Preplanning and initial goals:

In many ways, Tanzania is an ideal location to offer a Global Service Course. It has had an interesting history of colonization by several other nations including Great Britain and Germany with the result that English is one of the official languages (Swahili is the other) and the language of instruction in secondary education. However, its population is still nearly exclusively composed of African Bantu groups. It is a stable democracy today and has been a point of stability for nations around it that have suffered turmoil. For instance, the Karagwe region where we propose to develop the course was the site of Rwandan refugee camps during the Rwandan civil war of the early 1990's. However, despite its stable political environment, it is a third world country. Students visiting there will be exposed to many issues involved in daily life in such an environment.

Subsequent newspaper article:

The district of Karagwe is one of the poorest areas of Tanzania, far removed from the tourism centers of the eastern area of this country. Despite archaic equipment (the only X-ray machine is thirty-seven years old) and a dearth of medicine, supplies, and funds, the hospital provides in-patient treatment for a wide range of illness including tuberculosis, AIDS related diseases, leprosy, and malaria (separate wards for males and females), surgical treatment for all types of injury and illness, and delivers over 1000 babies a year (high risk pregnancies, 50% are Caesarean section). The children's ward is filled to capacity (sixty beds, over 100 admissions during our visit, 2 per bed) with children ill with malaria, dysentery, and some with malnutrition.

Malaria is one of the major health risks in tropical countries such as Tanzania and is the number one killer of children under the age of five. Death can occur within twenty-four hours from the most acute form, cerebral malaria. The Nyakahanga Hospital is incredibly important in providing treatment and in developing education projects for malaria prevention (including encouraging the use of mosquito nets while sleeping). Malaria is endemic to Tanzania with most of the population infected at one time or another (see http://www.who.int/inf-fs/en/fact094.html for more information on malaria). Visitors to Tanzania from western countries commonly use antimalarial drugs to protect themselves from malaria, but these drugs are either not available or too costly for most Tanzanians. Malaria presently accounts for approximately 35% of inpatient diagnosis and 40% of outpatient diagnosis at hospitals in Tanzania (http://www.who.int/disasters/country.cfm?countryID=57&doctypeID=10). Young children and pregnant women are at greatest risk for malarial complication and death. Some immunity appears to develop with recurrent infection so that children that survive to the age of five years have a much greater chance of surviving subsequent malaria attacks. The Nyakahanga Hospital has approximately 100 malarial admissions at present. Most are infants. Fatality rate is less than 10% at present but can rise as high as 20% during epidemics (most recently in 1998)(Nyirenda, personal communication). Infants with malaria are admitted to the hospital, monitored and given intravenous treatment (and transfusions if they suffer from malarial induced anemia). Once through the acute phase of the disease (3-4 days), they are released to recuperate at home in order to make room for new patient intake.

The AIDS Control Project is another crucially important program that is operated through
the Nyakahanga Hospital. The Lutheran magazine recently published an article on AIDS and AIDS orphans in northwestern Tanzania. The area discussed in The Lutheran is partially serviced by the Nyakahanga Hospital. Tanzania has been harder hit by AIDS than many of the surrounding countries. The northwestern area of the country had the earliest reported case of AIDS in Africa in 1983 and continues to report high incidence of infection. The Nyakahanga Hospital has screened blood donated for transfusions for HIV beginning in 1997. In 2001, 17% of the blood was infected with HIV. In addition, the Karagwe Diocese (ELCT) requires that all couples seeking to marry within the Church be tested. HIV infection rates from pre-marital testing have varied between 5-32% from 1997-2001 (14.5% in 2001). The AIDS control office at the hospital provides counseling for HIV positive individuals and support services for those with HIV, AIDs and the orphans and widows of deceased AIDS clients. Many of these widows and some of the orphans are themselves infected with AIDS. The AIDS control office presently has more than 9500 registered clients (2001 figures). Over 8400 of these are orphans whose parents have died from AIDS. The hospital and Karagwe Diocese are actively trying to develop new programs to provide housing and education for the AIDS widows and orphans.

The Global Missions committee of the Northwest PA Lutheran Synod is also actively seeking ways in which to assist its companion diocese in Karagwe and the Nyakahanga Hospital. For further information contact the Northwest PA Synod office at 814-677-5706, Nyakahanga hospital at Nyakahanga@africaonline.co.tz, or the Karagwe Diocese (ELCT) at kad@africaonline.co.tz. Mr. Joseph Croskey and Dr. Linda Winkler have developed a website for the hospital at http://nyakahanga.tripod.com/.

References:
http://www.who.int/disasters/country.cfm?countryID=57&doctypeID=10 (July 5, 2002)
http://www.who.int/inf-fs/en/fact094.html (accessed July 5, 2002)

Submitted by Dr. Linda Winkler