Local children

Treated mosquito nets are well used

Family care

Mvumi hospital

After a busy day's work on the noisy, smelly and overcrowded Children's Ward, there is no better place to go than Sunset Boulevard, the track leading round the side of the hill on which Mvumi Hospital is built.  There, there is space and peace and quiet, apart maybe from the odd sound of a goat bleating or children playing in the distance.  You can watch the sun setting over the plain; the plain which looks so empty but is the reason for the hospital being there.  Spread out before you is a densely populated area of smallholdings, a fertile area for the gospel when the missionaries arrived in 1900 and home to wild animals such as elephants, antelopes and giraffes.  The game has mostly gone, but animal attacks on humans still lead to admissions, with patients with lion, hippo, crocodile and hyena bites treated in my ten years here.

What has increased is the human population.  Pressure on good farming land is intense and the farms barely sustain the local people, most of whom have no paid employment.  The hospital serves 220,000 people in Dodoma Rural District, and others come from surrounding districts by foot, bicycle, local bus, string bed, ox- or donkey-cart and if they're lucky, car.

Many of the diseases the first missionary nursing sisters saw are still public health problems, and preventable diseases such as TB and malaria are increasing despite modern drugs being readily available.  New diseases such as HIV, which kills 4 Mvumi village people a week out of a population of ten thousand, add to the high death rate.  

Bewitched

On a walk round the village in the months from February to June it is a common sight to see sick children lying on mats outside the houses.  The problem is usually fever and headache and the home treatment is paracetamol - when what most of them need is antimalarial medicine.  Once the malaria parasites are in the blood, the red blood cells are destroyed leading to anaemia.  It is often not until the child is pale and gasping for breath due to severe anaemia that the parents decide to bring him or her to hospital.  A child with convulsions due to malaria is thought to be bewitched and taken to a local diviner where rituals such as throwing a winnowing bowl over the child's back are used to treat the child.

For every child admitted with severe malaria or malaria-induced anaemia, there are probably 100 children in the community with uncomplicated malaria languishing at home.  Because of the delays in bringing children to the hospital until they are really sick, children die every day on the Children's Ward in the malaria season when they could have been saved with earlier treatment.

Attitudes

Changing people's attitudes to sickness and their behaviour in seeking medical help takes time.  In the short term it seems important to find ways in which people can protect themselves from disease, thus avoiding the costs of treatment and transport and the unnecessary loss of life. One way to prevent malaria is to treat mosquito nets with insecticides to kill the malarial mosquitoes which are most active at night. This reduces the risk of malaria by half and reduces deaths in children under 5 by over a quarter.  The insecticide used on the nets is a synthetic version of pyrethrum, which is found in daisies. It easily degrades to carbon dioxide and water, is harmless to humans but kills the fleas, lice, bedbugs, ticks, chicken lice and other insects found in the local people's homes.

Roadshows

I have been involved with a social marketing project set up in four areas of Tanzania since 1998 to enable poor people living in villages to buy nets and insecticide kits for dipping nets at subsidised prices. Social marketing uses marketing and advertising techniques such as product branding, roadshows, village cinemas, T-shirts and posters to sell health products in the same way you would sell soft drinks. The nets are called "Sweet dreams" and insecticide "Shield" in Swahili. A net costs under £2 and insecticide 30 pence . The net lasts up to five years and the insecticide is reapplied every 6 months. Compare this with the hospital cost of treating a child with cerebral malaria: £3 or that of transfusing a child with malarial anaemia: £5, to say nothing of transport and other hidden costs to the family such as time lost from farming. Even with screening of blood for HIV antibodies, in an area like Mvumi with a high incidence of new infections, there is a risk of transmitting the virus in blood transfusions. Some estimates put it as high as 1 in 100 bottles of screened blood.

Crosslinks magazine August 2002 index