania zimegunduliwa kuwa zimepotea au kuibiwa kutoka kwenye Hospitali ya Kiluteri ya Bulongwa na miradi inayodhaminiwa na wafadhili tangu mwaka 2003. Wizi huu umethibitishwa na wakaguzi kadhaa wa kujitegemea, lakini KKKT na wafadhili wa kimataifa wa makanisa ya Kiluteri hawajachukua hatua yoyote ile kudai au kurejesha fedha hizo ambazo zilitolewa na makanisha ya Ulaya kwa ajili ya manufaa ya masikini na walalahoi na ambazo zimepotea kutokana na uzembe.

“Mamia ya mamilioni ya shilingi ziliibiwa na maafisa wa hospitali hiyo na wale wa kanisa,” anasema Bi Sanga. “Kuna ukaguzi wa kitaalamu unaoonyesha hili wazi wazi. Fedha hizi ziliibiwa kutoka kwa watu wa eneo letu na ni lazima zirejeshewe.” Maaskofu wa KKKT na washirika wao wanaokutana Arusha wanapaswa kujadili suala hili la kutowajibika katika taratibu zao za kazi na athari mbaya dhidi ya watu masikini. Watu wetu wanafariki dunia kutokana na kukosa matibabu mazuri, jambo ambalo limesababishwa na wizi huu na ufisadi katika Kanisa la Kiluteri.”
PIUMA ni shuhuda kwamba wananchi wa Makete wanateseka na Watu Wanaoishi wan a VVU wanafariki dunia kwa sababu ya uzembe, ubadhirifu wa fedha na ufisadi wa Kanisa la Kiluteri nchini Tanzania na Ulaya. PIUMA inaamini kwamba toka Kliniki ilipofungwa, mamia ya watu wameambukizwa au kufariki kutokana na ukosefu wa matunzo na huduma bora katika hospitali ya Bulongwa.Kanisa hilo linapaswa kuwajibika katika sakata linaloendelea na lazima libadilike kikamilifu katika utaratibu wake wa kushirikiana na Tanzania na Dayosisi ya Kuni Kati, SCD.

“Huduma bora ya Afya ni haki ya msingi ya binadamu,” anasema Jackson Mbogela, mshauri wa PIUMA. “Kuwasaidia Watu wanaoishi na Virusi vya UKIMWI Makete ni haki ya msingi sio msaada. Ingekuwa bora kama fedha zisingekuja kutoka katika makanisa ya ulaya kuliko kuishia mikononi mwa viongozi wa kanisa wenyeji ambao wametumia kujipa nguvu za kuwakandamiza watu wao”

PIUMA wamefanya mkesha wa siku moja nje ya Ukumbi wa Kimataifa wa Mikutano jijini Arusha ambako Jumuiya ya Dunia ya Waluteri walikuwa wanakutana na walitoa madai matatu yafuatayo kwa maafisa wa makanisa hayo:

- Kwamba washiriki wa KKKT, hususan, Mission EineWelt (Evangelical Lutheran Church in Bavaria), NMZ (North Elbian Centre for World Mission) na KPS (Lutheran Church in the Province of Saxony) ya Ujerumani kutambua kwamba wameshindwa kuwahudumia wananchi wa Makete kutokana na ubadhirifu wa fedha na kutokuwa wawazi na kutowajibika, ikiwa ni pamoja na ukiukaji wa haki za kimsingi za binadamu za kupata huduma za afya;

- Kwamba KKKT na washiriki wake kuwalipa wananchi wa Wilaya ya Makete fedha zilizowekezwa kwenye Wilaya hiyo kwa ajili ya matibabu na miradi ya maendeleo ya Wilaya hiyo ambazo zimeibwa kutokana na uzembe wao;
- Kwamba KKKT, SCD, na washiriki wake warejeshe haraka huduma za Watu Wanaoishi na VVU ambazo zilikuwepo kabla ya 12 Aprili 2008 katika Kituo cha matibabu ya VVU kwenye Hospitali ya Kiluteri ya Bulongwa kabla ya kufukuzwa kwa PIUMA na wataalamu waliokuwa wanafanyakazi nao.

PIUMA, iliundwa Mei mwaka 2005 na kusajiliwa mwezi Novemba mwaka 2005, kama kikundi cha kujisaidia na uhamasihaji wa Watu Wanaoishi na VVU. Kikundi hicho kimedhamiria kuendesha harakati za kuelimisha, kuhamasisha na kutoa huduma kwa watu waliopo mbali na kituo na pia kupinga ufisadi na urasimu unaofanywa kwa mamia ya watu unao kiwakilisha. Mwenendo wake unatokea kwenye mizizi ya utamaduni wa Tanzania wa demokrasia na haki kwa ajili walalahoi. Mwaka uliopita PIUMA walitoa ushauri nasaha kwa zaidi ya watu 2,000 waliopo kwenye kliniki za mbali kwenye vijiji vya Wilaya ya Makete, eneo lenye umaskini wa kukithiri nchini Tanzania na ambako kuna kasi kubwa ya maambukizo ya VVU nchini.

Kwa taarifa zaidi wasiliana na:
Jackson Mbogela, +255 787 410 315 (English and Kiswahili)
Wema Sanga, +255 783 099 324 (Kiswahili)

PIUMA fordert das Ende der Korruption in der Lutherischen Kirche

Arusha, Tansania (30. Juni, 2008)

PIUMA, die Selbsthilfegruppe der HIV/AIDS Patienten aus Bulongwa, prangert die Lutherischen Kirchen aus Tansania, Deutschland, Europa und Nordamerika wegen Mangels an Transparenz und fehlender Rechenschaftslegung über die Verwendung von internationalen Entwicklungshilfegeldern und HIV-AIDS Funds auf dem Treffen des Lutherischen Weltbundes in Arusha an. PIUMA fordert, dass die Lutherischen Kirchen sich mit der anhaltenden Krise am Bulongwa Lutheran Hosptial und seiner HIV Klinik beschäftigt.

“Die Menschen in der Umgebung Bulongwas im Makete Distrikt leiden unter der Korruption und dem Fehlen der Rechenschaftslegung der Süd-Zentral Diözese (SCD) der ELCT (Evangelical Lutheran Church of Tanzania), ihres Krankenhauses, dem Bulongwa Lutheran Hospital (BLH), und der Lutherischen Geber Organisationen, die jene unterstützen,” sagt PIUMA Sprecherin Wema Sanga. “Menschen die mit HIV/AIDS leben (PLWHAs – People Living with HIV/AIDS) sind unter jenen, die sehr direkt und am schwersten von den Betrügereien und Diebstählen betroffen sind.”

Seit 2003 wurden aus dem Bulongwa Krankenhaus und von anderen geberunterstützten Entwicklungsprojekten zumindest 272 Million Tansanische Schillinge abgängig oder gestohlen gemeldet. Diese Diebstähle wurden durch einige unabhängige Buchprüfungen bestätigt; aber die ELCT und die internationalen Lutherischen Geber haben praktisch nichts getan, um dieses Geld zurückzufordern oder zu ersetzen. Dieses Geld wurde von den nördlichen Kirchen aufgebracht, um den Armen und Bedürftigen zu helfen, ist aber durch deren Inkompetenz verloren gegangen.

“Hunderte Millionen Schillinge wurden durch die lokalen Krankenhaus- und Kirchenangestellten gestohlen,” sagt Frau Sanga. “Es gibt professionelle Buchprüfungen, die das klar belegen. Das Geld wurde den Menschen aus unserem Gebiet gestohlen und muss zurückbezahlt werden. Die Bischöfe der ELCT und ihre ausländischen Partner, die sich in Arusha treffen, müssen sich mit diesem Fehlen von Rechenschaftslegung in ihren Systemen und dem negativen Einfluss auf die Armen beschäftigen. Unsere Leute sterben wegen dem Fehlen einer anständigen Behandlung, hervorgerufen durch Diebstahl und Korruption in der Lutherischen Kirche. ”

PIUMA kann bezeugen, dass die Menschen in Makete leiden und Menschen mit HIV/AIDS im Distrikt sterben, weil die Lutherischen Kirchen in Tansania und Europa inkompetent und korrupt sind. PIUMA berichtet, dass seit der Aussperrung aus der HIV Klinik, hunderte Menschen infiziert wurden, oder wegen dem Mangel an anständiger medizinischer Behandlung und fehlendem HIV follow-up durch das Krankenhaus (BLH) gestorben sind. Die Kirche muss ihre Verantwortung für diese andauernde Krise anerkennen und ihren Ansatz zur Partnerschaft mit Tansania und mit der SCD fundamental überdenken.

“Basisgesundheitsversorgung ist ein Menschenrecht,” sagt Jackson Mbogela, Senior Advisor von PIUMA. “Den Menschen mit HIV/AIDS in Makete zu helfen ist eine Frage der Gerechtigkeit, nicht eine Frage der Barmherzigkeit. Es wäre besser, wenn kein Geld aus den Europäischen Kirchen käme, anstatt dass es in den Taschen der lokalen Kircheneliten endet, die ihrer Kraft und ihren Einfluss missbraucht, um die Menschen in ihrem Umfeld zu unterdrücken.”

PIUMA hielt eine Tagwache außerhalb des „Arusha International Conference Centre“ ab, wo sich der Lutherische Weltbund tritt und präsentierte drei Forderungen an die Offiziellen der Kirche:

- Die Nördlichen Partner der ELCT, im besonderen die Mission EineWelt (Evangelische Lutherische Kirche in Bayern), das NMZ (Nord Elbisches Missionzentrum) und die KPS (Kirchenprovinz Sachsen) aus Deutschland, müssen anerkennen, dass sie gegenüber den Menschen in Makete durch finanzielles Missmanagement, fehlender Transparenz und fehlende Rechenschaftslegung versagt haben, das betrifft auch das Agieren gegen das fundamentale Recht für eine Basisgesundheitsversorgung;

- ELCT und ihre Partner und Geber zahlen den Menschen des Makete Distrikt das Geld, welches ursprünglich in das Gesundheitssystem und in Entwicklungsprojekte investiert werden sollte, aber in der Folge des Missmanagements gestohlen wurde, an die Menschen zurück;

- ELCT, SCD und deren Partner müssen unverzüglich die Serviceleistungen für Menschen die mit HIV/AIDS leben in einer Qualität wiederherstellen, die jener entspricht, die bis zum April 2006 am BLH HIV „Care and Treatment Center“ gegeben war. Die Zeit bevor PIUMA und die professionellen Mitarbeiter ausgesperrt wurden.

PIUMA wurde im Dezember 2005 gegründet und ist eine Selbsthilfegruppe, die für die Rechte der Menschen die mit HIV/AIDS leben eintritt. Die Gruppe engagiert sich bei Aufklärung und Beratung im Feld und kämpft durch demokratische Aktionen gegen Korruption und gegen das bürokratische Desinteresse gegenüber den hunderten Menschen, die durch die Gruppe repräsentiert werden. Die Grundlagen für dieses Handeln sieht PIUMA in den stolzen tansanischen Traditionen der Demokratie und der Gerechtigkeit für die Armen. Im letzen Jahr hat PIUMA für mehr als 2000 Menschen HIV Testungen und Beratungen in den Dörfern Maketes durchgeführt. Makete Distrikt liegt in der ärmsten Region Tansanias und hat eine der höchsten HIV Raten im Land.

Für weiteren Kontakt und Information:

Jackson Mbogela, +255 787 410 315 (English and Kiswahili) oder
Wema Sanga, +255 783 099 324 (Kiswahili)

Since the organization’s lock-out from facilities supported by the donor EAWM of Austria, the people of the Bulongwa area have been unable to access services of even minimal quality.

The full story is available at http://www.fr-online.de/in_und_ausland/politik/aktuell/?em_cnt=1358515&sid=9

English translation to follow.

Hii ni taarifa ya ujenzi kwenye Jengo la PIUMA, tunashushukuru kwa misaada ya wafadhili na marafiki wote wa PIUMA kwa michango yenu mnayotoa kwa ajili ya kuisaidia PIUMA kwa mambo mbalimbali.
Mpaka sasa jengo letu la PIUMA vyumba vilivyoisha kusakafiwa ni nane, katika hivi vyumba nane vyumba vine vinaendelea kupigwa dari, vitapakwa rangi na vimefungwa milango tayari. Lakini vyumba vingine vilivyobaki hatuna fedha kwa ajili ya kuendelea na ujenzi, hivyo basi mpaka sasa ujenzi umesimama.
Endapo tutapata msaada wa fedha tutaendelea na kusakafia chumba kikubwa cha katikati, veranda na ukarabati wa vitu vingine.
Pamoja na nguvu kazi za wanachama bado tunahitaji msaada wa fedha kwa ajili ya kuweza kukamilisha zoezi hili.
Malengo yetu tulipanga kuwa endapo tutamaliza jengo haraka mwezi wa tisa mwaka huu tuwe tumeshahamisha ofisi kwenye jengo letu la PIUMA.

Ahsante.

UTANGULIZI: Kikao cha kamati zote za PIUMA kimefanyika jana tarehe tajwa hapo juu kwa ajili ya kuwaelimishwa wajumbe wa kamati kujua wajibu wa kazi kwa kila kamati, kikao kilifunguliwa saa 4:00 asubuhi.
Mwenyekiti aliwaeleza wajumbe kuwa tumetembelewa na mgeni toka Canada ambaye amekuja kututembelea, na mgeni huyu amekuja na vifaa vifuatavyo.
- Compyuta, kamera na begi ya compyuta.
Mwenyekiti aliwaeleza kuwa mgeni huyu amekuja kufungua website ya PIUMA, kuwatembelea wanachama wa PIUMA pamoja na vikundi vyake. Ametumwa na Royal kuja kufanya kazi nasi, atakuwepo kwa mwezi mzima.
Alimkaribisha mgeni ili ajitambulishe, mgeni alisema kuwa yeye anaitwa Gabe Maldoff. Wajumbe walishukuru kwa ujio wake huyu mgeni na kumpokea kwa kuimba wimbo wa PIUMA.
Wajumbe waliokuwa wamehudhuria walikuwa 28 kati ya wajumbe 41 katika kamati zote, katibu Mkuu wa PIUMA aliwasomea wajumbe wajibu wa kila kamati.
1. KAMATI YA UTENDAJI
Kamati hii ndio kamati kuu itawajibika na mambo yote yanayohusu mambo yote ya PIUMA pamoja na kuwajibisha kamati ndogondogo na viongozi wa PIUMA.
2. KAMATI YA FEDHA
Kamati hii itawajibika na mabo ya fedha za PIUMA, kuandaa bajeti, kuandaa ripoti, kudhibiti pesa, na mambo yote yahusuyo fedha.
Kamati zingine zote zitawajibika kwa kufuata wajibu wa kila kamati na kamati hizi zitapeleka maombi na maazimio yao kwenye kamati ya utendaji na kamati hii ndio yenye kutoa uamuzi wa mwisho.
Mwisho kikao kiliahirishwa kwa kuimba nyimbo za PIUMA. Kikao kiliahirishwa saa 8:00 mchana.

The Financial & Planning Committee was established one month ago in order to oversee PIUMA’s use of money. The committee will look into the allocation of resources and will have to be consulted in the drawing of PIUMA’s future budgets. To best prepare the new committee for its upcoming tasks, today’s meeting suggested scheduling a seminar with Mr. Rayben Sanga, PIUMA’s financial advisor, upon his arrival from Dar es Salaam next month.

The meeting today, which drew 24 members from villages as far as Makwaranga for a festive singing of the PIUMA song and collective feast, also proposed training PIUMA volunteers in home-based care treatment. With the arrival of a new VCT nurse as early as July 1st, PIUMA hopes to hold a seminar on the second week of July to train its volunteers.

In the past, seminars on home-based care have been provided to PIUMA members through the Makete NGO, Tunajali, and conducted by the Lutheran Church. It is hoped that with PIUMA’s own VCT nurse, home-based care seminars will be able to reach a greater PIUMA membership.

From July until December of last year, PIUMA’s Bulongwa-based Voluntary Counselling and Testing Centre (VCT) and its mobile outreach clinics to surrounding villages provided testing to more than 2,000 people.

Because of a change in PIUMA staff, the local District Medical Officer (DMO) revoked permission for the organization to continue with the VCT. This unacceptable situation has continued for more than five months.

The Coordinating Committee is calling on the DMO and the District Commissioner to give PIUMA permission to re-open its clinic immediately. PIUMA Clinical Officer Juma Nzige says that all demands of the DMO for clinic resources have been met. A further demand by the DMO to send staff for a month of specialized training has been characterized by a local health professional and HIV expert as “not reasonable”.

“No one else is required to do this in the region or in the country,” says this expert.

PIUMA supporters suspect this bureaucratic opposition by local officials is part of a sustained campaign to suppress PIUMA that has been going on since the organization publicly criticized local health and church officials for theft and corruption.

“Our people are dying,” says PIUMA Executive Officer Taimu Sanga. “We are pleased that our local NGO partners have recognized that we are best at this and support us with the DMO.”

On Saturday, June 21st, Highlands Hope affiliate NGO, Chakunimu, held an information session in the village of Mlevele, just outside of Njombe. The session was used to spread awareness of HIV and the importance of testing.

Using several teaching methods, the session focused on expelling local myths about the virus. An address to the entire crowd of 450 presented the information in a straightforward manner, while small group discussions allowed the villagers to ask more personal questions. Songs repeated information given with a catchy tune, which eventually had many of the villagers reciting the lyrics. Lastly, a role playing exercise had the crowd rolling in laughter as it compared traditional treatment methods with modern medicine.

Chakunimu operates within six villages in the surrounding area, and has made its presence known. Aside from weekly information sessions rotating through its constituent villages on topics ranging from HIV awareness to environmental concerns, the NGO has been an important leader in community building projects.

In Nyumbanitu, one of the villages within which the NGO operates, a new health center is nearing completion. The large red testing center and planned maternity center, built by the villagers with minimal government help, will be the first center for Highlands Hope`s mobile testing program. The program will bring Highlands Hope nurses to the various villages where they operate in order to reach those who cannot make the walk into Njombe.

After the information session in Mlevele, organizers got together to evaluate Chakunimu`s work. The only criticism to surface was that only three village chairmen attended, and in the future they should strive to have all six present. However, the most resounding comment was that of the Wald Executive Officer who praised Chakunimu`s work and suggested that it expand to more villages.

The solidarity visit by Canadian Friends of Highlands Hope to Makete District has been made possible by the support of the senior economics class of Lindsay Place High School among others.

Gabe Maldoff

Finn’s Facts: Lutheran leaders should censure graft culprits among them

FINNIGAN WA SIMBEYE,
DAR ES SALAAM

THE country’s northern tourist enclave of Arusha town will this week play host to a high profile Lutheran Church leaders’ conference. Lutheran World Federation leaders will convene at the Arusha International Conference Centre (AICC) to discuss several issues pertaining to its global members’ activities.

This LWF conference is being held in the country at a time when the government of President Jakaya Mrisho Kikwete has gone head-on to tackle high level graft in public office.

The church, specifically the Evangelical Lutheran Church in Tanzania (ELCT), has played a leading role in denouncing high profile graft among public officials. During annual Christian commemorations such as Easter, Christmas and the like, ELCT leaders have used the opportunity to call on their followers to emulate the life of Jesus Christ by practising honesty, courage in defending the church and justice while leading a simple life.

But this time around, the ELCT and some of its so-called Northern partners are in the dock. Graft, embezzlement and cheating allegations have been made against some personalities at ELCT, its German partners, Nordelbisches Zentrum f�r Weltmission und Kirchlichen Weltdienst (NMZ) and Arusha based Lutheran Mission Cooperation.

There are serious concerns that some church officials at ELCT and particularly from the Southern Central Diocese of Iringa, NMZ and LMC are engaged in acts which are contrary to the moral teachings of Christ and in some cases, acts which border on criminal offence.

When I first got the allegations against an NMZ seconded employee, Reichenbach Vogt Ingeborg who worked as treasurer at SCD between 2003/5 when audit reports from the diocese show misappropriation of funds, I took a task of contacting the Germany-based institution and the individual but so far no response has been made.

Ms Vogt Ingeborg’s tenure at ELCT/SCD left several stories of loss of EUR 100,000 and some 270m/- cash lost through graft and thefts. Several church leaders who faced allegations at ELCT/SCD were booked by the police in Iringa Region but later left free following a visit by a former prime minister.

There are serious allegations on how some ELCT/SCD church leaders at Bulongwa Lutheran Hospital collaborated with some dishonest Ministry of Health and Social Welfare officials to close down a properly functioning HIV/AIDS clinic which used a German made Cyflow CD4 Counter machine and replaced it with an American made FacsCount CD4 Counter and threw away most of its volunteer personnel including an Austrian medical doctor, Dr Rainer Brandl in 2005.

Today we are told that the FacsCount machine at Bulongwa is no longer working and that people living with HIV and AIDS through their association, PIUMA, are dying or going through the worst suffering because some dishonest ELCT/SDC leaders have betrayed their trust. The church is seriously in need of cleansing itself before the public in Makete where the country’s worst cases of the HIV/AIDS virus are found and yet some greedy people are cashing on human suffering.

Dr Brandl and some PIUMA members accused the LMC of collaborating with ELCT in making sure that funds from the Northern partners such as NMZ and the government goes to BLH where graft is the order of the day and past culprits have been left off the hook

Serious allegations have also been made against leaders at LMC, NMZ and ELCT/SCD but have often been dismissed. In the worst act of defiance against allegations of wrongdoing at ETCL/SDC the NMZ published articles recently stating that all is well in Tanzania and that its German members can continue to bankroll projects which ordinary people on the ground argue are simply misappropriated by few dishonest individuals on the ground.

The LMC secretary Lars Hofgren from Sweden, vice chairman Manfred Scheckenbach from Bavaria in Germany are among the names being accused of continuing to work with ELCT/SCD by backing them financially while ignoring graft allegations being made against its leadership some of whom have been forced to resign.

But LMC’s secretary Mr Hofgren dismissed all the allegations made against the charitable institution arguing that LMC and ELCT/SCD are completely different entities with different managements. They only have a memorandum of understanding to work together.

Lutherans in the country and the general public who benefit from generous contributions being made by the ELCT/SCD at Bulongwa and elsewhere want to see action taken against few individuals who are shaming the church by their immoral conduct.

The LWF should also censure some of its own high profile members from LMC, ELCT and NMZ who have formed a cartel whose conduct and activities are a disgrace in the eyes of Lutheran faithfuls and the general public. The LWF must seriously be seen as an anti-graft crusader especially among its hierarchy members.

PARTICIPANTS
Evangelista Kayombo chair/Counselor TANWAT
Leonila Samlongo counselor Ikonda
Rose Msigala counselor Ikonda
M. Msigwa counselor Ikonda
Onolina Mahenge Treasurer Ikonda
Potania Mfuse PMCTC counselor Ikonda
Andrew Auruku Laboratory Tech volunteer TANWAT
Batseba Betty Liduke Counselor /Coordinator Tanwat

Apologies
Tasilo Mdamu - Secretary HHT- Advanced diploma student – Iringa PHC
Elekia Msigwa – HBC Counselor TANWAT
Anahilda Mtega – Adherence Counselor TANWAT

AGENDA
Opening
Reading of past minute
Matter rose from past minute
Other matters
Closing

Before opening of the meeting prayer was done to bless all which is going to be discussed during the meeting

Opening
The meeting was been opened by HHT chair E. Kayombo by explaining on why the number of participants is not satisfactory. The meeting was opened at 10:15 am

Reading of past minutes
One participant read the past minute carefully followed by questions and addition from other participant generally the participant agreed the minute.

Matters rose from the past minute
Computer Training
Ikonda nurses reported of four nurses who have already started the training and they need fees for the 3 program which is remaining. HHT coordinator gave them 240,000 Tsh which is a fund for training. Nurses who are on Computer training this time are
• Rose Msigala
• Leonila Mfuse
• Potania Mfuse
• Onolina Mbilinyi

Registration of HHT network
Participants decided together to register officially HHT and from now the process of registration to be prepared and those participants who are in Njombe to go on with registration.

Other matters
Planning for other training for nurses will be of benefit to HHT nurses as this will be easy to know how many nurses should be attending the training. Participants insisted that those nurses who are not yet under gone secondary education should be helped to reach the level of secondary and 5 nurses from HHT nurses are not yet done the secondary examination one is going to sit for secondary examination this year 2008 the remaining should arrange for next year where by almost 300,000 Tsh is needed for them.

Conclusion
Every year at list 2 nurses to join Diploma or Counseling and budget for it should be done so to know how much will be needed every year. Other participants said at list Three million Tsh is needed every year for the Diploma training for 2 nurses.

TOPIC OF THE DAY
The selected topic was not made as the clinician who was supposed to present it was in theatre for emergency work. The topic was spared for next meeting.

Next meeting will be held on September but the date should be announced later as this will depend on the student from Canada arrival.

The meeting was closed at 1:30 noon by Chair who thanked all participated for their presence.

Prepared by
Mrs. Onolina Mbilinyi
Treasurer HHT

PIUMA Advisory Committee member Jackson Mbogela is very involved with planing the project.

“PIUMA has wanted to be online for a long time,” he says. “We are looking forward to Gabe’s time with us.”

PIUMA was founded on World AIDS Day, 2005. It quickly established a reputation for tough advocacy on behalf of its members, including demanding an end to corruption in public health services. Last year, it began operation of its own voluntary counselling and testing (VCT) services, taking HIV education and testing to villages in Makete District where no testing had been available before.

More than 2,000 people benefitted directly from PIUMA’s VCT services. The organization is proud to have made its contribution to Tanzanian President Jakaya Kikwete’s national testing campaign.

Unfortunately, HIV services are generally ineffective and inaccessible to most of the people in the more remote parts of Makete District. Makete is the poorest region in all Tanzania and thought to have one of the highest prevalences of HIV infection in the country. Efforts by a number of NGOs and international agencies to establish adequate care have been insufficient and unsustainable, often due to corruption and mismanagement in the provision of health care by public, NGO, and Lutheran church officials.

Support for the PIUMA website project comes from the senior economics students of Lindsay Place High School in Pointe Claire, Canada, who held a “24 Hour Famine” to raise funds to support Highlands Hope and PIUMA.

PIUMA is imara kama simba - strong like a lion!

On behalf of Kibena Women’s Association, I thank St Georges School for a very big help to smoothen the work of KWA . We thank you very much ST GEORGE’S SCHOOL FOR THEIR DONATION OF 1365 USD which we just received recently .

MAY THE GOOD LORD BLESS AND KEEP YOU ALL.

Thanks,

Betty Liduke for Kibena Women’s Association

The Kibena Women’s Association provides regular support to more than twenty orphans, including food, school uniforms, and academic tutoring. The Association also sponsors a community-wide gathering of orphans and vulnerable children each Boxing Day.

PIUMA is rushing to complete work in order to move its Voluntary Counselling and Testing (VCT) Centre from rented premises to the new site as quickly as poossible.

The VCT is not operating at the moment as negotiations continue with the District Medical Officer over equipment issues. These negotiations are expected to be completed next week.

Work continues on PIUMA House interior

The entrance fees and the revenue of selling CD´s of more than EUR 2,600 will al go to support PIUMA’s efforts for PLHWA in Makete District.

The two well-known musicians from Austria und Germany were performing as volunteers and were temselves active in securing sponsors, who covered the costs for the rent of the concert hall and the advertising.

Diane Borisov, chair of the Committee made specific reference to an interest by the Neuroscience mission in relation to neuropathic pain (a widespread and chronic effect of under-treated HIV) and offered specialty knowledge and resources from other missions.

The Committee has pledged that “the MUHC Nursing Department will support this initiative with content experts” and will explore with Highlands Hope the possibility of MUHC Nursing experts workng directly with their Tanzanian counterparts.

The McGill University Health Centre is one of North America’s leading advanced health care centres and its Research Institute has the largest, most-cited concentration of medical and life science researchers in Canada.

This week PIUMA’s General Secretary Anna Mwinuka and its new staff coordinator Taimu Sanga are in Dar es Salaam to process the organization’s permit for its Voluntary Counselling and Testing services offered at PIUMA House in Bulongwa and through the organization’s village-based outreach program. Last year, PIUMA counselled and tested more than 2,000 people in Makete District as its contribution to the President’s national HIV testing capaign.

Both the District and Regional Medical Officers have endorsed the application and PIUMA is now completing the paperwork for its formal licence from the Ministry of Health. PIUMA is the first patient-led HIV testing initiative in Tanzania and has plans to expand its services to include a full range of HIV care and treatment options.

Another member of PIUMA, Nasibu Ntullo, has just completed a seminar on HIV /AIDS Training for Youth in Dar es Salaam. He is returning to Makete. PIUMA has identified youth and children affected by HIV as a priority for action by the organization.

HIV prevalence in the sexually active population of the district is thought to be close to 20%. Availability of education, testing, and treatment remains, unfortunately, inadequate across the entire district.

The members of PIUMA who will attend are Esterina Swalloh from Mwakauta and Nasibu Ntullo from Utanziwa, both committed volunteers and accomplished local HIV activists.

While in Dar es Salaam, the PIUMA representatives will meet with the Dar-based members of the PIUMA Advisory Board.

Increasingly, PIUMA is being recognized for its leadership in Makete and invited to participate in training events, with the support of local District authorities.

In January, Ofesa Sanga and Alanyibata Sanga attended a two week training program in Njombe on fighting the stigmatization of PLWHAs. Ofesa and Alanyibata praised the training , saying that they learned a lot regarding human rights and stigma.

PIUMA sees basic health care, including access to HIV counselling, testing, and treatment, as a human right. The organization’s work is rooted in deep Tanzanian traditions of individual respect and democratic decision-making at the village and district levels. PIUMA is proud to be a contributing part of the greater national effort to fight the AIDS pandemic. It has, for example, sponsored clinics that have tested more than 2000 people in the past 10 months as its contribution to President Jakaya Kikwete’s campaign to test all Tanzanians for HIV.

As its name says, PIUMA believes that people can “test and live in hope” — pima ili uishi kwa matumaini!

PIUMA members march for solidarity and awareness in Makete District

Earlier this school year, two Secondary V Economics classes were visited by well-known Quebec broadcaster, Mr. Royal Orr. Mr. Orr is a member of Canadian Friends of Highlands Hope Hospital, an organization that includes Mr. Terry Mosher (Aislin of The Gazette) and Lindsay Place High School Vice Principal Mr. David Abracen.

This group works to build partnerships between Highlands Hope and Montreal health care institutions, such as the McGill School of Nursing and the Family Medicine Group at the McGill Faculty of Medicine. It also furnishes medical equipment and underwrites the cost of staff training.

Last year, one of our Secondary V Economics class donated a laptop computer, which was taken by members of Canadian Friends when they visited Tanzania last summer and given to the Highlands Hope nurse-counselor network. This year’s class is determined to maintain this tradition, and so they will be holding this upcoming Famine to raise funds which we be used to buy requested medical and technological equipment. This equipment will be taken directly to Highlands Hope by members of the Canadian Friends organization.

The Secondary V students are seeking donations from the local community and will be gathering to fast together as a gesture of solidarity with the nurses of Highlands Hope and the people of Njombe and Makete Districts, especially persons living with HIV-AIDS.

PIUMA’s former Coordinator, Jackson Mbogela, is preparing to go to the Netherlands for advanced university studies as a a recipient of a scholarship from the Ford Foundation and has become a member of PIUMA’s Advisory Council.

PIUMA is eager to get its new staff members in place and restart its counselling and testing services as well as its mobile clinics in villages in Makete District. PIUMA tested thousands of individuals in its testing drive beginning in the summer of 2007 as its part in the nation-wide testing campaign launched by the President of Tanzania, Mr. Jakaya Kikwete.

PIUMA also anticipates renewing its commitment to outspoken advocacy on a range of health and humans rights issues, including its repeated calls for an end to corruption in the provision of health care in Makete District.

Congratulations to Taimu and Juma.

Kwa pamoja tutashinda! (Together we can accomplish all things!)

The project links McGill University’s School of Nursing with nurse-counsellors in the communities of Njombe and Makete in the Southern Highlands region of Tanzania. HIV-AIDS is creating great suffering and hardship there; estimates of HIV prevalence in the adult population range as high as 20% in the region and the majority of patients in hospitals the east African nation are living with the complications of AIDS.

“We are honoured to be working with the professional nurses of Highlands Hope of Tanzania and with nurse leaders like Betty Liduke from Njombe,” says Madeleine Buck, Associate Director of the McGill School of Nursing. “We are very excited that we have completed our preliminary work of project development through the efforts of our two Highlands Hope Fellowship holders and are now integrating students from our School’s Global Health Studies section into our efforts.”

Nursing students Andra Leimanis and Jacqueline Bocking are studying Kiswahili and preparing the research/teaching projects that they will be taking to Tanzania in the fall of 2008 to implement with Highlands Hope of Tanzania and with the TANWAT Company Hospital in Njombe as part of their studies at the M.Sc level in Global Health.

“A growing number of globally conscious individuals are looking for a way to effect global health change,” says Buck. “Many of these individuals have started looking towards nursing as a means to gain practical skills and knowledge that will enable them to work in international settings.
The McGill School of Nursing’s two-year Global Health Studies option provides students with global health content throughout the program. Students complete their final year clinical component in an overseas placement to further help them to develop the skills needed to work internationally.

The Global Health Studies section sets out to prepare nurses for the challenges of working with diverse populations in limited resource environments with a philosophy stressing the importance of understanding the inherent power dynamics, equity issues and ethical dilemmas that arise through this work. It is based on a belief that we have much to learn from one another.

Ms. Leimanis and Ms. Bocking will be looking at home-based care and antiretroviral adherence challenges in TANWAT Company Hospital and Villages. The TANWAT Company Hospital in Njombe is a training partner with McGill’s School of Nursing.

The work of these students extends efforts by McGill nurses Christina Clausen and Sylvie Lambert who went to Tanzania in 2006 and 2007 as McGill Nurses for Highlands Hope Fellowship holders. Ms. Clausen worked to identify opportunities for McGill University partnerships with Highlands Hope of Tanzania clinical agencies and Ms. Lambert developed and implemented a pilot training module on pain assessment and management with Highlands Hope nurses in Njombe that is a template for the development of the McGill School of Nursing Clinical Training Series that the Global Health Studies nurses will be building on next fall.

“It was a life and career-changing experience to go to Tanzania,” says Highlands Hope Fellow Sylvie Lambert who is now pursuing post-doctoral studies in nursing. “Our colleagues in Africa face almost unimaginable challenges, but their spirit and dedication is an inspiration.”
Canadian Friends of Highlands Hope is honoured to support McGill Nurses for Highlands Hope in their efforts to:
• Expand professional nursing relationships across continents.
• Provide instrumental resources to support sustainable Nursing projects originating from the Highlands Hope Nurse-Counsellor Network.
• To facilitate the Highlands Hope Nurse-Counsellor Network in establishing South-South funding sources and partnerships.
• To assist Highlands Hope Nurses in documenting and disseminating their knowledge and the outcomes of their nursing interventions.
• To provide educational and research opportunities for McGill University Nursing students.

For more information about Highlands Hope of Tanzania, visit their website at www.highlandshope.com. For interviews, contact:

Prof. Madeleine Buck
McGill School of Nursing, (514) 398-4155.

Royal Orr
Canadian Friends of Highlands Hope, (819) 432-0420.

On the 25. 2. 08 and 21.2., the committees sat together and discussed following topics:

Solidarity march:
In the discussion about the solidarity march, the budget issue was questioned because in the review of the previous march, we remember that the budget was prepared not well enough, we had money problems. We are afraid the budget will be finished too fast again, it should be prepared early enough.

Doing the solidarity march is very good, and we know that the budget for it would not be the same like our administrative one. If the budget is prepared very well, that the march could be really good and it would be easy.

The is hope for a big success for PIUMA marching into the villages:
- we can reach areas which PIUMA has not reached yet
- PIUMA could attract new members
- There can be teachings about HIV/ Aids and people can be tested
- People can decide if they are free to get counseling from the PIUMA`s
- Even PIUMA members can prove and test their health in this way

Nutrition program:
It was decided that we should be with an nutrition program, but without buying the grinding machine. The 1500 dollars of the Canadians should be used for the PIUMA`s building, as the will to finish it is very strong.

Choir project:
It was agreed, that we will go ahead with the choir- project, after getting the needed financial resources from Jackson. Then the training can start.

PIUMA VCT- Center:
PIUMA`s VCT- center was closed down because the nurses have been intimidated. We got a a letter from the doctor in charge of BLH (Bulongwa Lutheran Hospital), which said, that the VCT has to be closed because there is no staff and the leadership has left PIUMA, so they can not care for their patients properly.

The General Secretary and the Chairman are going to meet the District Coordinator for HIV/ AIDS to discuss this issue.

Ahsante

Witness Ngumba.

PRESENT
1. E. KAYOMBO PMCTC COUNSELOR TANWAT HOSPITAL
2. B. SANGA NURSE COUNSELOR IKONDA HOSPITAL
3. O. MAHENGE NURSE COUNSELOR IKONDA HOSPITAL
4. B. LIDUKE NURSE COUNSELOR TANWAT HOSPITAL
5. P. MFUSE NURSE COUNSELOR IKONDA HOSPITAL
6. M. MSIGWA NURSE COUNSELOR IKONDA HOSPITAL
7. L. SAMLONGO NURSE COUNSELOR IKONDA HOSPITAL
8. S. MANGA NURSE COUNSELOR IKONDA HOSPITAL
9. M. MAHENGE NURSE COUNSELOR IKONDA HOSPITAL
10. E. MADUNDA NURSE COUNSELOR IKONDA HOSPITAL

APOLOGIE S
1. TASILO MDAMU STUDENT PHC IRINGA
2. ELEKIA MSIGWA HBC COUNSELOR TANWAT HOSPITAL
3. ANAHILDA MTEGA ADHERENCE COUNSELOR TANWAT

LEFT THE NETWORK:
Macksenzia Manga joined advanced diploma in midwifery Mbeya 2008 intake
Charles Mhagama joined advanced diploma in general nursing Mbeya 2008 intake
Melina Chalamila followed her husband in Dar es salaam

AGENDA
1. Opening
2. Reading of the past minutes
3. Matters arising from past minutes
4. Computer training
5. Topic presentation
6. Closing

OPENING
The meeting was been opened by the chairperson, Evangelista Kayombo, who thanked all members for coming. She asked to the member if we can start the meeting or we should wait for others. Members suggested continuing with the meeting as the time is ready to start.

Reading of past meeting minutes:

Chairperson asked one of the member to read the past report and followed with discussing of the report which one of the member asked if the bank account is ready opened, The answer from the coordinator B.Liduke was not yet as she got an information that the treasurer has already left for joining more studies thus made him not join the team in Njombe for the process of opening the account.

Conclusion:
All members agreed to elect another treasurer for replacement where by Mrs. Onolina Mbilinyi was elected to take the position.

Another question was about the secretary who took the position of Mr. Tasilo Mdamu: why not attending the meeting and no contribution for the membership? Chairperson said following our constitution if the HHT member does not appear to the meeting without information and not paying the contribution means that he/she is not longer a member.

Conclusion
All members agreed that there is no need of doing election for the secretary as Mr Tasilo is finishing his studies soon (June 2008) so the vice secretary has to do the work.

Other matters:
Members agreed to write a proposal for continuing education for nurse counselor and be put into the plan this will help to know how many members are going for further studies and it will be easier also to ask help from HHT friends.

Computer skills training:
Members agreed that those 7 counselors who are not undergone computer training should start as the desk top computer is already been bought but they need to contribute for the fees as one program cost 20,000 Tsh per person and almost 4 program is needed per person total cost per one person will be 80,000 Tsh for 7 will be 560,000 so it will be good for those who are starting the training to contribute some as we have been doing before.

Time of meeting:
Should not be changed but every member should know her/his responsibility of attending the meeting without delaying the time.

Accounting reports see attachment.

Topic Presentation:
This was been prepared by Tasilo Mdamu and presented by Sr. B.Liduke (see below).

Closing of the meeting:
Before closing the chair announced the next meeting will be on 7th June 2008 and member agreed to have the topic on HOW ARVs WORK AGAINST HIV and they suggested finding the doctor for presentation; Ikonda nurse counselors are responsible for the matter.

The meeting was closed at 1:30 pm East Africa time

Prepared by
B. Sanga,
Vice treasurer

PRESENTATION OF WHY ONE OF COUPLE WITH HIV POSITIVE LIVING TOGETHER REMAINS NEGATIVE FROM HIV.

DATE: - 1st March 2008

PLACE: - Ikonda Consolata Hospital

Participants: - HHT Nurse Counselors

What is couple?
Couple means two persons normally male and female living together more than six months voluntarily (without being forced by anybody).

HIV
Human Immunodeficiency virus.

HIV Positive.
Some body being with human immunodeficiency virus infection within his/ her body.

What is happening to this couple?
First we have to remind ourselves on the mode of transmission and fluid caring virus.

Mode of transmission.
Through sexual intercourse
Infected blood transfusion
MTCT ( Mother to Child Transmission)

Fluids carrying virus.
Several types of body fluids carry virus, but the following are the richer in hosting virus, these are;
Blood
Semen
Vaginal fluid
Breast milk

So far let us look what is happening to this people living together by implementing the work of increasing the people in the world and the task of fulfilling of the needs of each other as are couples.

The following are some factors that can precipitate, reduce or inhibit the HIV transmission.
Amount of virus received (Dose).
Trauma.
Frequency of coitus
Morphology of receptors

Amount of virus received (Dose).
The big dose you receive the more you create the infection. We have to know that the body has the ability to fight against any kind of infection. When there is small/ few infections that means could within the ability of body to fight it.

Trauma.
Trauma occurs during sexual intercourse when the action is done without preparation esp. for women, rough sex, more frequent per day. Any trauma on the penis or vaginal wall allows easy HIV penetration, so we have to avoid that kind of sexual intercourse.

Morphology of receptors.
In order any infection enters the body establish its life in the body, grow and multiply it needs the conducive and acceptable surrounding that can favor it. Receptors are the cups like structure which virus it enters the body goes direct to the receptors for binding with other protein for starting the process of invading lymphocytes for sake of multiplication.

It has been that the abnormality of the receptors (cups) makes the virus uneasy to recognize the receptors this hinders the virus on binding with other protein and process of multiplication not to happen.

View video

Prepared by
Tasilo B. Mdamu

Presented by
Betty Liduke
March 1, 2008

“We’re excited to be moving forward with this,” says Associate Director of the McGill School of Nursing, Prof. Madeleine Buck. “This builds on the very positive relationship that we have with TANWAT and with nursing leader and Highlands Hope of Tanzania Coordinator Betty Liduke in particular.”

Two McGill Nurses for Highlands Hope Fellowship holders have worked with Betty in Njombe and Ikonda. The first Fellowship holder, Christina Clausen, helped with the formal establishment of Highlands Hope of Tanzania in early 2007. Sylvie Lambert, the second Fellowship recipient, recently returned from a three month visit where she developed a professional training module on pain assessment and management with TANWAT and Highlands Hope healthcare workers.

The McGill University School of Nursing is already planning for two MSc students to be at TANWAT for the Fall 2008 term. These students will be doing advanced studies on issues that have been identified by Highlands Hope of Tanzania nurse-counselors as areas of professional concern.

Watch for more updates as this exciting partnership continues to grow!

According to the expressed interest of the nurses at TANWAT, the overall pre-departure objective of this project was to pilot a first education module on pain assessment and management in pediatrics (see web entry November 8th 2007). As soon as we began to develop the module, the health care professionals at TANWAT were involved in determining its format and content. A series of short pain workshops was identified to be most appropriate as previous professionals development activities in this setting had been implemented using this format.

To determine the workshops content, the staff’s pain information preferences and approach to pain management were explored in more depth by conducting individual interviews, a group discussion, and regular clinical observations, particularly when participating in the morning rounds. In addition, questionnaires, including a pre-workshop pain knowledge survey, were distributed to nurses at TANWAT and Ikonda.

Specific questions explored included: “If a pain seminar is offered to nurses, what topics do you think should be included? What strategies do you use to alleviate/decrease pain? What types of pain are most often seen? How do you determine if a patient is in pain?” Together, the information gathered was integrated in the planning, implementation, and evaluation of the workshops.

Health care professionals identified pain as the most common symptom they face in their daily practice. Although an interest for pain in both adults and children was identified; a particular importance was given to pain in pediatrics as health care professionals felt a strong responsibility in recognizing when the extent of a child’s pain might go unrecognized due to children’s limited communication skills. Additional topics of interest included: identification of pain, types of pain, neurophysiology of pain, and pharmacological and non-pharmacological management of pain.

Accordingly, four pain workshops were developed:

1) pain assessment part 1: definition of pain, types of pain (e.g., neuropathic pain, referred pain), myths and misconceptions, and pain assessment in adults, including use of pain measurement tools,

2) pain assessment part 2: pediatric pain assessment and non-pharmacological strategies for procedural pain,

3) pain neurophysiology and non-pharmacological strategies, and

4) pain management principles and pharmacological strategies with a particular focus on reviewing the World Health Organization analgesic ladder.

Each workshop lasted between 60 and 90 minutes. Learning strategies used consisted of didactic lectures to discuss the main topics and provide new information, flip charts to facilitate communication, providing Power Point handouts with detailed information about the topics discussed, and presentation of clinical cases and role plays inspired from practice. In addition, I was regularly present in the clinical setting to further support the integration of knowledge and to determine, with nurses, the applicability of learnt skills to patient care.

Clinical outcomes of the workshops included integration of pain as the 5th vital sign, adaptation and use of a pain assessment documentation sheet, use of pain measurement tools, and implementation of some non-pharmacological strategies for minimizing procedural pain in children. Feedback questionnaires were distributed to workshop participants and overall comments were positive, particularly the use of role play, and allocating enough time to practice new skills was favored.

This was my first trip to Africa, and although I had tried to prepare in many ways, I really did not know what to expect. My journey to Njombe was exhilarating and exceeded all possible objectives I may have had. I brought back many souvenirs from Africa, however those that are most precious to me, were not the ones packed in my suitcases.

During my stay at TANWAT, I was particularly inspired by the enthusiasm of the staff to embark upon this project. Despite an already busy schedule and managing daily care challenges, the nurses and medical officers were willing to participate in the planning of the workshops. It is through these exchanges that we learned how we should go about implementing the workshops and how we can combine our experiences to make it happen. It is also through these exchanges that relationships were forged and led to going above and beyond to ensure that the workshops would benefit everyone.

The most important lesson I take away is: ‘just listen’. At times, it might be challenging to ‘just listen’, without responding or offering a ‘solution’ or making comparisons with our own approach to care. I think ‘just listening’ permitted a more in-depth exploration of perspectives and it invited others to provide suggestions and directions. The pain resources that I had brought with me were helpful, but the conversations with the other health care professionals provided the most important information upon which to develop the project.

Listening takes time (pole pole) and sometimes it might feel like one is standing still or even moving backward, however I realized, in the end, we were moving forward even faster than I thought.

Shukrani zangu kwa wafanyakazi wote wa TANWAT kwa kushiriki kwenu na kunisaidia katika maandalizi ya warsha yetu. Asanteni sana.

Sylvie Lambert,
McGill Nurses for Highlands Hope
Montreal, Canada

INTRODUCTION
By the end of 2005 and estimated 24.5 million adult and children was living with HIV in sub-sahara-Africa. During that year of 2 million people died from AIDS. The epidemic left behind some 12 million orphaned children (UNICEF report 2005) most individuals are un aware that they are infected, with young women being the most vulnerable group. Mobility and poverty continue to contribute to the high prevalence rate. In Tanzania 7% national rate among adults translating approximately 2 million Tanzanian of these 1 million are in need of HIV care and 400,000 are estimated to be in need of treatment with anti-retroviral therapy.

HIGHLANDS HOPE OF TANZANIA

HHT is a small network of health professional and community who are struggling on frontline to fight HIV/AIDS pandemic that scything through people of rural area in mountains district at southern highland basing Njombe and Makete district.

The nurses, organizers and ordinary patient involved with Highlands Hope are courageous, committed and racing the clock to bring education, testing and anti – retroviral therapies to thousands of individual who are PLWHAS, widow, widowers and orphans who’s already in difficulty lives which have been made almost impossible by HIV/AIDS.

Highlands Hope demands justice and better treatment for the people of rural Tanzania (Njombe and Makete district). The Highlands Hope HIV clinics have provided counseling and testing to more than 3000 patients.
The increase rate of HIV/AIDS in Njombe and Makete district made inaquate health care centers, care and treatment and voluntary counseling and testing services thus made Highlands Hope network start addressing long term care and issue to PLWHAS.

HIGHLANDS HOPE CENTRES AND PARTNERSHIP

Ikonda CTC, TANWAT CTC, PIUMA and other NGOS Kibena Women Association and CHAKUNIMU and partners St Georges school Canada, Mcgill school of nursing Canada EAWM in Austria and Friends of HHT have invested substantial amount of money and created impressive network of trained and volunteers who have demonstrated their ability to provide dozens of villages with great efficiency. The argument the impact of professional allows the entry of HIV education and testing into village life in away that is impossible without it.

ACTIVITIES CARRIED OUT
• Awareness of HIV/AIDS to community
• Voluntary counseling and testing
• Care and Treatment services
• PMCTC services
• Home based care services
• Supporting and care of orphans and children with difficulty situation
• Nutrition counseling
• Research program

PROJECTS CARRIED OUT 2006-2007

With support of EAWM Austria, St Georges School Canada, McGill School of Nursing Canada and Friends of HHT the following projects have been performed.
1. Capacity building to widow/widower ( Kibena Women Association HHT and St Georges school)
2. Care of orphans at schools ( Kibena Women Association HHT and St Georges school)
3. Computer skills training ( HHT nurse counselor and Mcgill school of nursing)
4. Support nurses with funds:- Mcgill school of Nursing and HHT friends
5. Tasilo Mdamu advanced diploma at PHC Iringa supported with learning material
6. Flora Haule diploma at Ilembula school of nursing suppoted in school fees to finish forth year 2008
7. Betty Liduke and Jackson Mbogela supported in attending the HIV conference in Toronto Canada
8. Pain assessment and management workshop at TANWAT hospital done by Sylvie Lambert from the McGill School of Nursing

9. Conducting standby and mobile VCT PIUMA, EAWM
10. Solidarity walk PIUMA, HHT friends
11. Research of PMCTC this is ending on 15th February is carried on by the student nurse Tasilo Mdamu and HHT nurse counselors the main objective of the research is to find out why mothers with HIV after delivery they don’t turn up to CTC and the area of interest is Makete district.
8. Care and Treatment Ikonda and TANWAT
9. Trainings to Peer Educators and village HIV committee TANWAT

Published: November 7 2007 02:46

It is 7.45am and the sun is beginning to warm Bulongwa’s icy mountain air. A Toyota Landcruiser appears at the crest of the hill, rattles down the slope, and stops at a pair of painted road signs that mark the village’s social apex.

It is the only public transport that serves Bulongwa, a speck in Tanzania’s southern highlands, and its lifeline to the outside world. But with 12 passengers sitting knee-to-knee on benches in the back, it looks full.

Nine villagers, however, are not deterred, because they need it to get to the next settlement 21km away – a metropolis by Bulongwa standards – where it is possible to buy fresh meat, tomatoes and water buckets. Five women squeeze themselves between the legs of those who are seated, and four men step on to the rear bumper outside, clinging on where they can with frosty fingers.

Then the discomfort really begins. The clay track to Makete, the district capital, is cracked, ribbed, rutted and strewn with rocks. The Landcruiser judders up and down for an hour and lurches left to right, giving passengers the equivalent of a rodeo ride. But they are the lucky ones. Most of Bulongwa’s 1,437 inhabitants are peasant smallholders confined to the village and their clay brick homes by poverty. They cannot afford the TSh2,000 ($2) fare to Makete, let alone TSh10,000 for a four-hour ride on to Njombe, a real town where there is bread, cheese and a bus station.

“The transport is too hard, especially in the rainy season,” says Edwin Swallo, Bulongwa’s acting ward executive officer. Wet weather between November and April, he explains, pushes up the Landcruiser fare and often makes the road impassable: “Communication is very important. Here we are dormant.”

Bulongwa is very poor even by Tanzanian standards. Like thousands of other villages, it matters little to anyone other than its inhabitants, but collectively these settlements make the country what it is.

Many have no electricity, no stand pipes for water, hole-in-the-ground toilets, and inadequate healthcare. But it is their isolation, the result of bad roads and worse public transport, which makes life so tough for their inhabitants – especially the women and children who are the workers of the rural economy.

To visitors who pass through dozens of flat, dust-blown villages on the way to Bulongwa, its plunging green slopes, filled with trees and shrubs, are enchanting. But for peasants the undulating terrain makes large-scale farming impossible. Most have little surplus left to sell once they have eaten what they need.

Sitting in a flower-lined garden outside her clay brick home, Grace Nyivambe, a peasant aged 50-something, says she subsists on the maize and wheat grown on her plot and – in a good year – produces about eight litres of peas for sale from her garden. They earn her about TSh8,000.

It is not a competitive price, but most people in Bulongwa grow peas of their own and she is a captive seller to the village’s roadside vegetable trader. She would probably get a better price in Makete, but the cost of public transport would wipe out the gains. The three-hour walk would be too tiring and, while a richer diet would make her stronger, the price of food ferried in from outside Bulongwa puts it beyond her reach.

Like most villagers, however, Ms Nyivambe is not inclined to complain. “I’m not content, but there’s nothing I can do,” she says. Asked how the government could help, she replies: “The government can’t do anything. If they could they would.”

Nord Sanga, Bulongwa representative of the ruling CCM party, says: “Quality of life here is good because most people don’t need more than they can get. But, for people who want more, it is bad.”

Inaccessibility has contributed to the impact of an affliction that has hit Makete harder than almost anywhere else in Tanzania: HIV/Aids. Official statistics say that between 14 and 17 per cent of the adult population in the district are infected, but Jackson Mbogela of the Piuma HIV care centre in Bulongwa says his organisation’s tests suggest a rate more like 21 per cent.

The disease reduces the work capacity of infected peasants and, at the village’s primary school, 114 of the 248 pupils are orphans, many of them living in households led by their siblings.

Mr Swallo says HIV/Aids was brought by men who were driven by a lack of opportunity in Bulongwa to seek work on distant tea or timber plantations, leaving their wives in the village for two or three years.

“They came back with something called HIV and they planted it in the district,” he says. The disease’s spread was accelerated by a local tradition through which the brother of a dead man will take on his widow as a wife. “So if I die, I will have infected my wife, and then when I die, my brother will be infected too,” says Mr Mbogela.

Awareness of HIV/Aids is low because few district officials, non-governmental organisations or newspapers reach the village. Before 2000, it was even difficult to get radio reception.

One NGO that has got to Bulongwa is Students Partnership Worldwide, which each year sends one Tanzanian and one western student to live in the village and teach school children about reproduction, contraception and HIV/Aids.

Vicky Riley, one volunteer, has been barred from teaching about condoms because her head teacher says it would encourage children to have sex – even though the incidence of teenage pregnancy shows they are doing so already. “Girls lack confidence and it’s important to teach them how to say no to sex,” she says.

Mr Sanga, the CCM representative, acknowledges Bulongwa’s transport trap. But he says the district office does not have enough money to both maintain the road and grade new sections. “There are lots of people in the same position,” he says. “But not enough people use this road to make it worth their while.”

PIUMA held the second in a series of training workshops on financial management for volunteer leaders and staff in late December. Rayben Sanga, an accomplished professional accountant from Dar es Salaam, is a wakinga by birth who has worked tirelessly over the years to help his home region of Makete. He is also a Trustee and member of the Advisory Committee of PIUMA.

“It was a very nice and effective training,” said Jackson Mbogela, former Coordinator of PIUMA and current Trustee. “Our leaders are better prepared to make budgets, to prepare and review books and financial reports, and to plan for the budget needs of the organization.”

PIUMA is committed to the recognition of decent health care as a basic human right, especially in the fight against HIV which is ravaging the Ukinga, and is proud to share in Tanazania’s historic democratic traditions of local leadership and decision-making.

I hope everyone is having a great holiday season! Although, for the first time, I am away for Christmas several happenings reminded me of nyumbani without feeling too nostalgic (actually made me smile).

On Christmas Day, Betty and I were at the Kibena Market and I was surprised to hear ‘Petit Papa Noël’ on Radio Africa – A ‘classic’ Christmas carol for me. Those of you who met Betty will not be surprised to read that she knew the lyrics and began to dance. We also sang and danced to ‘Jingle Bells’ at a local music store. There is something quite special about hearing ‘Silent Night’ in Swahili - Usiku Mtakatifa. Overall, family gatherings, multilingual singing, and dancing characterize the holiday season in Njombe.

December 26th was a happy day for the orphans and their caregivers invited to the Kibena Women’s Association (KWA) Orphanage/Boxing Day at the Kibena club. KWA initiated ‘Orphanage Day’ last year and hopes to carry on with this annual event in the future.

KWA is a group of 10 women offering support to 16 orphans (3-15 years old) and their caregivers living in Kibena village through a variety of activities, including home visits to distribute essential supplies such as sugar, rice, and soap. The members of KWA are teachers, nurses, and accountants volunteering their time. Most of the orphans’ parents passed away from HIV-AIDS and several of the children are also HIV positive. Caregivers include members of the extended family such as elderly grandparents and neighbors, struggling to support their own families. KWA funds its activities mainly through yearly membership fees and the women’s additional personal contribution (not counting the incalculable hours volunteered). Supplementary moneys are also obtained from local and international donations.

A total of 26 orphans were present for the Boxing Day festivities, in addition to the children supported by KWA, the group invited 11 orphans and their caregivers from the neighboring Kofu Orphanage Centre.

Members of KWA arrived early at the Kibena club to decorate the room; balloons and pink and white draperies were hung from the ceiling and contributed to the festive ambiance. The group of women had been preparing this event for quite some time and they were eager to distribute the gifts to the children. KWA sponsored the lunch and purchased school supplies, shoes, uniforms, blankets, and soap for the children. Also, KWA offered blankets and soap to members of the Kofu Orphanage Centre to distribute to the orphans in their community. Each child’s ‘goodie’ package was carefully prepared to best respond to their needs.

Guests of honor including, the District Adult Education Officer, the Chair of the Njombe Youth Development Association, and the Kibena village Chairman, offered the children their gifts. In addition, no event in Tanzania goes without dancing and singing, the KWA members and guests soon filled the dance floor to the sounds of rhythmic Swahili music. It is not possible to stay sitting down during this time, even if you are like me and have no rhythm! Games were organized for the children including musical chair and a version of “Simon Says”; which would have been difficult to play as I am still confused about the names of the body parts in Swahili.

The celebration’s atmosphere echoed the true spirit of Christmas. KWA brought together community members, leaders, children, and their caregivers to share a meal and enjoy this special day. Christmas time is often a moment when there is magic in the air and dreams come true. For most of the children and their caregivers, having access to the materials distributed was a dream come true! Oh yes and Betty was Santa Claus! This is a Christmas that I will remember.

I don’t feel that this brief description does justice to the benevolence and dedication of the KWA members nor to the happiness that KWA brought to the children and their caregivers that day, however I hope it does provide a glimpse into the resourcefulness and type of activities that are organized by community groups here, like KWA.

Star TV and the Njombe local radio station were also present. The Kibena village Chairman visited Betty the next day to thank KWA and congratulate its members. Indeed, Hongera Sana for a wonderful day!

In addition to Highlands Hope and other international contributors, I would like to extend a special asante sana to my family and friends for their donations to KWA.

Wishing you all New Year Njema,

Sylvie

Much of what I wanted to say in this series has been well said by the Dar es Salaam Regional Commissioner, Abbas Kandoro.

When marking the World’s AIDS Day in the Dar es Salaam Region, Kandoro started by condemning some of the AIDS control institutions for failing to do their job.

But Kandoro explained that his region has already contributed more than TShs. 1billion approximately US$1million one million dollars to empower such institutions. However, he said that he is very surprised that figures of HIV infected people are still high. There are 469 NGOs dealing with just one issue of fighting against AIDS.

I will quote a fraction of his speech: “I have tried to visit the stalls in these grounds and I have noticed many things. There are many NGOs, but they are dealing with petty issues and also I have realized that there is no harmony among these groups. Now, mates, let’s wake up and get to work, because this pandemic does not belong to one person only.”

He concluded his speech by saying that if things continue at this pace then donors who donated funds for raising awareness of the scourge will be discouraged.

Maybe what Kandoro was not aware of is the fact that there are signs that some of these donors have started getting tired of providing funds. Those who continue to donate monies are businessmen only who would not want to see the end of AIDS.

Another thing that needs research before one delivers their speech and a rally is to look at the fact that the more money pours into the country for the AIDS campaign the better the lives of people who involve themselves with the HIV activities become and they richer they become. Had the Regional Commissioner done his homework he would have not been astonished by something that is widely known; AIDS funds do not reach the targeted people.

AIDS reports have been extensively written. Reports that NGOS dealing with HIV and AIDS campaign do not deliver have been published at length. In Tanzania, leaders have vehemently condemned the embezzlement of AIDS funds. The question that one has to ask themselves is, why is that these NGOs do not change, are not afraid and are not concerned?

Another person could respond by asking concerned about what? Why should these NGOs be worried while things from the highest level in the war against the scourge are disorganized?

In his speech while marking the AIDS Day nationally in Tabora Region, President Jakaya Kikwete said that the war against AIDS is tough and that the pace has to be increased.

He said that there are two objectives of this campaign against the pandemic: the first one is to intensify efforts of control the infection and the second one is to offer better care to those living with HIV and AIDS.

Do the people at the forefront of this campaign know the methods of preventing new infections? It is possible that they know this because most of them are experts. But do they implement what they preach?

I would not like to say much about the issue of the care for people living with HIV and AIDS, because it is such a wide topic. How can we assist this is person? By offering anti-retroviral drugs (ARVs)? And that is it? How many people have died after being given ARVs and how many would not have died if they were not supplied with these drugs? How are we, as a country prepared to deal with the side effects from these anti-retroviral drugs?

From my understanding and little knowledge on health issues is that when one is found that they are HIV positive after being tested, what follows is to investigate how much have the virus destroyed his immune system. This is when the machines are needed to measure the person’s CD4 Counts.

Why is it necessary for the person to be tested before being given ARVs? A person is supposed to be tested for obvious reasons. But the one who has the virus is supposed to use the drugs only when their CD4 counts are less than 300. Normally a health person whose immune system has not been infected has between 800 and 1,500 CD4 Counts is their body.

Because we do not have enough machines many patients’ CD4 counts are not tested. There are people with 1,250 CD4 counts who are already on ARVs. When one starts to use the drugs has keep on doing that continuously everyday throughout their life.

But the one with CD4 1250 could have stayed for three to four years without using the drugs and could start the treatment when their immune system starts to drop.

So putting this patient on ARVs is to causing a huge loss to the nation and also to himself/herself because the process of taking the drugs on a daily basis is not as easy as it is written in newspaper pages.

Why is that people are not tested for their CD4 Counts before they embark on ARV therapy? Is it because of stupidity or is it because of personal reasons? May be the experts at the Ministry of Health and Social Welfare could explain this to us why there are only 20 CD4 count machines in the whole country and make it impossible for many infected people reach this service? Well, because they are unable to speak out, I will speak on their behalf.

The world is full CD4 testing expertise. But in Tanzania we have agreed to go into marriage partnership with an American company, Becton & Dickinson (BD). This company produces FacsCount CD4 machines using a very expensive technology. In order to test CD4 Counts the government has to use about US$40 per test. This means this equipment requires one person to pay about TSh.45,000.

Other countries such as Malawi, Zimbabwe, Nigeria, Mozambique, Sudan and Kenya, use a different technology. The equipment used in these countries is CyFlow machine. They are German machines. One test costs US$2. It means that one patient will need about TSh. 2,500. But using the American machines the patient will need TSh. 45,000. Two people are required to operate the machines that we Tanzanians have decided to use. Either your country has to be filthy rich to use these machines or some of your experts have to be totally stupid. We are not rich.

And to demonstrate what type of people we are, we have allowed the German machines to be used in private hospitals. So the technology that costs TSh. 2,500 per test have been allowed to be used in private hospital, where the government does not pay anything except workers’ salaries; and the technology that costs TSh. 45,000 per test is used in government hospitals. We are told that the test is for free. But we are not told that it is the government that carries the burden of the cost by using donors’ funds and taxpayers’ money. Ask the experts why they have failed to provide every hospital and dispensary the CD4 Count machines, and you will here their political rhetoric.

Recently we heard about Bugando Referral Hospital which has bought a new technology for testing the HIV status of infants under five months of age.

This is the first technology of its kind especially for testing children in the country. I would like to commend Bugando Hospital.

At the moment, only 18 month old toddlers can be tested for HIV. The Minister of Health and Social Welfare Professor David Mwakyusa who was present during the inauguration of the machine said that the technology has come at the most opportune moment as it is in parallel with the Voluntary HIV Counseling and Testing campaign.

I would like to congratulate Bugando Hospital because this technology will help children.

But I would like to ask Mwakyusa this question: Do you remember four years ago when this programme was to start in the country including testing of CD4 counts and to know the CD4 counts of toddlers which even the Bugando new machine has not yet started testing? Should we say that any HIV programme in Tanzania has to be supported by American donors?

Because it shows that without the American hand, nothing in the war against AIDS can be done without any hindrance. People have been made to believe that even Salama condoms are only safe when the Americans are involved. Which direction are we heading to in this campaign against AIDS if the Americans are privatizing this war? Or is it because of the money from Bush and his PEPFAR? Efforts by Bush are good, but its goodness should not allow them to go overboard to the extent of deceiving and luring us to use only goods from his country. That is business not services to the community.

The President’s and Kandoro’s concern is that despite all these efforts to fight the scourge, we still have more new infections. One of the reasons why the infection rate is still high is that we are not well organized. Let’s first start with allowing competition in acquiring the technology to fight the scourge. We should not allow monopoly which will benefit a few people, who unfortunately are well known.

I keep on asking myself how the new Bugando technology can work if it would not be able to determine the CD4 count of an infant! Or will they be using FacsCount machines and A Lymphocyte and compute? But whatever they do they should remember that if the Ministry of Health had allowed competition, the technology to help children so that they could start treatment when their status is confirmed is available in the world outside the United States of America.

What is needed is to allow another technology to work in competition with the American machines. If this is allowed to happen, the child who is HIV positive could know his CD4 count in 15 minutes. Donors do not scare us because we have the power to fight against AIDS without getting a single cent from foreign countries. Our contemporaries fight this war without using a lot of money.

On the World’s AIDS Day, I was one of the people who were invited to the Austrian Parliament. This parliament highly respects and honours this Day and many times it invites people who have made some contribution in the war against AIDS from various countries in the world. I was one of them.

I have learnt a lot. One is managing finances. The Parliament Hall did not have any decorations. There were some leaflets which were made with the help of funds donated by students of Kenyogasse Secondary School. There was a vital message to their young contemporaries.

They said that the leaflets were made from affordable type of paper because the most important thing was the message it carried. They did not ask for any money from anyone. They did not have any T-Shirts and everyone wore their own casual outfit. The only costly thing was the candles which everyone brought with them.

They said that it is the patients who need the money and clothes. The President of the Parliament, Barbara Prammer was the one who addressed the gathering, saying that each HIV infection was a headache to Austrian leaders. There are 300 infections annually in the country. But this rate terrifies everybody. However, she thinks that her country owes a lot to developing countries, because her nation has not yet started to contribute towards the Global Fund.

Account from people living with HIV and AIDS from several African countries were very moving, because many believe that a huge amount of donated money ends in the pockets of people who are in offices dealing with this scourge.

I agree with them and their explanation. I did not want to go very far from what is happening in my own country, Tanzania.

I remember in 2005 on the World’s AIDS Day which was nationally marked in Songea, in their speech to the guest of honour, the then CCM Presidential candidate Kiwete, Tanzania Commission for AIDS Control – TACAIDS said that they had organized to start a HIV registry for the whole country. The cost of that registry was TSh. 2 billion shillings (US$2m). Some of us laughed because we knew where the money would be channeled to.

I would like to conclude by quoting Charles MacCormack of Save the Children. His confidential Memo which he wrote in 1993 was grabbed by a book author Michael Maren and published it in the book titled, “The Road to Hell”. The Memo said: As communities often receive a small portion of the sponsor’s contributed dollar, they are obviously going to ask questions about where the money goes. All the explaining in the world would not make this question go away or our own strategy look good in an investigative report.”

December 26, 2007.

Austrian development worker Elisabeth Zenz has created a blog that reports on the PIUMA visit and also on her own work with the Austrian Lutheran development agency EAWM in support of PIUMA’s efforts advocating for basic health care as a human right and for an end to the stigmatizing of people living with HIV-AIDS in rural Africa.

Elisabeth’s blog (in English and German) is available at:

elisabethzenz.blogspot.com

PIUMA’s nurse-counsellor Mary Musoma and coordinator Jackson Mbogela have worked at a ferocious pace with PIUMA volunteers and village leaders to make this outstanding contribution to the national testing effort announced by President Jakaya Kikwete last summer.

PIUMA held counselling and testing clinics in sixteen villages and also at a local secondary school in Mwakavuta. Makete District is thought to have one of the highest prevalence rates for HIV in all of Tanzania, with estimates of 18-20%. Results from PIUMA testing were encouraging, especially from the secondary school.

Among the 1,850 people tested, 230 were HIV positive, or about 12-13%. About 50% more women than men sought testing. 178 tests were done at the clinic at Mwakavuta Secondary School; only one female tested positive.

In her monthly report on activities, PIUMA nurse-counsellor (and Treasuere of Highalnds Hope of Tanzania) Mary Musoma writes:

The number of villages for the mobile VCT in Nov was 16 villages and one secondary school. Achievements were very good.

1) The rain is still raining so the road is very rough.
2) We need other nurses to work together.
3) Some villages have not been tested in the area, so it would be good if next time we started with those villages.

PIUMA is committed to increase village-based testing and home-based care services and has called on the Government of Tanzania to grant it a licence to operate full CTC services (dispensing ARV drugs and monitoring CD4 counts) on a mobile platform.

The conference was hosted by the president of the Austrian Parliament, Barbara Prammer and enabled NGOs to introduce their efforts to fight HIV/AIDS.

Mrs. Sanga concentrated on the role of PLHWA (people living with HIV-AIDS) in prevention and care. She was applauded by the audience when she demanded more commitment from state and church officials because PLWAH “have a human right to get proper medical treatment.”

The PIUMA General-Secretary was accompanied by Gerhard Raxendorfer, a HIV-positive volunteer serving with PIUMA in Bulongwa, and by Elisabeth Zenz, EAWM employee and interpreter for Wema.

Gottfried Mernyi

HIGHLANDS HOPE TANZANIA
NURSE COUNSELOR MEETING REPORT
1ST DECEMBER, 2007

Attendance
Evangelista Kayombo PMCTC Counselor Ikonda Hospital (Chair of Highlands Hope of Tanzania)
Charles Mhagama Counselor/HBC Ikonda Hospital
Leonia Samlongo Counselor/HBC Ikonda Hospital
Maria Mahenge PMCTC Counselor Ikonda Hospital
Sixberta Manga PMCTC Counselor Ikonda Hospital
Potania Mfuse PMCTC Counselor Ikonda Hospital
Optatus Mwalongo DCT Counselor Ikonda Hospital
Evelina Madunda PMCTC Counselor Ikonda Hospital
Onolina Mahenge VCT Counselor Ikonda Hospital
Rose Msigala Counselor/HBC Ikonda Hospital
Elekia Msigwa Counselor/HBC Tanwat Hospital
Sylivie Lambert Nurse Mcgill University
Annahilda Mtega ART/Counselor Tanwat Hospital
Betty Liduke Nurse Counselor Tanwat Hospital
Tasilo Mdamu Student/Counselor Iringa PHC

Agenda
Opening of the meeting
Reading of past minutes
Matters arise from past minutes
Theme of the day ORHANS AND HIV/AIDS
Discussion after the topic
Closing of the meeting

OPENING
The meeting was been opened by the chairperson who thanked all members for coming. She said, “Today is a very special day to HHT counselors as is the AIDS day and having special wonderful day to meet again to discuss on Children rights especially Orphans/HIV/AIDS .”

READING OF THE PAST MEETING
One of the members read the minutes and members who were present at the past meeting agreed and blessed the minutes.

MATTER ARISE FROM PAST MINUTES REPORT
- Members agreed that those who are not going to pay the contribution as we have been agreed before are not live members so every one has to pay to be live and good member.

- Constitutions should be given to those who have paid their contribution

- Ikonda nurse counselor who are not yet under gone computer training are supposed to find a place where they can use as a class and HHT to buy one desk top computer for the use at the class and practice. Rose Sigala a nurse counselor of Ikonda was nominated to work on the issue and give report to the HHT coordinator.

THEME OF THE DAY
ORPHANS/HIV/AIDS AND THEIR RIGHTS
(see below)

OTHER MATTERS
Chairperson gave report on bank account that the account is not yet opened due to miscommunication from PIUMA nurse counselor but all members insisted that the account must be opened there is no need of waiting.

Members also discussed on the topic of the next meeting which they agreed together after long discussion to have the topic of FACTORS CONTRIBUTES ON THE COUPLES ONE TO BE NEGATIVE AND OTHER TO BE POSITIVE.

CLOSING
Chairperson closed the meeting by thanking all the members for their good participation during the meeting and she insisted by saying “UNITY” is the only thing to make the network grow and work smoothly. And last but not least, she announced the date of the next meeting 1st March, 2008, if God wishes.

Prepared by
B.B.Liduke

THEME: ORPHANS/ HIV/AIDS AND THEIR RIGHTS

TOPIC: MANAGEMENT OF ORPHANAGE CHILD

FACILITATOR: BETTY B. LIDUKE

OBJECTIVE
TO CREATE AWARENESS OF GOOD QUALITY OF CARE TO ORPHANS
TO HELP COUNSELORS TO KNOW ORPHANS RIGHTS AND THEIR NEEDS

MEANING OF THE WORDS

CHILD: 1. An individual who has not reached the age of puberty
2. An individual between the toddling stage and adolescence
3. An individual under 18 years of age

ORPHAN:
• Child who lost both parents
• Child who lost one parent

What are rights?
Rights tell you what you can do in society and what other people should do for you.
Rights tell you how other people must act towards you.

What are duties or responsibilities?
Duties or responsibilities tell you how you must act towards other people

In order to have rights, you have the duty to respect the rights of other people. And other people have a duty to respect your rights also

Examples:
• Governments have the duty to provide schools
• Parents have the duty to educate their children
• Children have the right to be educated
• Teachers have the duty to teach well
• Children have the duty to study hard

Why do children need special rights and care?

All human beings have rights. All members of the United Nations agree that human beings have equal rights without regard to their nationality, sex, colour, race, language, religion or any other status.

Children’s rights need special protection and care because children are mentally and physically young.
Many children also live in difficulty conditions. These children need extra care and help.

Orphans children needs to grow up in a family where there is happiness, love and understanding. Orphans children need peace, dignity, acceptance, freedom, equality, and support. Children need all of these rights to help them to grow up to become adults who will contribute to a good society.

What are the children rights?
The many different children’s rights stated in the convention can be organized into four different groups

RIGHT TO SURVIVE
These are all children basic needs, including the right to food, shelter, health and a reasonable standard of living.

RIGHT TO DEVELOP
These are all the things children need to develop physically, mentally, spiritually and morally.

RIGHT TO PROTECTION
These rights allow children to be protected from many things including violence, neglect, sexual abuse, torture and improper use of children labour .

RIGHT TO PLAY A PART OF SOCIETY
This means having freedom to express opinions and to be included in decisions that affect children. It means freedom to form groups or clubs and freedom to obtain information from different sources.

COMMUNITY RESPONSIBILITY
• Community has a big responsibility of caring orphans like other children
• Community responsibility to make sure orphans children are getting their basic needs like education, Health, Food, Shelter and clothing
• Community responsibility is to plan how they can help orphans children together with continuous plan of projects.

Summary

RIGHTS OF ORPHANAGE CHILDREN
• Live——– kuishi
• Security—- kulindwa
• Loved —— kupendwa
• Developed – kuendelezwa
• Information – kupata taarifa sahihi mbalimbali na kushirikishwa
• Independence/decision – kupewa uhuru na nafasi ya kuamua
• Not to be stigmatized – kutobaguliwa
• Play — kupewa muda wa kucheza
• Time to rest – kupewa muda wa kupumzika

CONCLUSION
Since 1991 Tanzania government has made a lot of progress towards promoting and protecting the right of children.

However, Tanzania still has a long way to go towards fulfilling children’s rights. Many children in Tanzania still do not ha all their rights respected. The government with our help must keep working hard to improve this situation.

LET US ALL TOGETHER PROMOTE AND PROTECT THE RIGHTS OF ALL CHILDREN ESPECIALLY ORPHANS CHILDREN LIVING WITH HIV/AIDS.

PREPARED BY
Betty Liduke
HHT Coordinator/Counselor

I was invited to attend two events this weekend underscoring world AIDS day. Saturday December 1st, Betty Liduke, 2 nurses from TANWAT, and I left Njombe early in the morning to attend the Highlands Hope of Tanzania nurse counsellors meeting in Ikonda. The nurse counsellors meet triennially and take this opportunity to discuss different issues related to HIV-AIDS. Case presentations are typically prepared by the counsellors and used to share important information.

At this meeting, Betty Liduke led an animated discussion on the rights and responsibilities of children and orphans with HIV-AIDS, including the meaning of individuals’ rights and responsibilities in general and within the Tanzanian context. Also, several continuing professional development activities were discussed, such as the future acquisition of a computer for online education. I took this opportunity to pursue our exploration of nurses pain information needs and distributed a questionnaire focusing on nurses’ preferences for pain information and knowledge and attitude about pain.

Also, during this visit to Ikonda, the second Highlands Hope Student Nurse Scholarship was presented to Flora Haule, a final year nursing student at Ilembula School of Nursing, Ilembula, Tanzania. Flora was excited to meet with us and was extremely happy to receive this scholarship. Her gratitude was very moving. Congratulations Flora on your accomplishment! I will have the opportunity to meet with Flora again when she visits Njombe within the next few weeks. (Students in the Saint Francis Xavier University nursing programme provided the money for the scholarship)

Sunday December 2nd Betty Liduke, health educators from TANWAT, and I left for Matiganjola to meet with other health educators from five villages: Kibena, Ibumila, Myombo, Utebetala, and Matiganjola. Together, the educators had organized several activities to mark world AIDS day. The theme of this day was: “Njombe bila ukimwi imawezekama” which translates to “Njombe without AIDS is possible”.

Throughout the day, different teaching strategies were used by the health educators to communicate HIV-AIDS information to the community. One of the health educators sang about the risks of contracting and transmitting HIV-AIDS when involved with multiple partners. Also, two role plays were organized by the health educators of CHAKANIMU. The first one dealt with some of the stigmas associated with HIV-AIDS, particularly addressing how HIV is and is not transmitted. The second role play addressed some individuals’ preference to seek initial health services from ‘witch/bush doctors’ and the inappropriateness of this service for individuals with HIV-AIDS. This was a particularly humorous role play as the health educator mimicked a bush doctor. The role plays definitely captured the audience attention.

In combination, these different activities provided the community with information about the prevention, transmission, and management of HIV-AIDS. Although I still do not understand most of the words, the teaching approaches used by the health educators were interactive and lively and contributed to a clear understanding the main message. I think this attests to the skilfulness of the health educators.

At the end of the day I was asked to say a few words, I quickly asked Betty to write on a piece of paper in Swahili what I wanted to say and I read it to the community. Again, I felt exceptionally fortunate to have been able to participate in the day’s activities and be part of the gathering of the community in an effort to prevent and fight HIV-AIDS. The organized activities and the skilfulness of the health educators in reaching out to the community were outstanding.

Description of activities (November 12th – November 28th)

I arrived in Njombe two weeks ago and time is going by very quickly. As soon as I arrived, I was invited to participate in the many events and activities taking place at TANWAT hospital and within the Njombe community and surroundings villages. I was quickly introduced to our Tanzanian colleagues at TANWAT hospitals and found that the few words that I knew in Swahili were really helpful in establishing initial contact. A simple “Kamwene” or “Shikamo” were found to be important ‘ice breakers’. As I tried to anxiously put together a few words, people smiled (and laughed) and were keen to show me more Swahili.

Early on in my stay at TANWAT, nurses and other health care professionals expressed their interest to learn more about different health-related topics and participate in professional development activities. Consequently, we promptly began discussing the different aspects of pain assessment and management that could be addressed at upcoming workshops. Since, I have been interviewing nurses, nursing students, and medical officers to learn of their pain education needs to contribute the most appropriate pain information. Our first workshop will be planned within the next week.

In addition, I have been involved in several community activities in Njombe and the surrounding villages. A few days after I arrived, Betty Liduke, Director of the TANWAT HIV-AIDS Care and Treatment Centre and Coordinator of Highlands Hope of Tanzania, was invited to a formal event organized by the local NGO in Matembwe for the orphans, widows, and people living with HIV-AIDS. During this time, school materials and other goods (e.g., soap, shoes) were distributed to the orphans and pigs were given to the widows. I felt extremely fortunate to be invited to this event and had the unique opportunity to observe the gathering of this community to respond to the needs of their members.

The following day I was invited to a second communion. That morning Betty left Njombe for Dar es Salam to attend a seminar on sexual health education and gave me my first mission: go to the reception and have fun!

I was a little anxious as I entered the home and introduced myself. By that time I had learned: “Jina langu ni Silivia, nina toka Canada, ni muguzi” and the response was a warm “Karibu sana”. I was quickly introduced to the 6 or 8 women preparing the feast and shown how to cook on an open fire. The festivities lasted all day and were filled with dancing and singing. Guests danced their way through the head table and presented their gifts to the family. As the Kibena Women Association and staff of the TANWAT hospital presented their gift to the young boy, I was invited to join the group, although I was a little shy to dance in front of 70 + guests.

Last week, I also had the opportunity to join a group of visitors meeting with the teachers and children of two neighboring elementary schools. We met with every class and were greeted with lovely songs in Swahili, including the national anthems, and English. Teachers were enthusiastic to talk about the different subjects they teach and the teaching strategies used. Many were curious to learn more about the education system in Canada. This was another exceptional day that contributes to making my stay here in Tanzania remarkable.

PIUMA was represented by Wema Sanga, General-Sectretary of the organization. She and Gerhard clearly demonstrated the truth of PIUMA’s slogan, imara kama samba (“strong like a lion”) in their forceful presentations.

Wema spoke about the efforts of PLWAHs in the Makete District of the Southern Highlands of Tanzania to secure basic human rights, better health care, and support for orphans. She also spoke of the organization’s fight against corruption in political and church bureaucracy’s in her region.

Wema and Gerhard addressed an to an audience of about 120 activists and dignitaries in the town hall of Bürmoos.

In addition to a cheque of 1.000 Euros, PIUMA received a unique sculpture by the artist Christiane Pott-Schlager.

The student is Flora Haule, a young woman in her final year at Ilembula School of Nursing in Njombe. She will be graduating in the spring of 2008. She was chosen to receive financial support by Highlands Hope of Tanzaia because of her good academic record, her personal need and her intenton to practice in a rural setting when she completes her training.

Flora is hoping to work at the Ikonda Hospital - one of the hospitals in the Highlands Hope of Tanzania network.

The bursary from the students at Saint Francis Xavier and Highlands Hope will allow Flora to move forward with her training and her professional goals. Otherwise she would have had to stop her education, at least temporarily.

Tracey MacDonald from the Saint Fraincis Xavier University Nursing Society writes with a bit of background about their group:

We are located in rural, Northeastern Nova Scotia, Canada. We are a student run organization that represents and serves Nursing students here at our university. Our mission is to foster, support and serve the nursing community at Saint Francis Xavier as a team, through communication, health promotion, education and social event.

We are involved in many campus and community wide activities. We are made up of multiple committees such as health promotion committee, curriculum committee, social committees, and a fundraising committee. We operate a student run nursing library, and offer tutoring services once a week.

Every year we donate to a local, national and international charity or organization. I had the pleasure of hearing Madeline Buck (from McGill Nurses for Highlands Hope) speak about the Highland Hope nurses at the Canadian Nursing Students Association last January in Toronto and thought it was an amazing opportunity for Canadian nursing students to reach out an connect with nursing students in Tanzania. As nursing students we understand the challenges that being a student creates in people’s lives not only academically but financially as well.

We are so pleased that we could offer some assistance to a fellow nursing student, as this is really core to what we are trying to accomplish
with our society, be it here on our own campus or across the miles.

All the best,
Tracey MacDonald
Saint Francis Xavier University Nursing Society

Wema Sanga is a member of the Executive Committee of PIUMA. She is accompanied by Muhingo Rweyemamu, editor of the investigative newspaper Rai, published weekly in Dar es Salaam. Mr. Rweyemamu was one of the first journalists to report on the situation of PLWHAs in Makete District in a series of searing reports published in 2003 and 2004. He has continued as a friend and trusted advisor to PIUMA.

Ms. Sanga has worked as a volunteer and staff person with PIUMA since its founding. She has a passionate commitment to PIUMA’s work on behalf of AIDS victims, especially children and orphans, and she has been a key leader in the group’s fight against corruption in the local health care system.

The Austrian Lutheran development agency EAWM is the main sponsor of the visit. While in Austria, the PIUMA representatives will meet with AIDS acitivists at the University of Vienna, at the Vienna AIDS Centre, and with supporters in Salzburg (in particular Gerhard Raxendorfer, a close collaborator with PIUMA since its earliest days), Bürmoos, Graz, and Münster (Germany).

They will also attend a “Life Gala” and fund-raising event at the end of the month in Vienna and participate in events marking International AIDS Day in the Austrian capital.

Weman and Muhingo will have an opportunity to meet the nursing students who worked with the organization last summer to train home-care workers for PLWHAs as well as the students at the Vienna design school who are working with PIUMA to develop a khanga pattern for the organization.

“Starting next week, McGill Nurses for Highlands Hope and Highlands Hope of Tanzania (a network of HIV nurse-counsellors in the Makete region of Tanzania) will come together to develop a pain assessment and management education module. This first module inaugurates a series of modules that will address various educational and professional needs determined by the nurses in the Makete region. The overall purpose for the pain module is to offer a culturally pertinent information resource for the optimal assessment and management of pain. Based on the expressed interests of the nurses, the module will focus on pain management in pediatrics.

“At the outset of this project, interviews with nurses and other health care professionals will be conducted to discover and understand current perspectives on and approaches to pediatric pain assessment and management. During this time, topics that will be explored include pain knowledge and attitudes, assessment tools, and pharmacological and non-pharmacological interventions. This phase will contribute to the sharing of our different experiences, understandings, expectations, and thoughts about pediatric pain. Accordingly, information to be included in the module will be identified and prioritized.

“Several cultural differences are expected to influence the format and content of the module (e.g., available medications) and understanding of these is required to develop a culturally responsive and relevant pain resource. However, beyond cultural differences, there exists a common professional goal of relieving pain to the best of our knowledge and skills. This sets a foundation on which we will build the education module and forge ongoing and lasting relationships.

“Once we begin to develop the module, nurses’ feedback will be sought through informal conversations and group discussions. Also, formal seminars will be planned to present and disseminate the content of the education module. Nurses will work together to develop interactive educational strategies (e.g., role playing, videos).

“We are looking forward to beginning this exciting project, which will contribute to the individual and professional development of nurses in the Makete region and at McGill University.”

November 8, 2007.

Ms. Lambert is a candidate for the PhD degree at the School of Nursing and will embark for Tanzania in November for a two month study period. During her stay, she will collaborate with Betty Liduke, Director of the TANWAT Hospital HIV Care and Treatment Centre and Coordinator of Highlands Hope of Tanzania.

The focus will be on the development of training modules for nurse-counsellors and other health professionals in Highlands Hope hospitals and clinics, beginning with a pilot module on pain and pain management. Nurse-counsellors focus primarily on testing and referral at HIV Care and Treatment Centres. But they also act as an important surce of information about HIV-AIDS care more generally for their patients.

Highlands Hope of Tanzania is a network of more than 20 nurse-counsellors who work at four health care centres or with HIV patient activist groups. McGill Nurses for Highlands Hope was established by the McGill School of Nursing in 2006 to support health care education and professional networking between Canada and Tanzania.

The first fellowship recipient was Christina Clausen who prepared much of the groundwork for the training module development now underway. Ms. Clausen is active with the School of Nursing in its advisory committee on International Health and its networking with the Family Medicine Group of the McGill Faculty of Medicine on health projects in Tanzania.

Hello dear friends,

In connection to the government’s target of testing as many people as possible, national, regional (target about 80 000) and in the districts (target 11870), Piuma decided to take action.

Since July the President launched the campaign of testing as many people as possible. It has already reached many regions. Njombe two weeks ago, last week Makete town.

To reach the target of testing about 11870 people in this district, Piuma supports the process with going to about 20 villages within 2 months.

From 13. 10. 07- to 2. 12. 07.

The PIUMA campaign was launched this Sunday at the PIUMA testing centre in Bulongwa.

In the PIUMA- committee meeting it was decided, that for each village there should be chosen one main representative and other PIUMA members (depends), one or two counselors (eventually hired by AMREF), one driver.

The program will include teaching, awareness video and testing.

Tomorrow we will start in IMEHE with a hired car.

Here attached the Timetable

Many regards to all

Elisabeth

PIUMA Mobile VCT- Timetable

Date Village Piuma- Representative
17.10.2007 IMEHE MARKUSI CHAULA
19.10.2007 UNYANGALA DAUDI LUVANDA
22.10.2007 UTENGULE ESKAKA MOLOHANI
24.10.2007 KILANJI ESKAKA MOLOHANI
26.10.2007 MADIHANI WITNESS NGUMBA
27.10.2007 BULONGWA WITNESS NYALUKE
28.10.2007 MAKWARANGA SABINA MATIASI
29.10.2007 UGANGA KABUYU KYANDO
31.10.2007 LUWUMBU KABUYU KYANDO
02.11.2007 LUGAO KABUYU KYANDO
04.11.2007 MBANGA ELENIDA CHAULA
05.11.2007 USILILO NAHUMU KYANDO
07.11.2007 UNENAMWA NAHUMU KYANDO
09.11.2007 IDENDE ILIMA KYANDO
11.11.2007 MAFIGA SABITI KYANDO
12.11.2007 IYOKA - KITULA JOSOPHINA SANGA - JOSEPHATI SANGA
14.11.2007 ILOLO - UTANZIWA REHEMA NYAMULE

18.11.2007 MISIWA/MAKEVE FONI KILALE
19.11.2007 UNYAGOGO BENITHO CHENGULA (MASUPHA)
21.11.2007 MWAKAUTA SOPHIA PELLA
23.11.2007 LUMAGE EZEKIA TWEVE
25.11.2007 IPELELE ABERINEGO MUMBENU
26.11.2007 INIHO WILBADI SANGA
30.11.2007 KIDOPE ALWISYE KASUKARI
02.12.2007 UBILUKO ABERINEGO MUMBENU

KIBENA WOMEN’S ASSOCIATION (KWA)
REPORT FOR TRAINING OF CAPACITY BULDING

PARTICIPANTS:-
Widow, Widowers and KWA members

VENUE:-
Njombe district at Desderia Hotel

DURATION:-
From 7th to 9th September ( Three days)

TOPIC:-
1. Human rights in general ( National Policy and International Policy)
2. Rights of children and women
3. National Policy and Land Law as it applies to widow/widower/children
4. Income generation
5. HIV/AIDS

FACILITATORS:-
1. Deborah Nsemwa – District Community Officer
2. Cassian Mapunda - District Social Welfare Officer
3. Lems Ngole - District Land Officer
4. Betty Liduke - HHT Coordinator

1. In general the participation was hundred percent (100%), participants were very happy to know Laws, Policies and changing ideas with others
2. There were many questions from participants
3. Facilitators were active to explain and answer question from participants and they opened a door to participants to pop in to their officers for any queries and help

EXPECTATION:-
1. Participants to gain knowledge of Policies, Law, income generation and HIV/AIDS
2. Participants to use the knowledge on their daily life and activities
3. Participants will be able to educate others on the issue of Policy, Law, income generation and HIV/AIDS

THANKS:-
1. St Georges School for their contribution
2. Canadian Friends of HHT for their support

Prepared by
Betty Liduke

KIBENA WOMEN ASSOCIATION
TRAINING BUDGET REPORT 7TH - 9TH SEPTEMBER

ACTIVITY/ITEM NAME OF ITEM Unit Used Unit Cost Total Cost
Teaching and Flip Chart 3 3 USD 9 USD
Learning material Marker pen 1pkt 3USD 3USD
Exercise books and ballpen 30 pcs 1 USD 30 USD
Photocopy for books and pictures 500 1 USD 1000 USD
Facilitators 3 30×3days 270 USD
Class cost 3days 20 USD 60 USD
Total 1372USD

Accomodation Participants 25PT 3dx3USd 225 USD
Breakfast 27 Pt 3dx1USD 71 USD
Lunch 27 Pt 3dx2USD 162 USD
Total 458 USD

Transport Participants 25Pt 2tr x1Usd 50 USD
Material 10 USD 10 USD
Total 60 USD

MAIN TOTAL 1890 USD

THANKS ALL FOR YOUR CONTRIBUTIO GOD BLESS YOU

Trainers and participants at capacity building workshop in Njombe

At the meeting, the nurses considered the care needs of HIV+ couples wanting to have children and welcomed four nursing students from Austria who were working with home-based care volunteers in Bulongwa. They also approved the organization’s new logo.

The minutes of the Highlands Hope of Tanzania meeting follow:

HIGHLANDS HOPE TANZANIA
HH NURSE COUNSELOR MEETING MINUTES, 1ST SEPTEMBER 2007

PRESENT
1. Evangelista Kayombo———Chairperson——-Ikonda – PMCTC – counselor
2. Charles Mhagama ———–Treasurer ———Ikonda – HBC – counselor
3. Mary Musoma ————– Secretary ———PIUMA – Nurse counselor
4. Betty Liduke —————- Coordinator———- TANWAT – VCT/CTC Counselor
5. Tabia Mwigune — Member – St David Anglican VCT Njombe – counselor
6. Mary V. Eliasi - Member _ St David Anglican VCT Njombe – HIV/AIDS coordinator
7. Maksensia Manga – Member – Ikonda – PMCTC – counselor
8. Grace E. Mkindo – Member – St David Anglican VCT Njombe- counselor
9. Optatus A. Mwalongo – Ikonda – VCT – Counselor
10. Sixbertha Manga – Ikonda – PMCTC – Counselor
11. Onolina Mahenge – Ikonda – VCT – Counselor
12. Rose Msigala – Member – HBC – Counselor
13. Maurisia Msigwa – Member – Ikonda – VCT counselor
14. Reinhard Welser — Guest – Austria – Nurse Student
15. Michi Schreiner —–Guest – Austria – Nurse Student
16. Sabine Winkler —– Guest – Austria – Nurse Student
17. Wolfojing Rausch —Guest – Austria – Nurse Student

AGENDA
1. Opening of the meeting
2. Reading past minutes
3. Opening of the Bank account
4. Report of the HHT money
5. Case Study
6. Welcoming of the new members and guests from Austria
7. Closing of the meeting

1. OPENING
The chairperson opened the meeting at 10.00 am by welcoming all members and thanking them for coming to the meeting. She thanked also the members for the good cooperation, contribution and participation when guest from Canada came, she said is good to have a good and strong unity as this is the only way to build our network.

2. READING OF THE PAST MINUTES
The coordinator read the past minutes careful and participants agreed with the minutes

3. MATTER ARISE FROM THE MINUTES
Every center gave the report about the guest which visited HHT in August 2007 started with TANWAT followed by IKONDA Hospital and last PIUMA.
HHT Coordinator gave a brief on all the items brought by the guest (Laptop, Books and the check of 500usd) she said the money is banked in her account as HHT has no bank account.
About the HHT logo the Coordinator showed the sample of the logo which was made by Michael Wuu from Canada all the members of HHT agreed to use that logo other added that may be it will be good if the sunrise color to be at the back of the logo if possible if not the sample available is nice.

4. OPENING OF BANK ACCOUNT
After long discussion from all members the HHT agreed to open the account at NBC Njombe and the signatories will be the chairperson Evangelister Kayombo, the treasurer Charles Mhagama and the Coordinator Betty Liduke one from the signatories is allowed to take the money at the bank after all signatures are in the bank form and allowed by the meeting HHT.

5. REPORT OF THE MONEY
The report from treasurer
Treasurer reported the amount which was been contributed with HHT members and how much has been used as follows:-

IN COME TSHS OUT COME TSHS
Member contrib. 480,000.00 Preparation of food 134,300.00
& gifts for guests

TOTAL REMAINING FROM CONTRIBUTION 345,700.00 TSH in hand

Report from Coordinator
Coordinator reported all the amount she has in bank and those which is used as follows

IN COME USD USE FOR USD
Remaining from June 400 desk jet printer 150
Check from Canada 500 Hp ink no 29 colored 32
Hp ink no 28 black 30
Stamp preparation 5
A-4 plain paper for printer 5 1rim
Total in = 900 Total out = 222

TOTAL MAIN REMAINING UP TO NOW IS 678USD

After the reporting of the money the coordinator submitted all the receipt to the treasurer for documentation.
Members of HHT thanked to the coordinator for the all good work she has done and they requested her to take care of all HHT office item till they get a good room for the use of the office.
They thanked also the friends of HHT in Canada for all their effort and help to the HHT they said together let the Good LORD Bless them.

5. CASE PRESENTATION

The presentation was done by Mary Musoma the PIUMA nurse counselor
Presentation was about the couple which decided to get a baby while the man is HIV+ and the women is HIV-
HISTORY OF THE COUPLES
The couple has been tested for HIV since 2004 and the result of man revealed HIV+ and the women revealed HIV- . The man was been put in ARV since 2004 as the CD4 count was below 200 count. The women was been monitored by checking her HIV status frequently in 2005 the couple felt they need to have at list one child for their life and together they visited PMCTC for advice. From their own decision the women conceived and in 2006 January she got a normal delivery of a female living baby with 3.5kgs up to now the child is having 10.9kgs the women HIV status is still negative.
After long discussion between participants the coordinator explained to the counselors on the rights of the HIV clients and a bit on sex without getting the bruises. Counselors admitted that they still need more knowledge and information on HIV/AIDS

6. WELCOMING OF THE GUEST

The chairperson welcomed the coordinator to introduce the new guest member from St David Anglican VCT Njombe, the counselors got a chance to introduce themselves and they gave their view why they want to join HHT as they have been hearing this for long time and they felt is good to have a network with other counselor as they are new to this field. The names of the new comer are:-
1. Mary V. Elias - HIV/AIDS coordinator and counselor at St David Anglican VCT
2. Tabia Mwigune – Nurse Counselor at St Anglican VCT
3. Grace E. Mkingo – Nurse Counselor at ST Anglican VCT
Other members are
1. Optatus A. Mwalongo – from Ikonda Hosp VCT counselor
2. Rose Msigala - from Ikonda HBC counselor

The chairperson also thanked the Nurse student from Austria who came to visit the HHT and to attend the meeting she said they are welcome to join HH if they feel doing so.

7. CLOSING OF THE MEETING
The chairperson closed the meeting at 1:30pm by thanking all members for their participation and remanded those who are supposed to work on bank account opening to start processing it as soon as possible.

She announced the date of the next meeting which is 1st December 2007 at Ikonda Hospital
The agenda of the next meeting is:-
As the day will be AIDS day the participants suggested to have a topic of MANAGEMENT OF THE ORPHANS LIVING WITH HIV/AIDS

THANKS EVERY BODY

Prepared by

Mary Musoma, Secretary
Charles Mhagama, Treasurer

Highlands Hope of Tanzania’s new logo

The March was a huge success with awareness evenings in each village stop and testing clinics held in Ipelele and Ujuni.

At the end of the March, Micahel Wou asked all the participants to sign his T-shirt emblazoned with the new PIUMA logo and, admittedly, slightly grimy and dusty from 90 kilometers of Makete District roads.

On the American Apparel website, the AA company post said:

Posted by: Cinnamon 8/30/2007 19:14
Montreal’s Michael Wou recently went to Africa to participate in a 90 km AIDS Solidarity March with about 45 HIV positive Africans from the group PIUMA.

We did.

You can see the post and the responses to it at:
http://www.americanapparel.net/presscenter/dailyupdate/dailyUp.asp?d=35&t=781

Micahel Wou’s autographed PIUMA T-shirt from the 2007 Solidarity March

PIUMA, a Swahili acronym for “Test and Live in Hope�?, is made up of 250 HIV patients who have tested positive and are receiving anti retroviral medication. It is one of the first such associations in Tanzania. For both health and logistical reasons, only twenty five members have been selected to participate in the march.

Kabuyu has oft repeated that HIV doesn’t kill, ignorance of the disease and its treatment do. The purpose of the march is to promote prevention, testing and treatment in the remote villages Makete, Bulongwa, Iniho, Ipelele and Ujuni. The very fact that ukimwi (HIV) infected persons can and will walk 90 kilometers over 3 days in very rugged and mountainous conditions is, literally and metaphorically, a moving symbol of hope for all Tanzania.

The timing of the March is ideal as it coincides with Tanzanian President’s Jakaya Kikwete’s announcement of a national testing initiative under the slogan “Defeat HIV through Testing�?. The battle will be exceptionally hard given a national infection rate of nearly 10% with some villages tracking at double and triple this level. The Southern Highlands where we are walking has the highest average rate in the country. The challenge is further compounded by very low enrollment rates in secondary schools (under 20%) and, as we will soon witness firsthand, brutal infrastructure (roads, water, energy) in the rural areas of the country.

To attract as many people as possible from the areas surrounding the villages where our march will end each day, Kabuyu and PIUMA staff members have arranged for onsite HIV testing as well as speeches from local officials, songs from local choirs and hip hop music for the younger crowd.

The District Commissioner gives the PIUMA marchers a courteous send off in Makete town on Day 1 of the March, even walking the first kilometer at Kabuyu’s side. PIUMA members are wearing t-shirts brought from Austria bearing their logo (a red lion with an AIDS ribbon) and their slogan, “Kwa Pamoja Tutashinda�? (Because together we shall succeed).

The marchers are singing hypnotizing Swahili songs along the way and waving to subsistence farming families which make up the great majority of the 100,000 population in Makete District. The singing doesn’t stop for uphill marching. It seems to get louder. Young children bearing even younger ones on their backs either smile or cry uncontrollably as I, a mzungu (foreigner), offer him or her a PIUMA balloon.

We are at 2600 meters above sea level and by lunchtime, the Canadians are firmly in the rear of the march and catching their breath. I will discover that there’s always a higher hill in this region. We eat rice and boiled beef for lunch in Bulongwa at a village councilor’s home. Kabuyu tells us the story of the elephant, lion and leopard who each vie to be named king. The little animals, fearing of oppression, elect a hyena instead. Although pleased at his luck, the hyena cannot avoid his old habit of continuously plundering garbage piles for bones to lick and chew. The hyena is quickly removed from office because he is never around to perform his duties. Kabuyu says that HIV positive patients are the lucky hyena who has a chance at a better life. The old habits are patients’ proclivities for alcohol and unprotected sex. Kabuyu declares that he himself plunders for these bones no more.

Kabuyu, like almost all other PIUMA members, is a Wakinga and his tribal language is Kikinga. Other marchers are from a neighbouring tribe, the Wabena. Kabuyu is 53 years old and a practicing Christian. His face is chiseled and handsome. He is fit and lean like the rest of the marchers. Until his public announcement of being infected, he was a security guard at the Bulongwa Lutheran Hospital. After his declaration, he was dismissed and could not find a job for over 18 months.

We recommence the march after lunch and make it to Iniho by five. No village officials are present to receive us due to the death of the village wazee (elder) that day. The office where the HIV testing was to take place is locked. Even the hip hop music is delayed as the generator is out of diesel and cannot seem to operate both the music and lighting at the same time. Finally, it is up and running and over a hundred village children and youth are dancing in the dark to 50 Cent.

We sleep at Pastor Sanga’s house and are served tea and bread in the morning in their mud hut. The children cling to their mother as we eat, the chickens run about and smoke gather overhead.

Kabuyu leads us out of Iniho towards Ipelele, a 20 Kilometer journey. As we approach the town in mid afternoon, dozens of green sweatered Ipelele students run to join us as we arrive in the town centre. A warm welcome clearly awaits us. The village Mayor and the HIV regional coordinator are present and give very supportive talks. The PIUMA nurse, Mary Musoma, has been given access to an office and tests 30 villagers that day. And the generator works. The clouds roll in but the dancing doesn’t abate until late.

A short night in a local guest house and tea and potatoes for breakfast precede the longest and hardest day, but the last leg of the March. A solidarity song is sung to the tune of Glory, Glory Halleluiah and we’re off by 6h45. Kabuyu is nowhere to be seen.

By 10h00, our canteen truck, which had left Ipelele the previous evening to fetch provisions, catches up with us. Kabuyu gets out. He had returned to Bulongwa with the canteen truck so that he could make his shift as a security guard with his new employer. After a short sleep, he’s back with us, beaming. He’ll return again to work tonight.

Today, we have a 35 kilometer walk through the beautiful but stark Kitulo Natural Reserve, reminiscent of the moors in The Hound of the Baskervilles. We are now at 3000 meters above sea level. It is a cool walk but, even leaving early, we won’t make it to Ujuni in time for the official reception. Part of our group jam into the canteen truck and the rest of us hop in the back of a passing 24 foot transport in order to make it by the designated hour.

The march, the first of its kind in East Africa, ends with speeches (“PIUMA Safi�?, meaning “good�?, starts every presentation), choirs and more hip hop. 21 people in Ujuni are tested by Mary. The village leaders have informed the BBC reporter (Swahili service) that they would like PIUMA to set up an HIV counseling and testing centre in their little town. PIUMA, which is entirely funded by membership fees and foreign donations, has no capacity to agree to the request. Ujuni residents, like most of the rural Southern Highlands, will have to continue to travel great distances, to Bulongwa or Mbeya, for testing. It is not just ignorance and the fear of testing positive that fuels the pandemic but the great difficulty in accessing any health services at all.

As a result, Kabuyu wants to take his organization mobile. PIUMA plans on buying and equipping a mobile HIV counseling, testing and treatment vehicle in order to bring quality HIV services to the whole district. The problem is scratching together the funds and permits to do so.

There is another problem. The day of President Kikwete’s announcement, the PIUMA nurse tells me the Southern Highlands has run out of the reagents necessary to use the equipment that tests the progress of a person’s HIV infection. Although Kabuyu’s PIUMA is on the march, Tanzania has a long road ahead to defeat HIV.

James Hughes
July 23rd, 2007

Wolfgang Rausch, Sabine Winkler, Michaela Schreiner and Reinhard Weiser are in the second year of studies at the Schule für allgemeine Gesundheits und Krankeplege im AKH in Vienna.

“We want to contribute somehow to the patients and the families living with HIV-AIDS,�? says Wolfgang Rausch. �? We think we can learn a great deal ourselves by observing a skilled nurse like Mary Musoma from Makete District.�?

The students raised money for their trip with help from friends and ocal communities in Austria. They will be distibuting basic supplies and teaching volunteers about safely providing care to HIV-AIDS patients in home settings.

HIGHLANDS HOPE CONSORTIUM TANZANIA
HHC NURSE COUNSELOR PLAN 2007 - 2008

PROFILE

Highlands Hope Consortium is a network of private hospital and non government organization in southern Highlands of Tanzania working together to respond to the challenge of HIV pandemic in their area. HHC consists of dedicated team of health care professional, community educators and volunteers activities working with people living with HIV and AIDS in Njombe and Makete district.

Read more at www.highlandshope.com

VISION
Better quality service to society (people infected and affected with HIV and AIDS) in rural area.

Highlands hope consortium works in partnership with Njombe and Makete communities to achieve health which takes into consideration of physical, emotional, mental, spiritual, sexual and social well being.

MISSION
Highlands Hope works to improve quality of life to people infected and affected with HIV and AIDS in Njombe and Makete.

AIM
The main aim of Highlands Hope Consortium is to organize Care and Treatment team of Njombe and Makete into corporate body.

OBJECTIVES
1. Raising and maintaining the standard of education and practice to Nurse Counselor and other health professional (CTC TEAM) workers in the targeted area.
2. Cultivating friendliness, mutual respect, good will unity and understanding among care and treatment team and community in general.
3. Increasing awareness of and expand access to quality care and treatment and support services by people infected and affected by HIV and AIDS.
4. To provide sustainable care and support services for household with orphans and vulnerable children (OVC).
5. To provide evidence – based TB/HIV disease management through comprehensive treatment in targeted area
6. To reach 80% of the population with TB/HIV and AIDS treatment education and prevention
7. To provide continuum of care and support services to people infected and affected with HIV, Home care provider, and care givers
8. Co-operate with other institutions in side Tanzania and outside Tanzania
9. To encourage and persuading PLHA to use as much as possible the care and treatment services (CTC) available to the area

HIGHLANDS HOPE CONSORTIUM ORGANIZATION

The board of directors is comprises of four experience Nurse Counselor, health professionals to ensure excellent care and treatment performance.

H. H. CORDINATOR

CHAIR SECRETARY FINANCE

FUTURE PLAN OBJECTIVES
1.To raise and maintain the standard of education and practice to nurse counselor and other health professional works at Care and Treatment targeted by
(a) Training of members:-
· Upgrading of nurse counselors
· Holding of seminar, workshop, meeting and report writing for CTC and workers

(b)Information and communication technology
· Computer training which is already started
· Data management as this is a new field in our place
· Advocacy will include lobbing and networking

(b)Research and development
Research is a key for implementation and success of any activity. HHC will take this seriously and thus invest and develop new products, techniques and services in the HHC area

(d)Monitoring and evaluation
· Formative, process and effective evaluation research

2. Encourage and persuading PLHA to use as much as possible the care and treatment services available at the area by:-
Public relations
Different clients need different kinds of public relations; HHC will cater for what clients need like-
· Managing events, group discussion, meetings, lectures etc
· HIV campaigns, drama and sports

3. Co-operate with other institution inside Tanzania and outside Tanzania including
· Media, schools, NGOs, and government institutions.

NAMES OF NURSES WHO ARE ATTENDING COMPUTER TRAINING

1. Potania Mfuse Ikonda CTC
2. Evangelista Kayombo Ikonda CTC
3. Sixbertha Manga Ikonda CTC
4. Maria Mahenge Ikonda CTC
5. Charles Mhagama Ikonda CTC
6. Evelina Madunda Ikonda CTC
7. Melina M.Chalamila Ikonda CTC
8. Bertha Sanga Ikonda CTC
9. Anahilda Mtega TANWAT CTC
10. Elekia Msigwa TANWAT CTC

THANKS TO ALL WHO CONTRIBUTED IN ALL ACTIVITIES OF HHC PHISICALLY AND IN MIND.

BETTY LIDUKE
HHC COORDINATOR

“We are pleased that we got everybody home safe and sound,” said Jackson Mbogela, Coordinator of PIUMA. “People here are used to walking long distances and seeing travelers on foot, but nobody has ever seen anything like this!”

The march was started by the District Commissioner of Makete, the Hon. Mr. Leffy Gembe, who walked a distance with the marchers along with local police and health officials. The marchers wore T-shirts bearing the new PIUMA logo and handed out stickers, balloons and tattoos along the way. Each evening there were speeches, choir performances and hip-hop artists carrying the message of HIV awareness and testing to all ages.

More than 50 people were counselled and tested at clinics held in Iniho, Ipelele, and Ujuni along the way.

PIUMA General Secretary Anna Mwinuka on the road to Ipelele

Starting Day 2 of the march

PIUMA marchers and Canadian friends pick up the pace and the volume as they enter Ujuni on Day 3

Wolfgang Rausch, Sabine Winkler, Michaela Schreiner and Reinhard Weiser are in the second year of studies at the Schule für allgemeine Gesundheits und Krankeplege im AKH in Vienna.

“We want to see for ourselves the situation oft he people in Bulongwa, especially the patients and the families living with HIV-AIDS,” says Wolfgang Rausch. ” We think we can learn a great deal by observing a skilled nurse from Makete District.”

The students will be with PIUMA nurse Mary Musoma for four weeks beginning in August.

“We learned about Makete District at a vernissage for a book about the hospital in Bulongwa,” explains Sabine Winkler. “We started learning more about Tanzania and decided to approach (Highlands Hope partner) EAWM and PIUMA about going to Africa to learn more about our profession.”

The students also learned as much as they could about HIV and about conditions that affect patients with untreated AIDS, patients who are, sadly, all too common in Makete District.

Two students from McGill University will be in Bulongwa for the month of July. Alexandra Orr is studying medicine and Mary Sweeny is in McGill’s anatomy programme. They will be with PIUMA volunteers and staff until early August.

Sabine Winkler prepares immunization injection for Tanzanian trip

Through EAWM, it partnered with the teachers and students at HBLA Herbststrasse in Vienna to design a traditional Tanzanian “kanga cloth�?. A kanga is a standard-sized, printed cotton cloth that includes a slogan as well as a patterned design. The kanga is a particularly meaningful gift exchanged by women and has a variety of uses in East Africa homes.

Four HBLA students (Tina Hammerschmidt, Nina Bedenik, Sukie Polleros, and Claudia Jirku) worked via Internet with a committee of PIUMA volunteers in Tanzania to create two kanga designs that are now going to Tanzania for consideration by PIUMA.

“We were impressed by the power and strength of the women of PIUMA,�? says Tina Hammerschmidt. “PIUMA members say that they are ´strong like a lion` (imara kama samba) so we used images of women and of a lion breaking the chains of ignorance and stigma that make the HIV epidemic worse for the people.�?

PIUMA also connected with the Montreal branding and design firm Origami to create a new logo that reflects its strength and hope.
“PIUMA is impressive in its ability to explain its purpose and mission,�? says Michael Wou, Design Principal at Origami. “We are very pleased to have been brought together with PIUMA by the Highlands Hope project.�?

Highlands Hope is a small network of HIV clinics and activists groups in the southern highlands of Tanzania (www.highlandshope.com).

“This kind of creativity and design excellence is a powerful weapon in our fight to save our people,�? says Jackson Mbogela, Coordinator of PIUMA in Bulongwa, Tanzania. “We value partners like the design students from Vienna and Origami.�?

HBLA Herbststrasse students with their kanga designs for PIUMA

“As an HIV patient activist group in rural Tanzania, we have been fighting for respect for the basic human right to decent health care,�? said PIUMA Coordinator Jackson Mbogela from the organization’s office in Bulongwa, Tanzania. “Our members say that PIUMA is ‘strong like a lion’ and this design captures that strength of spirit in the face of adversity.�?

PIUMA is based in the mountainous Southern Highlands of Tanzania in a district that is hard-hit by the HIV pandemic. PIUMA is an acronym of the group’s full Kiswahili name meaning “test and live in hope�?. PIUMA is a partner in a larger network of HIV clinics and activist groups called Highlands Hope.

“Our team of designers was enormously impressed by PIUMA’s ability to articulate its identity and branding needs, says Michael Wou, Design Principal with Origami. “We are very proud of the partnership and the brand visual identity that resulted from our pro bono involvement in the work of PIUMA and Highlands Hope.�?

“This partnership between Tanzania and Canada is creating tools that will help our friends in PIUMA communicate their demands for justice and their call to action,�? adds Royal Orr, President of Canadian Friends of Highlands Hope. “Advanced marketing and branding expertise has direct applications for grassroots HIV activism in Africa; we’re very proud to have brought PIUMA and Origami together.�?

PIUMA’s new logo was created in partnership with the design firm Origami of Montreal

“It has taken many, many months to get here,” says Wema Sanga, General Secretary of PIUMA. “We want to thank all our members, our community supporters, and our partners in Tanzania and around the world for their efforts on our behalf.”

PIUMA had demonstrated its ability to extend testing to large numbers of residents of Makete by involving patients in all aspects of HIV awareness, testing, and service provision and by taking its service to local villages before its work was brought to a halt in April 2006 because of a dispute over accountability for health care funds in the district.

Now PIUMA will redouble its efforts to bring services to the people in effective and sustainable ways through its new clinic space and organizational centre in Bulongwa. Planning is already underway for a series of village-based VCTs in early July. PIUMA is grateful for support in these efforts from the pan-African NGO AMREF and from action medeor.

The District Medical Officer has also provided PIUMA’s health care worker, Mary Musoma, with drugs for opportunistic infections among PIUMA members and other people with HIV-AIDS. This is a further confirmation of confidence in PIUMA’s ability to provide care.

Recognition of the importance of PIUMA was also underlined by the appointment last week of Jackson Mbogela, Coordinator of PIUMA, to represent all NGOs in Makete on the Makete District Council Commitee for HIV, the coordinating body for all anti-HIV efforts in the district.

“PIUMA will now have access to legal agreements and reports and that will help us make people more answerable,” says Mbogela. “For PIUMA, our most important contribution will be to see that resources are put where they are most needed and utilised in an appropriate way.”

PIUMA members put finishing touches to the grounds at the new PIUMA VCT Clinic

PIUMA Building Committee Chairman Majaliwa Pilla and his wife Esterina Swallo, who is secretary of the Home-Based Care Committee of PIUMA, volunteering at the PIUMA Clinic

The main item on the agenda was a lengthy discussion about the need for a coordinator for the Network.

A new chairperson was elected, Evangelista Kayombo, the assitant matron at Ikonda, and Betty Liduke, Director of the TANWAT HIV Care and Treatment Centre, was appointed as the first HH Coordinator.

The Ikonda site has been selected to be the headquaters for the HH Nurse-Counsellor Network and the nurse-counselors have decided to pay for transportation expenses for those who will be coming for meetings, as well as for office expenses, through a fund to which each member agreed to contribute 30,000 Tsh as a first investment.

The HH nurse-counselors expressed thanks to HH Canadian friends for their contribution to the computer skills training classes at Ikonda.

They also were happy to hear about the team from Canadian Friends of Highlands Hope coming to Tanzania in July. They invited the Canadians to join them for lunch or dinner at Ikonda with the nurse-counselors, before traveling on to Bulongwa. A computer class will be held on the Monday that the Canadian friends are expected to visit, starting at 3:00 p.m.

The members also discussed setting up the HH office and decided that a printer would be a priority purchase for them.

Drafting of the constitution and by-laws for the group is continuing and should be ready for the next meeting of the Network to be held on the 1st of September, 2007.

The nurse-counselors see that in future all health workers should be involved in the HH network as this will help all be more strong.

with files from Betty Liduke

Betty Liduke, Coordinator of the Highlands Hope Nurse-Counsellor Network, Director of the TANWAT HIV Care and Treatment Centre and McGill School of Nursing teaching supervisor

The award recognizes Partec’s achievement in having introduced the first mobile, battery-operated device for high sensitivity fluorescence microscopy. The CyScope® is ideally suited for very reliable TB and Malaria diagnostics at a price that represents a significant cost reduction for equipment and testing.

“We would like to use this opportunity to submit our deepest gratitude to all experts and scientists who have shown continuous confidence and trust in Partec,” said Roland Göhde, Partec Essential Healthcare International Project Manager. “Our adapted technologies and dedicated diagnostic solutions are being recognized as essential and affordable tools in the fight against the three global killer diseases HIV/AIDS, TB, and Malaria.”

The Partec website describes the CyScope® as “a new uniquely innovative microscope for fluorescence light detection employing incident UV light and transmitted light detection, simultaneously or in separate. It integrates the most recently available generation of powerful high-efficiency LED light sources with extremly long lifetime of several thousand of hours and highest efficiency as well as most sophisticated optics. For the first time, a fluorescence microscope is being offered battery-operated and mobile, designed for several hours of use completely independent from any regular power supply! The CyScope® is perfectly suited for all applications in light and fluorescence microscopy.

The CyScope® features a CCD camera connector (CCD camera upgrade, optionally available) for taking images of the slide for further investigation by image analysis software on PC (PC not included in system price).

The CyScope® is developed and produced in Germany following the long German tradition in manufacturing highest quality techniques in optics and microscopy. The unit price for the CyScope® is EUR 990.00, only.”

For more information about CyScope® and othe Partec solutions, contact Roland Göhde at info@partec.com

Highlands Hope extends its congratulations to Partec, its trusted partner for the most effective cd4 and cd4% count technology. CyFlow® CD4 counters are the solution of choice at Highlands Hope clinics and hospitals.

June 2, 2007.

Partec’s award-winning CyScope with laptop

We are working out the formalities of how the recipient children be selected. It is expected that there might be an interview, however it is intended that the most disadvantaged and capable child will be awarded with the sponsorships.

Here is the translation of the E-mail from Mr. Rweyemamu:

Dear Jackson,

I wish to congratulate you for the efforts you are all doing with PIUMA.

As you you know, me and my wife we have opened a school at Ilula, in Kilolo district. As you know we are very much attached with people of Makete. Therefore we have we have decided to offer two chances for form one for the year 2008. We would extend this sponsorship to children who are either children of PIUMA members who are not in the position to afford education costs for them, or orphans who have been whose parents were PIUMA members.

It will be good if the children will be those who have passed their public/national standard seven examination but have failed to secure a chance in a public school or their pass mark are not very bad in such a way that they will fail to pass form two exam.

We would have been able to accept them this year, unfortunately we are still in the process of building a dormitory which we believe by January next year it will be completed. These children will be sponsored by us for all their educational requirements from school fees to uniforms. If they will pass Form II Exam, we shall continuing sponsoring for their expenses, if they will pass their form four Exams we shall continue sponsoring them.

Therefore, we are requesting that the PIUMA leadership start looking for Pupils who will have these qualifications. I think we have enough time so you may accomplish this. I again congratulate you in all you are doing. Though we have been quiet, we have been behind you.

Muhingo

The members have received this offer with two hands and they will write their appreciation letter to Mr. Muhingo and his family soon after finishing with the consideration of the offer in all their relevant committees.

Jackson Mbogela
Coordinator
PIUMA

Sorry for the delay in updating news from Highlands Hope. A lot has been happening:

At TANWAT Company Hospital, the HIV clinic is closing in rapidly on its stage 1 goal of serving 300 patients with anti-retroviral drugs. Nurse Betty Liduke is now concentrating her efforts on the TANWAT HIV clinic as well as on her network of workplace and village-based peer educators. She also continues to mentor volunteer leaders in HIV patient groups across the Wabena territory.

Ikonda Hospital’s programming is also growing at a rapid rate, now serving more than 2,500 HIV patients.

Madeleine Buck from McGill Nurses for Highlands Hope has dedicated her recently published textbook on basic nursing techniques to Highlands Hope colleagues and pledged a portion of her revenue from the book’s sales to the work of HH.

St. George’s School in Westmount continues its generous support for Highlands Hope health-related programming as well as sponsoring new links with the Kibena Women’s Association to provide care to HIV orphans in Njombe. The teachers from St. George’s have also started a professional link with elementary school teachers in Njombe focusing on second-language training. The work of these Tanzanian teachers includes tutoring of HIV orphans.

The Highlands Hope Nurse-Counselor Network is nearing the end of its first computer skills training course, supported in part by McGill Nurses for Highlands Hope. Ten nurse-counselors from the HIV programs at Ikonda Hospital, TANWAT, and PIUMA are completing the training. At the next meeting of Highlands Hope Tanzania in June, network Chair Betty Liduke will lead the members in a discussion of next steps in professional development for nurse-counselors as well as considering extending the benefits of networking to other staff in the clinics.

The HH patient activist group PIUMA has completely restructured its staffing and organization, concentrating on services to members including voluntary counseling and testing clinics, volunteer home-based care, and livelihood projects. It has also adopted an anti-corruption accountability code for its work, a first for a rural Tanzanian HIV NGO. PIUMA uncovered extensive local corruption in the fight against HIV in Makete District that brought it into conflict with a number of leaders. A delegation of PIUMA leaders went to Dar es Salaam in April and held a press conference demanding greater attention to inadequate HIV care in Makete. The organization’s research suggests that more than 40 people have died in about a dozen PIUMA villages in the past year from AIDS.

PIUMA is completing an order for a custom-built mobile clinic that will allow it to extend its testing and follow-up services to the widely scattered villages of Makete District. Delivery is expected before the end of summer 2007. Several rooms in the PIUMA Centre in Bulongwa are also nearing completion. Wiring and plumbing remain to be done. District officials have given PIUMA their blessing to be more actively involved in HIV service provision and have granted permission to use a large municipal building in Bulongwa as a future clinic space.

In partnership with the Montreal design firm Origami, PIUMA recently completed an impressive brand identity process with a very strong new logo design. The logo will be applied to a line of PIUMA T-shirts and other promotional items. Origami owner and principal designer Michael Wou will be traveling this summer to Tanzania to discuss the extension of the brand into village-level brand tool kits and other innovative brand identity resources.

Canadian Friends of Highlands Hope is sponsoring an awareness and solidarity march with PIUMA in July 2007 in Makete District. Six Quebecers will be participating. Jim Hughes, member of the Board of Canadian Friends of Highlands Hope and one of this summer’s hikers, held a fund-raising squash tournament recently and raised nearly $5,000 for HH programs.

HH friend and supporter Terry Mosher (“Aislin�?) has generously agreed to the use of drawings from his Tanzanian Sketchbook for Canadian Friends of Highlands Hope fundraising purposes. Signed prints of individual sketches will be available for $150. A webpage is being prepared that presents all the sketches with directions on how to order. 100% of the money will go to work with our Tanzanian Highlands Hope partners. A separate email will inform you when you can view the site.

McGill medical student Alexandra Orr and anatomy student Mary Sweeney will be working this summer with PIUMA in Bulongwa. They will be looking at efforts to build awareness about HIV with teenagers and young adults in Makete District with support from PIUMA nurse Mary Musoma and coordinator Jackson Mbogela and from TANWAT HIV Clinic director, Betty Liduke.

After a months-long investigation, an official Government of Tanzania report has revealed extensive corruption in the procurement of key technology required to provide high-quality HIV care. CD4 counters assess blood samples and track the health of the immune system. Highlands Hope is partnered with the German CD4 counter manufacturer Partec whose machines (some of which had been donated to HH partners) were banned by the Ministry of Health in 2006. That ban has now been shown to be groundless and likely the result of corrupt business practices on the part of competitors. The Partec counters continued to be used at TANWAT and Ikonda despite the ban, but two machines owned by PIUMA have been lying idle since PIUMA’s lockout from the local clinic and the MoH decision about Partec machines. PIUMA will now integrate these counters into its mobile clinic and hopes to have dependable, mobile CD4 testing available to its members by the autumn of 2007.

May 12, 2007.

Betty Liduke, Chair of the Network, reports that the skills training programme is going very well in Ikonda. In Bulongwa, a Network member is working with a Peace Corps volunteer to get the same training. These nurse-counsellors have very heavy workloads in their clinics but have found the time and the resources to participate.

McGill Nurses for Highlands Hope provided a matching grant to support the program. Discussions are underway to look at next steps and to extend these skills into a clinical setting.

The new PIUMA Centre has been built with a number of local and international partners. Fund-raising is continuing for wiring, plumbing and windows.

PIUMA, whose name in Kiswahili means “test and live in hope�?, is active on a range of health, advocacy and economic development issues, fighting for justice and for dignity for people living with HIV, their families and their villages. PIUMA members are proud Tanzanians; their work is deeply rooted in Tanzanian law and in their country’s traditions of equality and community-based democracy.

Water for plastering is brought from a nearby well

Of these 113 new clients, 67 were found to be HIV positive: 33 males and 34 females.

46 were HIV negative: male 24 and female 22

The TANWAT CTC also provided 159 CD4 count tests during the same period and 134 liver function tests to track the health and monitor the anti-retroviral therapies (ARVs) being offered.

To date, there are 182 enrolled clients at the TANWAT CTC with 102 on ARVs. The target has now been set to reach the 300 client mark.

The TANWAT CTC is also working closely with the regional HIV coordinating NGO, FHI, providing valuable information about local conditions and best practices in the Njombe and Makete Districts.

April 20, 2007.

The delegation was led by Burton Mwawaya who is a member of the Planning and Financial Committee of PIUMA. Wema Sanga, PIUMA’s General Secretary, was the chief spokesperson for the delegation and they are accompanied by Izack Sanga, the head of PIUMA’s Construction Committee and Counseling and Testing Committee, and Alvina Tweve, also a member of the Counseling Committee.

The patients’ group says it is more convinced than ever that self-help is the source of its strongest hope for the future.

Izack Sanga and Wema Sanga arrive home to report to PIUMA Chairman Kabuyu Kyando and Coordinator Jackson Mbogela

Izack briefing the ward Executive Secretary Edwin Swallo and Councilor Mahenge

The delegation is led by Burton Mwawaya who is a member of the Planning and Financial Committee of PIUMA. Wema Sanga, PIUMA’s General Secretary, is the chief spokesperson for the delegation and they are accompanied by Izack Sanga, the head of PIUMA’s Construction Committee and Counseling and Testing Committee, and Alvina Tweve, also a member of the Counseling Committee.

At a press conference at the Dar es Salaam Press Centre, the group spoke of the poor state of health care in Makete District and the difficulties PIUMA has faced since it was locked out of the local HIV clinic following its demands that local health officials put an end to corrupt practices.

This is a short account of the exchange with the journalists in Dar es Salaam today:

Isack explained the purpose of our trip: 1st Anniversary of the Closure of CTC; Wema explained the background to the closure of the Bulongwa CTC by ELCT Makete Diocese Management on 12th April 2006; we told reporters that since the CTC was closed more than 40 PLWHAs have died. Should we continue to die?

We also narrated our encounter with NACP Dr. Bwijo wa Bwijo on 11th April 2006. We asked the media to work with PIUMA to expose the infringement of human right demonstrated by different institutions and the government against PIUMA and other PLWHAs. We spoke of the stigma we are facing from even government officials who are supposed to support and protect PLWHAs;

We spoke about the embezzlement of Tsh. 272 million under the leadership of ELCT Makete Diocese and the Tshs. 240 million from the Global Fund which was embezzled by government officers working at the Makete District’s department of AIDS.

We explained how PIUMA worked with the MSF and ANGAZA in running VCT and also about PIUMA’s outreach programme.

We asked the media to support us in the war against corruption and for accountability.

We then gave room for questions from journalists.

Some of the questions:

Question: Have you explained this to your Member of Parliament, Dr. Binillith Mahenge?

Answer: We told reporters that Dr. Mahenge knew of the problems facing PIUMA months before he became MP. However, he has never attempted to meet PIUMA members although he has visited Bulongwa several times, and despite the fact that PIUMA had requested an audience with him and he had given his word that he would meet us. We told reporters that we were surprised that in one of the meeting in Ipelele ward, Dr. Mahenge accompanied by the former District’s AIDS Coordinator Martin Gowere (who has been implicated in the Tshs. 240 million Global Fund embezzlement and is now out of office) asked PIUMA members to take off their PIUMA T-Shirts and burn them. As a result more than 20 members left PIUMA to form another group which is allegedly supported by the MP).

We also told reporters that we have been threatened not only by some ELCT Makete Diocese officials but also by some of the local government officers.

Question: Do you have machines and medical staff to work in the clinic that you want to set and for which the government does not want to grant the license?

Answer: We have CD4 Count machines, Viral Load, Liver and Kidney Function Machines and also medical staff for the clinic. With the support of donors from Austria, Germany and Canada, we intend to run a mobile clinic to benefit PLWHAs in Bulongwa and Makete in general.

Question: So why don’t you want to take the government’s advice to establish a clinic in Matamba?

Answer: Matamba is more than 70 km from Bulongwa. The government’s policy states that its citizens should not travel more than 2 km for health services. We are trying to help the government to reduce the stress and problems PLWHAs are facing by bringing the CTC closer to their residential areas.
Isaack asked, “How can you as a parent refuse your own blood daughter a dress and buy a garment for a neighbour’s child? This is what the government is trying to force us to do by stressing that we go to Matamba!

Question: So what do you expect from your trip and what do you want to happen now?

Answer: We are here to share our experiences with the rest of Tanzanians and ask the media to work with us in a successful campaign against HIV/AIDS. We also want the Prime Minister, Vice President and the President to hear our cry and help us in our fight for basic human rights including the right to health, care and life.

Meetings with government officials and NGOs working on HIV-AIDS issues will continue tomorrow. PIUMA will begin its two day trip home on Saturday.

Isack Sanga at Dar es Salaam press conference

Teachers from St. George’s are also involved in a project to support the professional development of their colleagues in Njombe. They have arranged for local teachers Lily Barnaba and Agnes Ndunguru to register with “Reading A-Z”, an online teaching resource. Reading A-Z offers thousands of printable teacher materials to teach guided reading, phonemic awareness, reading comprehension, reading fluency, alphabet, and vocabulary. The teaching resources include professionally developed downloadable leveled books, lesson plans, worksheets, and reading assessments.

Students in Tanzania study primarily in English at the high school level, which is often these children’s third of fourth language, and they begin learning English in elementary school. St. George’s hopes to transfer some of its expertise in teaching second languages to teachers in Njombe. The School has provided resources to Lily and Agnes to download Reading A-Z teaching resources for use in their classrooms.

St. George’s School is a co-educational, non-denominational school committed to a student-centred education of the highest quality within a spirited, engaging, creative and cooperative environment. Its philosophy encourages an individualized and flexible approach to learning and to teaching, while challenging each student to excel. The St. George’s community of students, parents, faculty and staff is dedicated to offering a caring and inclusive milieu that balances the importance of self-expression with the rights of others. This outreach to Tanzania is part of the school’s “Children Helping Children” awareness project for its students.

The developing partnership between St. George’s and Highlands Hope communities like Njombe is being led by Danielle Delhaes with support from a number of her colleagues.

April 12, 2007.

Members of the Kibena Women’s Association with orphans in Njombe

The training covered the following topics.

1. Tanzania law governing the Non Governmental organisation Act 24 (2002).
2. PIUMA constitution.
3. Leadership.
4. Financial control and Reporting.
5. Managing income generating projects and Evaluation.

During this training members of PIUMA asked their leaders to make and distribute copies of constitution and the brochures on the government law of NGO.

It was insisted that reports are important, to be delivered on time to donors and stake holders.

Information to be in the reports should be as accurate as much as possible and should be cross-checked by committees concerned.

PIUMA leaders were asked to become role model in advocating for democracy, accountability and transparency.

However PIUMA finance department was praised for proper record keeping, though it was noted that the financial committee to control all matters related with financers was not as well organised as it could be.

The training attracted more than eighty two members; it was conducted by facilitators Mr. Ben Kudenya and Mr. Frank Mhando from Mkuki consultants.

In her closing remarks Wema Sanga the General Secretary of PIUMA said, “Following this training there will be great positive outcome and our organisation will become one of the few institutions that are doing a best job on the battle field against HIV/AIDS�?

“We are empowered with knowledge, now we need capital for starting and improving income generating projects,�? said Burton Mwawaya a member of the Financial Committee of PIUMA.

The coordinator for PIUMA Mr. Jackson Mbogela promised to organise a study tour for the members of PIUMA to visit another successful group of peasants, COCOBA, in a neighbouring district Njombe.

The training was sponsored by the Evangelical Association for World Mission (EAWM) based in Austria, the organisation that has been assisting community in Makete in the health sector including a fight against HIV/AIDS for many years.

Jackson Mbogela
Coordinator,
PIUMA

PIUMA members at capacity-training workshop in Bulongwa

Madeleine Buck visited the Highlands Hope clinics in January 2006 and has worked tirelessly since to build professional links between McGill University’s School of Nursing and Highlands Hope nuse professionals. McGill Nurses for Highlands Hope, founded by Prof. Buck, sponsored attendance at AIDS 2006 in Toronto by Highlands Hope nurse Betty Liduke and has supported a Canadian and a Tanzanian recipient of the Highlands Hope Nursing Fellowship.

Prof. Buck’s book is described by the publisher as, “The premier book of its kind, Health Assessment & Physical Examination, first Canadian edition, is designed to teach you to assess a patient’s physical, psychological, social, emotional, and spiritual dimensions of health as a foundation to nursing care. The skills of interviewing, documentation, inspection, percussion, palpation, and auscultation are refined to teach you to make effective clinical judgments that promote healthy positive outcomes.”

Prof. Buck also included a dedication that reads:

Dedicated to Betty Liduke, Mary Musoma, Tasilo Mdamu, and other members of the Nursing team of the Highlands Hope Consortium for their commitment, courage, creativity, and perseverance in dealing with the HIV pandemic in Tanzania.

A portion of profits from the sales of the book will go to the work of Highlands Hope.

For more information about the book, visit the Thomson-Nelson at:

hed.nelson.com/products/productPage.aspx?isbn=0176102841

The building is well situated in Bulongwa and was built with support from DANIDA, the development service of the Danish government, for a project that has since run its course.

PIUMA has applied to the Ministry of Health of Tanzania and the National AIDS Control Program for a license to manage an HIV Care and Treatment Centre (CTC) for the area. Currently, the only CTC that is readily accessible to people with HIV in the Bulongwa area is at Bulongwa Lutheran Hospital. That clinic is plagued with difficulties, however, and patients report going months at a time without CD4 tests and other care necessities. The technology used by the CTC at Bulongwa Lutheran Hospital is also incapable of providing proper care to pediatric cases.

PIUMA has demonstrated that by involving HIV+ people in their own care and in the management of the clinics that serve them, that investment in AIDS-related awareness, testing and care can be substantially leveraged. PIUMA is waiting for a visit by representatives of the NACP to review its application and to inspect the clinical facilities and technology that it has standing by for use by patients in dire need of adequate care. PIUMA is continuing with its programs of voluntary counselling and testing and advocacy and stands ready to offer CTC services as well if required.

PIUMA officials thank the office of the District Commissioner for its support in these negotiations and in the effort to bring quality HIV services to Makete District.

March 22, 2007.

March 2, 2007 (Bulongwa) PIUMA, the HIV+ patients’ self-help group in Makete District, Tanzania, announced today that it has adopted a Code of Conduct designed to fight corruption and encourage accountability in all its work providing HIV services and support in the District.

At a special ceremony at the office of the District Commissioner of Makete, PIUMA leaders met with the District Administrative Secretary, Mr. Francis Tumbo, who officiated at the formal signing of the new Code of Conduct. Present were PIUMA members Kabuyu Kyando (Chairman), Wema Sanga (General Secreatry), Amini Pilla (Treasurer), Izack Sanga (Member), and Alvina Tweve (Member).

“Fighting corruption should be a task of all citizens,�? said Mr. Tumbo. “PIUMA is the first NGO I have come across that is serious about fighting corruption in its words and actions.�?

He advised PIUMA to start small income-generating project that will enable its members to become more self-reliant so that they can fight corruption with clear hearts.

“The situation is desperate for HIV+ people in Makete,�? says Wema Sanga, General Secretary of PIUMA. “Health services are very bad. We know that corruption has led to the theft of many hundreds of millions of Tanzanian shillings that was supposed to serve people in need in our district. We know that we have to support our president and his government in fighting corruption in all levels. Corruption is killing our people!�?

In 2006, PIUMA uncovered that 240,000,000 Tsh from the Global Fund to Fight Malaria, Tuberculosis and AIDS earmarked to care for persons living with HIV-AIDS and to help prevent the spread of the disease in Makete District had disappeared and not been used as it was intended. This was in addition to hundreds of millions of Tsh that disappeared from health care and rural development projects in the local Lutheran church and hospital structures.

“We have made an innovative proposal to start mobile HIV services for people in the villages that are managed by HIV+ people themselves. We are waiting for a visit by the National AIDS Control Programme (NACP) to review our proposal,�? says Sanga. “But we also have to fight corruption by setting new standards for the honest use of all resources from the government, from donors, and from the community.�?

PIUMA’s partners in Europe and North America, principally the Austrian development agency EAWM, have also adopted PIUMA’s new Code of Conduct to Fight Corruption and Encourage Accountability.

“This is a necessary and exciting development,�? says Gottfried Mernyi, General Secretary of EAWM. “PIUMA stands for openness and truth-telling and we are enthusiastic about applying those values in a formal way to all our funding and programming in Makete District.�?

The principles and practices enshrined in the Code of Conduct will be the basis for any new partnerships undertaken by PIUMA with organizations from Tanzania, Europe and North America.

“We have been hurt gravely by corruption in the past,�? says Jackson Mbogela, Project Director with PIUMA. �?Corrupt officials closed our clinic in April 2006. That led to a serious decline in HIV services in the Bulongwa area. Hundreds of patients who could have been counselled, tested and treated by our clinic are still without care. Our people in Makete are dying!�?

PIUMA, whose full name in Kiswahili (pima uishi kwa matumaini) means “test and live in hope�?, is active on a range of health, advocacy and economic development issues, fighting for justice and for dignity for people living with HIV, their families and their villages.

PIUMA members are proud Tanzanians; their work is deeply rooted in Tanzanian law and in their country’s traditions of equality and community-based democracy and self-help.

For more information, contact:

Jackson Mbogela
Project Director
PIUMA
Bulongwa, Tanzania

+255 754 247 915
+255 787 410 315

Code of Conduct to Fight Corruption and Encourage Accountability for PIUMA and its partners in Europe, North America and Tanzania

PIUMA and its partners in Europe, North America and Tanzania agree to respect this Code of Conduct to fight corruption and encourage transparency in all work undertaken in and on behalf of Makete District.

I. Fighting corruption

PIUMA and its partners in Europe, North America and Tanzania undertake to respect the following principles for the prevention of corruption in their activities:

(a) PIUMA and its partners in Europe, North America and Tanzania and PIUMA staff shall strictly observe the state laws in force in Tanzania on the prevention of bribery and every other form of corruption, while implementing this anti-corruption and accountability Code in their operations in Tanzania.

(b) In particular, PIUMA and its partners in Europe, North America and Tanzania shall not grant, accept or disburse any monetary or other advantages directly or through third parties (e.g. consultants, intermediaries or even relatives) in ways that cause preferential and unfair treatment. There shall be no granting or acceptance of monetary or other advantages for the purpose of influencing decisions by public authorities and facilitating business including official inspections, approvals or other actions. That applies also to private business transactions with non-public business partners. It is, however, admissible to make gestures (small gifts, invitations to meals, etc.) that are in keeping with national legal systems, local regulations and national customs, as acts of courtesy not exceeding general customary hospitality.

(c) PIUMA and its partners in Europe, North America and Tanzania will develop a structure to oversee observance of this Code of Conduct by January 1, 2008, but is implementation will begin immediately.

(d) PIUMA and its partners in Europe, North America and Tanzania undertake to oppose acts of corruption of third parties that come to their attention in connection with their activities and to report them to the supervisory body to be put in place by PIUMA and its partners in Europe, North America and Tanzania.

II. Encouraging accountability

The orderly, transparent and understandable keeping of accounts is a key precondition for preventing corruption and encouraging accountability.

(a) The resources of PIUMA and its partners in Europe, North America and Tanzania must only be used for the stated purposes of PIUMA and its partners in Europe, North America and Tanzania.

(b) Orderly, complete and understandable systems of program and financial accounting shall be developed and accepted by PIUMA and its partners in Europe, North America and Tanzania and their use guaranteed; evidence of the use of resources for the stated purpose must always be available by observing regulations for keeping financial records and correctly documenting all business transactions.

(c) PIUMA and its partners in Europe, North America and Tanzania agree to keep the partnership informed as soon as possible and in writing of all monetary transfers from PIUMA and its partners in Europe, North America and Tanzania to programs in Makete District.

(d) Grants towards PIUMA projects will require externally audited annual accounts (or their reasonable equivalent for projects with budgets less than US$1,000).

(e) PIUMA and its partners in Europe, North America and Tanzania will only partner with organizations in Makete District that adopt this or similar codes of conduct to fight corruption and ensure accountability.

Bulongwa, Tanzania.

PIUMA NA HARAKATI ZA MAPAMBANO DHIDI YA UFISADI/RUSHWA.

1.0 Utangulizi.
Pima Uishi Kwa Matumani (PIUMA) ni moja ya jumuia za kiraia zilizomo Wilayani Makete inayojihusisha na mapambano dhidi ya maambukizi ya VVU, kutetea na kulinda haki za msingi za waathirika na kutafuta fursa za maendeleo ya jamii husika na wilaya kwa ujumla.
Jumuia yetu imeona ni busara tena ni muhimu kuweka bayana miiko ya kupambana na ufisadi kama njia mojawapo ya kujenga utawala bora na wa sheria katika kuendesha shughuli za jumuia hii. Azma hii ni moja ya harakati za jumuia yetu katika kuunga mkono vita dhidi ya rushwa inayoendeshwa na Serikali yetu ya awamu ya nne chini ya uongozi wa Mh. Jakaya Mrisho Kiwete, Rais wa Jamhuri ya Muungano ya Tanzania.
Kanuni hizi zinakwenda sambasamba na Sheria Mpya Na. 24 ya Mwaka 2002 inayoratibu jumuia zote za kiraia hapa Tanzania. (Rejea Sehemu ya V kifungu kidogo cha 27 cha Sheria hiyo- Code of Conduct of NGOs).

Kanuni za Kupambana na Ufisadi (Rushwa) na Kuchajisha Uwajibikaji kwa PIUMA na washirika wa nje na ndani ya Tanzania, wameazimia na kukubaliana kuheshimu Kanuni zilizoainishwa katika waraka huu juu ya kupambana na ufisadi (rushwa) na kuwa wanakusudia kuwa chachu katika kujenga dhana ya uwazi na uwajibikaji katika uongozi na shughuli zote zinazoendeshwa kwa maslahi ya Wilaya ya Makete.

2.0 Kupambana Rushwa/Ufisadi
PIUMA na washirika wake wa ndani na nje ya Tanzania wanaahidi kuheshimu
misingi ifuatayo ili kuzuia na kukabili ufisadi (rushwa ) katika shughuli zao:
(a) PIUMA na washirika wa nje na ndani ya Tanzania na wafanyakazi wa PIUMA watatii kwa dhati sheria za nchi ya Tanzania katika kupambana na hongo (mlungula) na aina yoyote ile ya rushwa (ufisadi),na kuwa wakati watatii miiko hii ya kupambana na ufisadi na uwajibikaji katika shughuli zao nchini Tanzania.
(b) PIUMA na washirika wake hawatatoa, kupokea wala kulipa fedha au mafao mengine moja kwa moja au kupitia kwa mtu/ watatu (kama vile washauri, mawakala / wajumbe au hata ndugu) katika njia ambayo itakayo sababisha upendeleo au uonevu wa aina yoyote ile. Itakuwa ni mwiko kutoa au kupokea fedha, vitu au mali au mafao mengine yoyote yale kwa madhumuni ya kuleta ushawishi katika kutoa uamuzi wa wakuu wa / ofisi za umma na kufanikisha shughuli za kibiashara ikiwa ni pamoja na ukaguzi rasmi, ridhaa au hatua nyingine zozote zile. Mwiko huu vile vile utatumika katika shughuli za kibinafsi zinazohusiana washirika ambao sio watumishi wa umma. Hata hivyo PIUMA inakubalika kutoa karama (zawadi ndogo ndogo, mwaliko wa chakula, na kadhalika) vinavyoendana na mifumo ya kisheria ya kitaifa, taratibu za nchi na desturi za kitaifa, kama shukrani zisizopita kiwango cha ukarimu wa kawaida wa kijadi.
(c) PIUMA na washirika wake Wataanzisha mfumo wa kusimamia ufuatiliaji wa Kanuni hii ifikapo Januari 1, 2008, lakini utekelezaji wake utaanza mara moja.
(d) PIUMA na washirika wake wanaahidi kupinga vitendo vyote vya ufsaidi unaofanywa na mtu wa tatu anayehusika na shughuli zao na atapelekwa mbele ya chombo cha usimamizi wa Kanuni hiyo kitakachoteuliwa na PIUMA na na washirika wake wa ndani na nje ya Tanzania.

3.0 Kuchajisha Uwajibikaji.
Utaratibu mzuri, uwazi na mfumo unaoeleweka wa kutunza rekodi za mahesabu
ni sharti kuu la kuzuia ufisadi na kuchajisha uwajibikaji wa watendaji na
wanachama.
(a) Mali za PIUMA na washirika wake zinapaswa kutumika kwa madhumuni yale tu yaliyoorodheshwa/kukubalika.

(b) Utaratibu mzuri, kamili na mifumo inayoeleweka ya mpango na mahesabu ya fedha utaundwa kwa maafikiano kati ya PIUMA na washirika wake na kuwa matumizi yake yatakuwa yenye uhakika; ushahidi wa mali kwa ajili ya madhumuni yaliyoorodheshwa kila wakati unapaswa kuwepo kwa kutii sheria za kutunza mahesabu ya fedha na kutunza hati / nyaraka za matumizi ya shughuli
zote.
(c) PIUMA na washirika wake wanakubaliana kutoa taarifa kwa ushirikiano huo haraka iwezekanavyo na tena kwa maandishi juu ya fedha zote zinazotolewa
au kupokelewa na PIUMA na washirika wake kwa ajili ya miradi nayooendeshwa katika Wilaya ya Makete.
(d) Misaada inayotolewa kwa ajili ya miradi ya PIUMA itahitaji mahesabu yanayokaguliwa kila mwaka na mkaguzi wa nje (au wakaguzi wanaofanana na hao kwa miradi yenye bajeti isiyozidi (Dola za Marekani) US$1,000).

(e) PIUMA na washirika wake watashirikiana na mashirika yale tu yaliyopo katika Wilaya ya Makete na ambayo yatakubaliana na Kanuni au kanuni nyingine zinazofanana na hizi katika kupambana na ufisadi na kuimarisha uwajibikaji.

The meeting brought everyone up-to-date on the progress of the new computer skills course and also focused on case studies for better patient outcomes.

THE HIGHLANDS HOPE CONSORTIUM TANZANIA
MEETING MINUTES 3RD MARCH 2007

PRESENT:

1. Betty Liduke Chairperson VCT/CTC counselor TANWAT
2. Mary Musoma Secretary Counselor PIUMA
3. Evangelista Kayombo Member PMCTC Counselor Ikonda
4. Maksenzia Manga Member PMCTC Counselor Ikonda
5. Potania Mfuse Member VCT Counselor Ikonda
6. Evelina Madunda Member PMCTC/RCH Counselor Ikonda
7. Sixbertha Manga Member PMCTC/RCH Counselor Ikonda
8. Maria Mahenge Member VCT/PMCTC Counselor Ikonda
9. Charles Mhagama Member VCT/HBC Counselor Ikonda
10. Melina Chalamila Member PMCTC Counselor Ikonda
11. Bertina Y Sanga Member VCT Counselor Ikonda

ABSENT:

Tasilo Mdamu Secretary VCT/CTC Counselor on training in Iringa PHC

AGENDA:
1. Reading of the past minutes
2. Computer course report
3. Case presentation ( case study )
4. Other matters

OPENING
The meeting was opened by the chairperson Betty Liduke by thanking all participants for their good attendance and welcomed all for the good start of the year 2007

COMPUTER COURSE REPORT

Ikonda and PIUMA counselors were very happy to start the computer course every one explained how he/she started learning computer and how the mouse was difficulty to them but now they are fine with it.
Chairperson explained the program and the discussion made between her and Father Duto the computer teacher the agreement is nurses for the start as foundation as most of them is their first time to use the computer is good for them to be trained the following computer program: Basic knowledge of the computer which they have already started, internet (email etc), word, excel and if time allows access.
Father Duto thinks he can manage to teach them most of the topics before he leaves as the Laboratory school is going to be shifted to Iringa University and all the computers belongs to laboratory should be send to Iringa on August this year.
After long discussion nurse counselors felt they still need more practice, more training and extra time to cover up the programs and still they will need more edition program like CTC2 NACP program as there is a lot to learn.
OPINION
• If possible the nurse counselor to have at list two computer for HH nurse counselor for practice at their place in the room at Ikonda this will be of much help
• Nurses to find extra teacher who is skilled in computer at Ikonda Hospital for the extra time and practice and who will continue with them when Father Duto goes.
• Nurses to pay for the extra time this is agreed with all nurses.
The chairperson explained to the meeting the donation from Rayben Sanga 100 USD which is already in the bank and the donation from Canadian HH friends which is not yet arrived but is already send . All nurse counselors were very happy and very thankful to all who put their effort to help them they promised to work hard and use the donation in a good way.

AGENDA 3

CASE PRESENTATION ( CASE STUDY )
This was been presented by the nurses from PMCTC Ikonda hospital
CASE:
A Pregnant woman aged 22 years from Ifakara Morogoro region reported at ANC as a waiting mother with nine month pregnancy; she hadn’t been tested before, even counseled. The nurse at ANC explained to the women about PMCTC (Prevention of Mother to Child Transmission Treatment) whereby after counseling she agreed to be tested and the result revealed HIV positive. The women refused the result, saying that it is not true as she is a born-again person. The counselor at the PMCTC advised the women to go to another place to be tested. She agreed to go to the VCT clinic whereby she discussed with her husband and both of them tested again and the result came, both HIV positive. After post-counseling, the woman agreed to take niverapine as prophylaxis for child. Before labour there was an early rupture of membranes; at the end the women got a normal delivery but the child died after 24 hours.
Question
What was the management of this mother?

AGENDA 4

OTHER MATTERS
Tasilo Mdamu the secretary has joined advanced diploma in Iringa PHC
The members agreed to do election for another person to take over the position. Mary Musoma the vice secretary was proposed to take over the position and Betina Sanga elected for vice secretary

Treasure of the HH
As the HH nurse counselor is growing all members felt it is time and important to have a treasure Mr. Charles Mhagama the VCT/HBC counselor at Ikonda hospital was elected for the position of treasurer.

CONSTITUTION FOR HH NURSE COUNSELOR
After long discussion nurses felt is the time now to have constitution and rules for guidance of the group so the next meeting will be for formulation of HH constitution and rules.

DONATION FOR COMPUTER TRAINING
Letter to be written to HH friends to thank them for their donation and richly heart

THE NEXT MEETING WILL BE ON 2ND JUNE 2007 AT IKONDA HOSPITAL

AGENDA
FORMULATION OF THE HH NURSE COUNSELOR CONSTITUTION

The meeting was closed by chairperson at 12:30 p.m

PREPARED BY
MARY MUSOMA
SECRETARY.

Working with IT experts at Consolata Hospital Ikonda, the Chair of HHNCN, Betty Liduke, and the Secretary, Tasilo Ndamu, developed an introductory course that will run for three months for approximately a dozen nurse-counselors. Course instruction began on March 1.

The nurse-counselors are each paying a registration fee with further financial support from the Dar es Salaam accounting firm Pima Associates, St. George’s Elementary School in Montreal, McGill Nurses for Highlands Hope and Canadian Friends of Highlands Hope.

The Highlands Hope CTCs are facing growing pressures from the numbers of patients seeking their services. They are among the very few rural HIV clinics in Tanzania that are providing dependable, effective AIDS care including anti-retrovirals and rigorous follow-up. They must use every technology available to maximize efficiency, including IT systems.

The Highlands Hope network will be looking at ways to extend the use of computerized medical records for better patient care and enhanced efficiency over the next year as a priority issue.

March 3, 2007.

The text of the press release follows in English and Kiswahili.

PIUMA demands that resources reach the people

February 12, 2007 (Bulongwa) The leaders of the HIV+ self-help group PIUMA are encouraged that the Central Committee of the South Central Diocese of the ELCT have taken steps to remove Bishop Shadrack Manyiewa from responsibility for direct administration of the diocese for at least six months as reported in the Dar es Salaam newspaper Habari Leo, February 7, 2007.

“PIUMA demanded public accountability from the Bishop for money that had gone missing from church-based health care and development projects,�? says PIUMA Chairman Kabuyu Kyando. “The people of Makete District are in desperate need and any resources that are made available to our region through the government or through donors must serve the interests of the people.�?

As a result of PIUMA’s demands for accountability, the Bishop locked the group out of the HIV Care and Treatment Centre at Bulongwa Lutheran Hospital in April of 2006. PIUMA’s specialized AIDS testing and treatment equipment worth millions of Tanzanian shillings has lain idle since. Local government officials also threatened to revoke PIUMA’s license as a Tanzanian NGO and PIUMA staff were harassed with one being jailed for several days without charge.

“We have not lost our confidence in the Tanzanian government or the Tanzanian police and court systems,�? says Kyando. “We trust that they will deal appropriately with Bishop Manyiewa and others who are accountable for the funds that went missing. We will accept their judgment in this matter. We insist, however, that the money that was embezzled must be recovered and used to save our dying people!�?

Repeated audits by Tanzanian accounting professionals demonstrated that several hundred million shillings disappeared from health care and development programs during Bishop Manyiewa’s tenure in the South Central Diocese. PIUMA is demanding that the ELCT, along with donors and government agencies who allowed the fraud to continue, replace these funds.

“Our people are in desperate condition,�? says Jackson Mbogela, PIUMA Project Director. “We feel that the money that was sent to Makete District for economic development, for health care and for the fight against HIV-AIDS must be recovered where possible and replaced where recovery is impossible. We will make that demand to church, government, and donor representatives.�?

A similar situation developed in 2006 with respect to hundreds of thousands of US dollars destined for Makete District from the Global Fund on Malaria, Tuberculosis and AIDS. TACAIDS, among other agencies, has been investigating that alleged fraud and corruption.

“PIUMA calls on all responsible donors, churches and government agencies to ensure that there is effective governance and full accountability for the resources that are sent to Makete District to fight HIV/AIDS,�? says Mbogela. “The needs of our people as well as Tanzania’s constitutional traditions as a law-abiding and democratic nation demand it.�?

For more information, contact:
Jackson Mbogela, Project Director
PIUMA

PIUMA yataka misaada ya fedha iwafikie wananchi

Februari 12,2007 (Bulongwa) Viongozi wa kikundi cha watu wanaoishi na virusi vya UKIMWI wilayani Makete, PIUMA wametiwa moyo kwa uamuzi uliofanywa na Halmashauri Kuu ya Dayosisi ya Kusini Kati, DKK, ya Kanisa la Kiinjili la Kilutheri Tanzania, KKKT kumsimamisha Askofu Shadrack Manyiewa katika kujihusisha moja kwa moja na shughuli za kiutawala za Dayosisi hiyo katika kipindi cha miezi sita kama ilivyoandikwa katika gazeti lilochapishwa Dar Es Salaam la Habari Leo la tarehe 7 Februari, 2007.

“PIUMA inamtaka Askofu huyo kuwajibikaji kwa umma kwa ajili ya fedha zilizopotea kutoka katika miradi ya huduma ya afya pamoja miradi mingine ya maendeleo iliyokuwa ikiendeshwa na kanisa,“ anasema Mwenyekiti wa PIUMA Kabuyu Kyando. Wananchi wa Makete wana dhiki kubwa na fedha zozote zinazotolewa na kwa ajili ya eneo letu kupitia serikalini au kwa wafadhili mbalimbali lazima zitumike kwa manufaa ya wananchi.

Kutokana na madai ya PIUMA ya kuhimiza uwajibikaji, Askofu huyo aliwafungia nje kikundi cha wafanyakazi wa kitengo cha huduma na tiba wanaoishi na Virusi Vya UKIMWI (VVU) cha Hospitali ya Kilutheri Bulongwa tarehe 12 Aprili, 2006. Mashine maalumu za PIUMA za upimaji wa VVU na zile za matibabu ya watu wanaoishi na VVU zenye thamani ya mamilioni ya shilingi za Kitanzania zimeendelea kukaa bila kutumika kwa muda mrefu. Viongozi wa serikali katika wilaya hiyo pia waliitishia kuifutia PIUMA usajili wake kama asasi isiyo ya kiserikali na wafanyakazi wa PIUMA walinyanyaswa na mmoja wao kushikiliwa na polisi kwa siku kadha bila kushitakiwa.

“Hatujapoteza imani yetu kwa serikali yetu ya Tanzania au katika mfumo wa jeshi la polisi na mahakama nchini mwetu,“ anasema Bw. Kyando. “Tunaamini kwamba vyombo hivi vya kisheria vitalighulikia kikamilifu suala la Askofu Manyiewa na wengine waliohusika na ubadhirifu huo wa fedha. Tutaukubali uamuzi wao juu ya suala hili. Hata hivyo tunasisitiza kwamba fedha hizo zilizopotea ni lazima zirejeshwe na zitumike watu wetu waliokuwa hatarini kufa kutokana na maradhi.“

Ukaguzi wa mahesabu uliofanywa mara kadhaa na wataalamu wa Tanzania wa mahesabu ya fedha ulibaini kuwa maia kadha ya mamilioni zilipotea kutoka katika miradi ya huduma za afya na miradi ya maendeleo katika kipindi cha uongozi wa Askofu Shadrack Manyiewa katika Dayosisi ya Kusini Kati. PIUMA inaitaka KKKT, kwa kushirikiana na wafadhili na mashirika ya kiserikali walioruhusu ubadhirifu huu kuendelea, kurejesha fedha hizo.

“Watu wetu wamo katika hali ya dhiki kubwa,“ anasema Jackson Mbogela, Mkurugenzi wa Mradi wa PIUMA. “Tunataka fedha zilizokuwa zimetumwa Makete kwa ajili ya maendeleo ya kiuchumi, huduma za afya na shughuli zingine zinazohusiana na mapambano dhidi ya UKIMWI lazima zirudishwe pale itakapo wezekana na kuzilipa pale ambapo haiwezekani kuzirejesha. Tutapeleka madai haya kwa kanisa, serikali na wawakilishi wa wafadhili.“

Hali inayolingana na hiyo ilijitokeza mwaka 2006 dhidi ya maelfu ya dola za Kimarekani zilizokuwa zimetolewa kwa Wilaya ya Makete kutoka katika Shirika la Mfuko wa Dunia wa Kupambana na Malaria, Kifua Kikuu na UKIMWI, Global Fund. Shirika la Kudhibiti UKIMWI Tanzania – TACAIDS miongoni mwa mashirika mengine, limekuwa likifanya uchuguzi dhid ya ufisadi na wizi wa fedha hizo.

“PIUMA inatoa mwito kwa wafadhili wote wenye dhima, makanisa na asasi za kiserikali kuhakikisha kuwa kuna utawala bora na uwajibikaji kwa fedha zinazopelekwa Wilayani Makete kwa ajili ya mapambano dhidi ya UKIMWI,“ anasema Mbogela. “Mahitaji ya watu wetu na vile vile utamaduni wa kikatiba wa Tanzania kama taifa linalozingatia utawala wa sheria na uhuru vinadai utekelezwaji wa hayo.“

Kwa maelezo zaidi wasiliana na

Jackson Mbogela
Mkurugenzi wa Mradi
PIUMA
P.O.Box 86
MAKETE - TANZANIA
Tel: +255 787 410 315
+255 754 247 915

Lots of things going on – sorry to have been delayed in updating recently.

First of all, our young volunteer Conrad Harrington is back after three months in Bulongwa working with PIUMA. Con said he had a “great experience�? and comes home feeling much more knowledgeable about the challenges of the HIV fight in a context of poverty, corruption and isolation. Con assisted PIUMA as the organization set up its new financial and management structure as an HIV advocacy and care group.

McGill Nurses for Highlands Hope have named their first Tanzanian Highlands Hope Fellowship recipient. Tasilo Mdamu has been the nurse leader of the HIV Care and Treatment Centre at Consolata Hospital Ikonda since its inception in 2004. The Centre currently treats more than 2,000 patients in Makete District and beyond. Tasilo is attending advanced studies in public health in Iringa. The HH Fellowship will pay for his books and other study resources.

Dr. Alison Doucet and Dr. Rick Mah from the Family Health group of the Faculty of Medicine of McGill have just left for a one-month site visit at the Highlands Hope sites as well as meetings with medical leaders at Muhumbili Hospital in Dar and at the National AIDS Control Program. They will meet with Betty Liduke, Ronnie Cox and Dr. Francis Masanje at TANWAT Hospital and with Father Alessandro Nava in Ikonda. In Bulongwa they are scheduled to have talks with PIUMA leaders as well as do a preliminary assessment of side effects being experienced by PIUMA members who currently have access to only one form of anti-retroviral treatment.

It was announced early this week that the Lutheran Bishop who locked out PIUMA and EAWM from the HIV clinic at Bulongwa Lutheran Hospital has been suspended from his job. PIUMA demanded that Bishop Shadrack Manyiewa’s be made accountable for the theft of hundreds of millions of Tanzanian shillings, much of it taken from health care budgets and economic development projects. PIUMA’s public protests about the fraud last spring led to intimidation by police and other threats from authorities as well as the clinic lock-out. PIUMA has drafted and is currently discussing a Code of Conduct to Fight Corruption and Encourage Accountability, a measure that they will require their partners to adopt to work with them in the fight against HIV in Makete District.

PIUMA’s application for a license to establish the first patient-run HIV clinic in Tanzania has been approved in principle by the Ministry of Health and is awaiting approval by the Tanzanian National AIDS Control Program (NACP). The NACP has agreed to come for a site visit and project review and PIUMA’s Jackson Mbogela and Mary Musoma are planning for the visit.

Canadian Friends of Highalnds Hope and McGill Nurses for Highlands Hope have agreed to partner with the Highlands Hope Consortium Nurse-Counsellor Network to provide basic computer skills training to up to 14 nurses who are part of the network on a shared cost basis. Computer skills were identified as a priority by the nurses and the course will be given by the lab technology school at Consolata Hospital Ikonda. The cost of the program is about $100 per student. Contributions would be very gratefully accepted and applied directly to this project within Highlands Hope.

The international award-winning design firm Origami from Montreal has agreed to work directly with PIUMA to create a new brand identity and promotion program. PIUMA leaders are providing input for the creation of a brand identity and communications products that will reflect PIUMA’s basic values of truth telling, accountability and self-help.

Planning continues for the first PIUMA Highlands Hope Solidarity March in July 2007. A PIUMA volunteer committee is in place and final dates are to be set soon. Media interest in Tanzania is very strong – this will be the first such march in Tanzania.

St. George’s Elementary School has partnered with the Kibena Women’s Association (a partner organization with Highlands Hope leader Betty Liduke in Njombe) to assist HIV orphans in Njombe. The students of the school continue to give financial assistance to McGill Nurses for Highlands Hope and will be doing a special fundraiser in March to support Tanzanian nurses at the Highlands Hope sites.

Dr. Arthur Porter, Executive Director of the MUHC, has agreed to continue efforts to find ways to support medical leadership at Highlands Hope Hospitals, especially Consolata Ikonda. Ikonda faces challenges at the moment following the retirement of two key physicians at the facility.

February 9, 2007.

Royal Orr
Coordinator
Canadian Friends of Highlands Hope

Mr. Mdamu is nursing leader and pioneering counsellor in the HIV Care and Treatment Centre (CTC) at Consolata Hospital Ikonda, one of the Highlands Hope sites. He is enrolled in a two year program of advanced studies in public health in Iringa and the fellowship will cover the cost of textbooks and other learning materials.

The Consolata Hospital in Ikonda began its CTC for HIV patients in December 2004. In two years, it has managed to register, counsel, test and begin treating 1,900 HIV+ patients. This is an outstanding achievement in a district where AIDS prevalence is thought to be as high as 20%.

Mr. Mdamu is also the founding Secretary of the Highlands Hope Consortium Nurse-Counsellor Network.

Tasilo Mdamu at the Ikonda CTC

Introduction

2006 has been a very busy year for Highlands Hope, a year for great successes and notable setbacks. This report touches on the highlights of the ongoing implementation of HIV-AIDS programming at the three Highlands Hope sites as well as a sketch of support activities by Canadian Friends of Highlands Hope.

It should be remembered that both Consolata Hospital Ikonda and TANWAT Company Hospital provide a range of health care services in a region of great poverty and need. It should also be noted that the local public health care system (including public hospitals in Njombe and Makete) is very weak where Highlands Hope clinics are operating.

Consolata Hospital Ikonda
The HIV-AIDS Care and Treatment Centre (CTC) at the 200-bed Consolata Hospital Ikonda has gone from strength to strength. Ikonda began its Care and Treatment Centre in December 2004. In two years, it has managed to register, counsel, test and begin treating 1,700 HIV+ patients. Ikonda also maintains a Prevention of Mother to Child Transmission Program (PMTCT) with Niverapine provision to all HIV+ pregnant women beginning in late 2005 and PMTCT training for all nurses working in the maternity ward. Ikonda is well known for its high quality laboratory work; this tradition continues with Ikonda’s effective use of Partec CD4-testing technology and computer-based records keeping for CTC patients. Ikonda also offers HIV-AIDS Home Based Care, with 4 workers who concentrate on 4 villages. Their care plan has these workers doing at least two home visits per patient per month.

Ikonda has also become the meeting place for the new Highlands Hope Consortium Nurse-Counselor Network, a professional association of nurse-counselors from the three Highlands Hope sites chaired by Betty Liduke. The Network met three times in 2006 and is planning to sponsor computer-training opportunities and case presentations in 2007.

Astonishingly, Ikonda still receives no support for its HIV-AIDS programming beyond the provision of anti-retroviral drugs from the Tanzanian Ministry of Health. It relies on private donations and the very hard work of its health professionals. The hospital also has a perennial challenge of maintaining the presence of professional staff, particularly its physicians. Two of its senior medical leaders will be retiring in the summer of 2007 and their replacement is necessarily Ikonda’s priority issue. The sustainability of the hospital’s HIV programming remains a concern, however, given the failure of public resources from national and international sources to reach the front line of the AIDS battle Makete District. Declining quality of service at Bulongwa Lutheran Hospital and Makete Public Hospital is creating more pressure on Ikonda and the decision by MSF (Spain) to close its Makete HIV clinic operation will probably create even more demand for services from Ikonda’s CTC.

TANWAT Company Hospital

At TANWAT Company Hospital, the implementation of its CTC program began in April of 2006. The TANWAT Company Hospital’s HIV/AIDS programming started in 1996 and aimed initially at HIV prevention through Peer Health Educators (PHE). At that time TANWAT focused on company workers and their dependants. By 2000, the program had extended to 17 villages surrounding the company and in 2006 has a total of 85 PHE. TANWAT HIV programming includes preventive education through peer health educators, voluntary counselling and testing (VCT), home based care and treatment of STIs.

Under the leadership of TANWAT Medical Director Dr. Francis Masanje and TANWAT AIDS expert Betty Liduke R.N., TANWAT has implemented a strategy to build sustainable CTC service provision to patients from the 19 villages that the hospital serves. The cumulative number of clients enrolled at the TANWAT CTC at the end of November 2006 was:

MALE ADULTS (15+) = 29
FEMALE ADULTS (15+) = 63
CHILDREN (0-14) = 15
TOTAL = 107

In addition to implementing its new CTC services in 2006, TANWAT was able to send its nurse-leader Betty Liduke to the AIDS 2006 Conference in Toronto with support from Canadian Friends of Highlands Hope and McGill Nurses for Highlands Hope. TANWAT also sponsored a study visit by the first Canadian Highlands Hope Fellowship recipient, Christina Clausen, who is working with the McGill School of Nursing to develop professional links between Canadian and Tanzanian nurses.

In 2006, TANWAT’s wood-processing operations were sold to a new owner. The plan, however, is to establish the hospital as a separate, not-for-profit corporation that will continue to provide services (including HIV programming) to its established population base. The leadership of the hospital is working towards this goal. Like Ikonda, the TANWAT operation receives absolutely minimal support from national and international AIDS programming budgets.

PIUMA-EAWM Centre in Bulongwa

Bulongwa was the site of both very encouraging and deeply upsetting developments in 2006. As the year began, the Austrian (EAWM)-sponsored CTC was growing very rapidly with nation-leading performance in terms of CD4 testing effectiveness and electronic records keeping. A newly-established HIV+ patients’ activist group called PIUMA was providing increasingly important volunteer support, helping to extend outreach services, especially VCT, far more effectively than what paid staff could accomplish on their own.

PIUMA’s activism was also moving in the direction of advocacy for people living with HIV, concentrating increasingly on problems of corruption in local health care systems. When PIUMA began making public demands for accountability for foreign donor, Ministry of Health, and Global Fund resources earmarked for Makete District, local authorities cracked down. Riot police were called in to prevent a peaceful demonstration against the local Lutheran bishop who controls Bulongwa Lutheran Hospital.

Shortly after that in April, the bishop padlocked the Bulongwa CTC. Patients were left without services for several days; HIV testing technology and other property of EAWM and PIUMA was impounded for months; the Austrian doctor on staff left Tanzania; services in Bulongwa went into severe, ongoing decline. Before the lockout, the Bulongwa CTC had registered more than 500 patients (including several pediatric patients) and PIUMA membership stood at 260. The Bulongwa CTC was already planning for advanced HIV program implementation challenges like lactic acidosis reactions to first line drugs and had begun developing a plan for mobile HIV services to surrounding villages. All this work was halted by the actions of the Lutheran bishop and Lutheran hospital authorities.

Since that time, Bulongwa Lutheran Hospital has failed to replace CTC services as they existed, has registered few if any new patients, has dispensed past-due drugs to a number of HIV+ people, and has refused to explain how it will replace several hundred thousand US dollars worth of health care budgets that have been stolen in recent years. Several members of PIUMA have died, some of them apparently because of the poor quality of care now provided by Bulongwa Lutheran Hospital.

As the year unfolded, it became increasingly clear that PIUMA’s activism was making many levels of authority uncomfortable. With EAWM support, PIUMA applied for a license to operate what will be the first patient-managed CTC in Tanzania. The application has been stalled in the Ministry of Health since July. When PIUMA spoke out publicly to the Prime Minister of Tanzania about local corruption (most pointedly with respect to Global Fund money) regional police threatened journalists covering the event and detained EAWM staff member Jackson Mbogela for four days without charge in unacceptable jail conditions.

By year’s end, however, the situation for PIUMA-EAWM was remarkably positive. Leadership of PIUMA remained strong and united (with a growing reputation locally for integrity and fearlessness), the new PIUMA Care Centre building in Bulongwa had reached a first stage of completion (fund-raising is being done for stage two), EAWM and PIUMA have negotiated a new partnership agreement that maintains at least two staff persons in Bulongwa (Jackson Mbogela and Mary Musoma), the license application to establish a first mobile, patient-managed CTC has been renewed, and the PIUMA ambulance project is underway with a new Nissan 4×4 vehicle purchased in Dar. PIUMA is also planning for a new membership push with special services available to PIUMA members including free hospital privileges at other Highlands Hope sites. Plans are also underway for the production of a regular PIUMA newsletter (PAMOJA) and for a solidarity march with Canadian supporters in July 2007.

Canadian Friends of Highlands Hope

Canadian Friends of Highlands Hope began 2006 by coordinating a site visit for McGill University and MUHC medical and nursing leaders to Highlands Hope hospitals and clinics. Dr. Norbert Gilmore, Prof. Madeleine Buck and Dr. Roy Baskind spent 10 days touring HH. Montreal artist Terry Mosher also participated in the trip and his “sketchbook�? was published by The Gazette later in the year.

As a result, the McGill University School of Nursing established the McGill Nurses for Highlands Hope Fund within the McGill University Foundation for charitable contributions. The McGill School of Nursing also made a commitment to work with Highlands Hope to advance its own International Health option. McGill Nurses for Highlands Hope sponsored Betty Liduke from TANWAT Company Hospital as a delegate to AIDS 2006 in Toronto. A week of meetings with Montreal partners was hosted by McGill Nurses and Canadian Friends following the Toronto gathering during which time, Betty Liduke was recognized as McGill’s first proposed clinical instructor in international nursing.

Two staff from Bulongwa PIUMA-EAWM also attended AIDS 2006 (Jackson Mbogela and Dr. Rainer Brandl). Canadian Friends also arranged for accommodation and other considerations for a representative of the National AIDS Control Programme of Tanzania, Dr. Bwijo Bwijo. McGill partners assisted the PIUMA-EAWM staff in their preparation and production of scientific posters for presentation at AIDS 2006.

During the August visit, the McGill University Health Centre welcomed the Highlands Hope delegation and the Tanzanian High Commissioner for Canada, Mr. O. Sefue, was the guest of honor.
In July, Royal Orr from Canadian Friends had traveled to Tanzania to deliver financial support to TANWAT Company Hospital for the purchase of key blood chemistry technology. He also participated in a series of meetings with PIUMA in Bulongwa and assisted in drafting a number of documents including PIUMA’s project description for a patient-managed mobile CTC for presentation to the Tanzanian Ministry of Health.

The first Canadian Highlands Hope Fellowship recipient was announced in September. Christina Clausen spent two months in Tanzania and is preparing a final report with recommendations on how to extend the McGill nurses partnership with their HH colleagues. The School of Nursing has also arranged for the printing of a special teaching resource in Kiswahili prepared by Betty Liduke and her Peer Health Educators for use in village outreach programs.

Canadian Friends of Highlands Hope was very active in October supporting efforts to secure Highlands Hope staff member Jackson Mbogela’s release from illegal detention in Iringa and to demand greater accountability from public health authorities in Makete District and at the National level. A Canadian Highlands Hope volunteer, Conrad Harrington, also left for Tanzania in October for a three-month working visit supporting PIUMA in the establishment of basic financial and volunteer management systems.

Canadian Friends of Highlands Hope began the process of registering as a charity recognized for tax purposes in November and has also maintained the Highlands Hope website with content and regular updates produced primarily by Tanzanian partners (see www.highlandshope.com ). Throughout the year, small fund-raising efforts in collaboration with McGill Nurses for Highlands Hope have raised several thousand dollars with all contributions going to HH programming. Of particular note is the support from St. George’s School in Westmount whose financial support has resulted in new project development with the HH-related Kibena Women’s Association to support education for orphans and other vulnerable children in Njombe.

Priorities for 2007

Going forward, Canadian Friends of Highlands Hope sees many opportunities for supportive involvement with our Tanzanian partners.

Experience in 2006 suggests that solidarity through direct connections between Canadians and Tanzanians can have a powerful effect on development. This, more than money, is the critical ingredient. In fact, money can have a perverse effect in areas where widespread corruption exists. In Makete District, for example, hundreds of thousands of dollars designated for health care and HIV programming from national and international sources have disappeared in recent years.

The new Highlands Hope nurse-counselor network should be a particular focus of effort. The McGill School of Nursing is the obvious lead on this and an approach has already been made to a member of the HH nurse-counselor network to become the first Tanzanian recipient of a Highlands Hope Fellowship. The School is also funding the printing of an HIV youth education resource created by Betty Liduke and her network. At the third meeting of the network, the members expressed great interest in acquiring more computer skills. Canadian Friends will investigate if this might be the most effective first step to implement computerization of medical records throughout the HH consortium.

Consolata Ikonda Hospital is doing an extraordinary job with virtually no support from government or international NGOs. We will look for opportunities for fund-raising to support Ikonda’s growing CTC patient roster.

PIUMA’s outreach and advocacy are another focus for support and encouragement. The accomplishments of this patient-led organization are already remarkable. Plans for involvement by Canadian Friends of Highlands Hope have been developed in three fields – ongoing communications support and mentoring (including support for a newsletter/magazine PAMOJA), planning for a the PIUMA-Highlands Hope Solidarity March in July 2007, and the Makete-Vienna-Montreal khanga project (a design and production initiative for a PIUMA-branded khanga for sale in Makete and on the Web).

Three representatives of the Family Medicine Group at the McGill Faculty of Medicine will visit Highlands Hope in February 2007 and investigate ways for the Group to be involved in the provision of medical services, training and support to HH hospitals and clinics. We await the results of their site visit.

Canadian Friends of Highlands Hope will also continue discussions with the MUHC and McGill Faculty of Medicine on further medical support for Highlands Hope.

Our relationship with St. George’s School will also be deepening, finding ways to support its creative outreach to orphans and its development of teaching resources for the Njombe area.

January 2, 2007.

Congratulations to Gerhard Raxendorfer, a dedicated volunteer with PIUMA in Makete District.

Gerhard is HIV+ himself and has used his status and his knowledge of the disease to educate and motivate PLWHAs in Tanzania.

Today, he was recognized as one of the “100 Top Salzburgers” by the large Austrian daily newspaper, Salzburger Fenster.

The paper’s citation reads:

Raxendorfer arbeitet engagiert und unter gefährlichen Umständen mit der Organisation „PIUMA“ in Tansania, die sich der Probleme von HIV-positiven Menschen in der Region annimmt, die in großer Armut leben und gegen das Verschwinden ihrer Spendengelder in korrupten Kanälen kämpfen.

Gerhard has worked closely with PIUMA leaders and members, spearheading the PIUMA Centre building project.

His blog (also in German) has a number of updates and pictures of the PIUMA Centre’s progress:
http://gerhardraxendorfer.blogspot.com/

Betty Liduke, chair of the Highlands Hope Consortium Nurse-Counselor Network and director of the TANWAT CTC, was an organizer and participant and she sends this email note:

HI!

Thanks,
Betty

The Kibena Women’s Association is supporting a number of orphans with financial help for their school fees, food and other necessities. A Montreal elementary school, St. George’s in Westmount, has made a commitment to work with them in this important effort.

Betty Liduke with Kibena Women’s Association supported orphan

Photo by Christina Clausen

This is the report of PIUMA Mobile VCT (Voluntary Counselling and Testing) from June 2006 to November 2006.

PIUMA made mobile VCT visits in two divisions. This work has been carried out with MSF (Medecins Sans Frontières) who have provided us use of a car, and with Population Services International and Angaza.

As the primary coordinator for these visits, PIUMA has been successful in attracting 468 adults, children and pregnant women for testing. Among them, 86 of the total tested positive for HIV/AIDS.

Another area where PIUMA helps victims of HIV/AIDS is as a provider of home based care and has plans of expanding its outreach in 2007. The PIUMA building continues to show signs of progress and the roof was completed in time for the start of rainy season.

The world can see how PIUMA is strong as a lion. Loving life and working on the prevention of new HIV/AIDS infections while remaining committed to providing access to those who need treatment.

KWA PAMOJA TUTASHINDA!

Merry Christmas and a Happy New Year.

Mary Musoma

PIUMA’s new care centre in Bulongwa. Fund-raising is underway for windows and electrical systems to complete the volunteer-built structure.

Photo by Con Harrington

We look forward to a day when recognition and support comes from the Tanzanian government and international agencies to our Highlands Hope partners for their outstanding work - more than 2,500 patients already registered and receiving HIV counselling, testing, and ARVs (when required).

The need in Njombe and Makete is enormous - there’s estimated to be 18% prevalence of HIV in the population - but the health care resources that actually reach the people are very, very limited.

And in Bulongwa, local hospital officials continue to fail patients with poor services and ongoing harrassment of patient activists.

Let’s make 2007 a year of solidarity and great success with People Living with HIV-AIDS.

It’s time to deliver! (For New Year’s wishes from Dr. Rainer Brandl of PIUMA-EAWM, see www.rainerbrandl.blogspot.com/)

KWA PAMOJA TUTASHINDA!

Wema Sanga and Kabuyu Kyando, leaders of PIUMA

Photo by Rainer Brandl

At that time the programme focused on company workers and their dependants. In 2000, the programme extended to the 17 villages surrounding the company. The programme has 19 co-ordinator and 66 PHE. That’s a total of 85 educators. This programme has been very successful with much enhanced awareness and openness among workers and community residents on health issues related to STIs and HIV.

The TANWAT programme grew to include the following activities

1. Prevention Education through Peer Health Educators
2. VCT- Voluntary Counselling and Testing
3. HBC – Home Based Care
4. Treatment of STIs

TANWAT Company Hospital added an HIV-AIDS Care and Treatment Centre (CTC), including CD4 count testing and anti-retroviral drugs, to its existing programmes of outreach, education and HIV Voluntary Counselling and Testing in April 2006.

Under the leadership of TANWAT Medical Director Dr. Francis Masanje and TANWAT AIDS expert Betty Liduke , TANWAT has implemented a program of sustainable service provision to patients from the 19 villages that the hospital serves.

The cumulative number of clients enrolled at the TANWAT CTC at the end of November 2006 was:
MALE ADULTS (15+) = 29
FEMALE ADULTS (15+) = 63
CHILDREN (0-14) = 15

TOTAL = 107

On anti-retroviral therapy:
MALE ADULTS (15+) = 15
FEMALE ADULTS (15+) = 32
CHILDREN ( 0-14) = 4
TOTAL = 51

ART eleigible but not yet on ART:
MALE ADULTS (15+) = 4
FEMALE ADULT (15+) = 8
CHILDREN (0-14) = 3
TOTAL = 15

TANWAT looks forward to continuing success but has underlined the need for official recognition and support for CTCs that demonstrate sustainable performance and service excellence.

TANWAT Company Hospital, Njombe

Ikonda started a Prevention of Mother to Child Transmission program (PMTCT) in 2004 with educational outreach and sensitization to 32 villages with Niverapine provision to all HIV+ pregnant women beginning in late 2005. Training in PMTCT methods was given to all nurses working in the maternity ward and implementation was quick and effective.

Voluntary Counselling and Testing (VCT) services at Ikonda Consolata began officially in 2002 and were integrated into the work of the CTC in December 2004. The provision of CD4 testing and anti-retroviral drugs at the CTC led a a rapid increase in demand for VCT with easy internal referrals from other medical departments.

Ikonda also offers HIV-AIDS Home Based Care, with 4 workers concentrating on 4 villages. Their care plan has these workers doing at least two home visits per month.

Consolata Hospital Ikonda

In the region of Tanzania known to have one of the highest incidences of HIV-AIDS, the Highlands Hope hospitals and clinics are giving HIV monitoring and treatment services to more than 2,500 patients.

With the most minimal support from government and large international agencies (anti-retroviral drugs are provided by the Ministry of Health and are the only resources being received), the doctors and nurses at Consolata Hospital Ikonda, TANWAT Company Hospital and PIUMA-EAWM in Bulongwa have received and treated hundreds of new HIV patients in 2006. This is in spite of inaction, corruption and (in some cases) harrassment by local authorities.

In addition to counselling, testing and anti-retroviral therapy, the Highlands Hope clinics offer peer education, community outreach and basic home-care services.

Highlands Hope progress can be attributed to an approach that favors small, bilateral funding mechanisms, high degrees of volunteerism, a commitment to professionalism and better patient outcomes, and governance and accountability mechanisms that ensure that all money reaches target groups in an effective way.

The supporters of Consolata Hospital Ikonda, TANWAT Company Hospital and PIUMA-EAWM can be justifiably proud of how well their organizations are respondng to the scourge of HIV in Njombe and Makete Districts.

EAWM-PIUMA nurse-counsellor Mary Musoma with HIV patient Jangala Chengula in Bulongwa

1. Betty Liduke – Counsellor – TANWAT ( Chairperson )
2. Tasilo Mdamu – Counsellor – Ikonda ( Secretary )
3. Evangelista Kayombo – Counsellor – Ikonda
4. Maksensia Manga – Counsellor – Ikonda
5. Sixbertha Manga – Counsellor – Ikonda
6. Potania Mfuse – Counsellor – Ikonda
7. Evelina Madunda – Counsellor – Ikonda
8. Charles Mhagama – Counsellor – Ikonda
9. Onolina Mahenge – Counsellor – Ikonda
10. Bertina Sanga – Counsellor – Ikonda
11. Mary Musoma – Counsellor – PIUMA Bulongwa

Jackson Mbogela and Dr. Rainer Brandl from PIUMA-EAWM were guests at the meeting.

Updates on progress were given from all three Highlands Hope sites. It was agreed that nurse-counsellors share common difficulties which they would like to solve together. Learning from each other is the network’s main goal.

The members of the network also discussed at length the need for basic knowledge of computers which would help them in their work and with their reporting systems. It was agreed that a plan would be made for counsellors to learn computer skills at Ikonda where they have a class in computer technology and teachers. The chairperson, Betty Liduke, expressed a hope that this could start soon.

Tasilo Mdamu, counsellor at Ikonda and Secretary of the Highlands Hope nurse-counsellor network.

The first Highlands Hope Fellowship allowed Christina Clausen, a McGill-trained nursing specialist in maternal-child health, to visit and work with Betty Liduke and other Highlands Hope nurses in October and November.

McGill’s monthly newspaper, The McGill Reporter has profiled Christina and her Tanzanian visit this month. You can read the feature by clicking the photo below.

Highlands Hope nursing leader Betty Liduke, right, McGill School of Nursing’s proposed first International Clinical Instructor in Africa.