Mwaka Kogwa Festival

Today I went with ZANGOC to the Mwaka Kogwa Festival in Makunduchi, Zanzibar in the south district of the island (highlighted on the map). 

The Mwaka Kogwa is an old traditional festival which marks the arrival of the new year, or 'Nairuz' according to the Shiraz (Iran) calendar. Shirazis were the first foreigners to settle in Zanzibar and many aspects of their culture were absorbed by the Swahili people and were given a local context.

Today was the first day of the 4 day festival which is marked by an opening battle of ritual physical combat, traditionally using sticks and cudgels as weapons which have now been replaced by banana stems. The fight is governed by a number of loose rules which are normally observed by the participants without the need for a referee. When one combatant feels that he has had enough beating, he simply raises both of his hands and surrenders, or changes his weapon for a better one and continues fighting.

Matters become complicated when supporters of either side join in the fight, making it becomes difficult to find an unscathed banana palm in the area! It is traditionally believed that since everyone has had a chance to fight, or to vent any hard feelings, there would be no future conflicts in the town in the coming year. Past year's misunderstandings and disagreements are exorcised and the new year can be started with a clean slate and in harmony.

Participants warm up by running around the pitch

Note the "weapons" in hand...actually used to hit each other with (no jokes!)

I didn't get close enough to the actual fight to take photos, one: because of the crowd and two: for fear of being hit with a banana stem by accident...I'm sure it can't feel good!

So, by now I bet your wondering what the heck ZANGOC's role in this festival was! Well, as I mentioned in my previous blog about Pemba, ZANGOC is currently running VCT services in Unguja and Pemba funded through ICAP. ZANGOC was stationed at the festival to provide free HIV counseling and testing services which were open to anyone at the festival from 11am until 3pm. At the end of the day, ZANGOC had tested and provided post test counseling to 120 people, of which all 120 people tested negative for HIV. The post test counseling was provided to everyone who tested, regardless of positive or negative status. Since all of the tests were negative, the counselors provided clients with information on how to remain safe from HIV and also gave each client free condoms.

ZANGOC/ICAP banner

Banner explaining ZANGOC to the public: Utangulizi - Introduction, Dira - Vision, Dhamira - Mission,              Majukumu Makuu - Objectives

Things I've learned

As I sit and write my midterm report for YCI, I can't help but think how my time here is just flying by. June has come and gone, yet it still seems like I just arrived in Zanzibar last week! Writing my midterm has made me reflect a lot over the past 3 months (as well as my time in Ghana) and I do feel as though I have accomplished a lot with work and in my personal life.

I have finally finished the first complete draft of the ZANGOC strategic plan which I feel is a weight lifted off my shoulders! Also, I have been expanding my circle of friends and dancing a lot which, as always, keeps me happy (and sane!) However, I must admit that I am finding myself missing Toronto these days, only because it's summer time and I miss playing baseball,cycling (without fear of dying!) and relaxing in the park with friends and cold beer!

At the half way point I want to reflect on some things I've learned since being on this continent for nearly 8 months now, minus the 6 weeks in February/March that I was freezing in Toronto!

1. It is impossible to keep your feet clean
2. Life is a strategic plan; you must have a vision, mission, values and goals!
3. I have a lot of trust in people
4. Sleeping under a bednet doesn't mean you won't be attacked by mosquitoes all night long
5. Mosquitoes exist for no other reason than to torment people
6. Thieves are cunning, sneaky and very quick
7. Germans are awesome and make great friends (and are everywhere...in large quantities!)
8. There are no road rules, except for honking 
9. Pedestrians DO NOT have the "right of way"
10. There is no limit on the number of people you can cram into a taxi (so far I've reached 8 people in a taxi in Koforidua and 5 people in a bajaji in Dar es Salaam)
11. Street food is always a good choice
12. Bargaining is great and really should be introduced into the Western world
13. The "muzungu" or "obruni" or whatever you want to call a foreigner is often left in the dark
14. Apparently the muzungu or obruni knows all...which is NOT true!
15. Smiles and laughter say a thousand words
16. It really is OK to strike a conversation with strangers on the daladala, trotro, mutatu, subway, bus or whatever mode of public transportation you use to get to work (ditch the ipod and give it a try!)
17. Hitch-hiking is not frowned upon and no one suspects the driver will attack you
18. Soccer really does run the world
19. Funerals are a huge party, and very fun
20. Celine Dion and Shania Twain are still popular here...and will forever be popular here 
21. Males START and FINISH the dance floor (much appreciated by me!)
22. You are always recognized and definitely stand out (get used to it!)
23. It's ok to talk to strangers, people just want to ask you questions
24. Stepping out of your comfort zone is a MUST
25. Hospitality really is an amazing quality
26. In order to get the right answers, you must ask the right question...sometimes this is a long process!
27. African "massages" ... don't let them fool you (aka: long bus rides on very bumpy roads)
28. When a policeman asks for a "Friendly" what he's really asking for is a bribe 
29. There is nothing more beautiful than the perfect sunset over the Indian Ocean
30.  TBD!

5 people + the driver in a Bajaji in Dar

Sunset in Nungwi, North Zanzibar

Forodhani Night Market, Stone Town

Steph and I dancing at a funeral in Koforidua, Ghana

Soccer stadium in Kumasi, Ghana

Dancing with some school kids in Koforidua, Ghana

I think this list will have to be ongoing as I am still here for another 3 and a half months! Please feel free to add anything you've learned while traveling/working overseas.

"Yes we can".... Can we?

Some interesting things have transpired this week during the ZACP workshop (round 2!)...

Monday was the beginning of round 2 for the ZACP strategic planning workshop. The last ZACP workshop I blogged about was in regards to a performance review of the previous ZACP strategic plan. During this 3 day workshop we reviewed the strategic activities, achievements, challenges and gaps in responses. From the  gaps we created new strategic issues at each identified intervention level that need to be addressed in the next strategic plan (2011 to 2016). 

This week's edition of the ZACP workshop is 6 days (Monday June 6 to Saturday June 11) during which time we are taking the identified strategic issues from each intervention level (ie: BCC, Home Based Care, Key Populations, etc...) to create outcomes, outputs and activities. This has been an amazing learning experience for me because I have been able to put my Results Based Management (RBM) skills to the test with the help of some really great minds. I ended up working with the Director of ZACP and an M&E Consultant who works for UNAIDS, to name a few. The M&E consultant was great as he was able to pin point the exact phrases and words that needed to be use to make each sentence either an outcome, output or activity. It may sound easy, but it's really a lot work! 

During Tuesday's workshop there was an American lady present who works for the Center for Disease Control (CDC) in Dar es Salaam. She made a little speech regarding the topic "yes we can" stop HIV and AIDS transmission in Zanzibar. I added "Can we?" to the title of this blog because I don't necessarily agree with her theories on this topic.

The theory was that since Zanzibar is a small island with an already relatively small rate of transmission, if we were to scale up prevention methods (focusing on early treatment) we could eventually stop new infections. Ok, that makes sense, but her implementation process would never fly especially in Zanzibar due to cultural and religious sensitivity.

She compared the implementation process of halting new HIV infections with the same tactics used to control malaria in Zanzibar which was achieved through 2 methods:

1. Prevention - providing bednets to everyone
2. IRS - indoor residual spraying 

She went on to say that we can use the same methods to stop transmission of HIV thus being

1. Prevention - providing condoms to all 
2. Door to door HIV testing

Both of these methods would never work in Zanzibar. First of all, I have spent the past 5 days discussing how highly regarded religious leaders are in Zanzibar and how difficult it is for them to allow the distribution of condoms in the public, an issue that was discussed heavily in my behaviour change communication (BCC) group. Second of all, it is difficult enough to get people, especially those who fall in the "Key Populations" group (MSM, IDUs and FSWs) to be tested for HIV due to the stigma and discrimination surround the disease. Therefore, it is in violation of a person's human rights to be forced into testing, even if it is in their benefit to know.

These were my opinions on her "yes we can" speech and I was curious to know what people from Zanzibar thought about her theories. I decided to do some reconnaissance work and ended up speaking with a few different people to hear their views. The first was a Zanzibari nurse who works for ZAPHA+ and she also said that it wouldn't work due to cultural factors. The next man I spoke with was a Zanzibari gentleman working for the Department of Substance Abuse. He said it would never fly because you would never be able to go door to door and test people as it's a violation of their human rights. Lastly, I spoke with a Tanzanian man who works for CDC in Dar es Salaam (a colleague of the lady who made the speech). He didn't agree with her and he told me that she had pitched the same idea to other people within the Ministry of Health and no one would really back her ideas. His issues were:

1. You will have a hard time convincing health people to go on ARVs at a young age for the rest of their life
2. There are 1.4 million people living with HIV in Tanzania and not even half of them have access to ARVs. Once funding is gone how will Tanzania be able to afford to keep 1.4 million people on ARVs for over 20 years.

Don't get me wrong, I enjoyed her optimism and if you do your research into early treatment as prevention for HIV you will find a lot of information. I just think that before she pitched this idea she should have had more support from Tanzanians in order to address cultural issues within this theory.

I'd love to hear your thoughts, please share with me!

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Quick Research: Early treatment as prevention

Treatment as prevention works

New Support for "Treatment as Prevention" Approach to HIV

Early treatment reduces HIV transmission in heterosexual serodiscordant couples

USAID – “From the American People”

On Friday May 20^th I was fortunate enough to be invited to attend a very high profile meeting in Stone Town at the ZAC (Zanzibar AIDS Commission) office with representatives from USAID, VSO, ZAC, ZANGOC and ZAPHA+. This meeting was in regards to a call for proposals that was recently sent out by USAID/Tanzania for a 5 year funded program for comprehensive and sustainable clinical and community based HIV services throughout Tanzania. Amongst those eligible to apply for this funding opportunity are Tanzanian, international or US NGOs who are able to form a consortium or partnership with other like minded NGOs to develop and submit applications to USAID for a wide ranging clinical and community based HIV services both at facility and community levels.

Outside the ZAC office in Shangani, Stone Town

 

Zanzibar is eligible to form a consortium and apply for this funding under “Core 2” which will cover community‐based HIV/AIDS care and support programs in Iringa, Dodoma, Morogoro, Singida, Mwanza, Kilimanjaro, Tabora and Zanzibar.

The purpose of the meeting on Friday was to get the ball rolling and to decide how many NGOs in Zanzibar this funding will be directed to and to identify which NGOs these will be. The decision came down to the following NGOs: ZAC, ZANGOC, ZAPHA+, WAMATA and UMATI. It is inevitable that other NGOs in Zanzibar will be involved in the roll out of this program as ZAC is a coordinating NGO and ZANGOC, as we know, is an umbrella organization and will hence distribute funds to its member organizations that have the capacity to take on such a large program.

The next steps for the Zanzibar Consortium:

The representative from VSO is to meet with USAID in Dar es Salaam on Monday May 23rd to see if the first round of concept papers due in February had been obliged. If not then the aforementioned NGOs will form a group and write a concept paper to USAID that will be due on June 24th (something I hope to be involved in, one way or another!)

It is possible that the second round of applications will be canceled if funding has been fully obligated. It is also possible that no Concept Papers for “Core 2” will be accepted in the Second Round if an award for “Core 2” has been made as a result of the First Round.

So, hopefully by Tuesday we will find out if we are able to move forward in writing a concept paper for this amazing opportunity.

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HIV/AIDS in Tanzania

Mainland Tanzania is grappling with a mature, generalized HIV and AIDS epidemic. According to the

2007‐08 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS), adult HIV prevalence in the country is estimated at 5.8% and an estimated 1.4 million Tanzanians are living with HIV and AIDS, of which approximately 10% are children HIV positive. Prevalence has declined slightly from an estimated 7% in 2004. Despite this documented decline in prevalence, an estimated 217,704 people contracted HIV in Tanzania in 2008, according to national surveillance data (National Prevention Strategy Review, 2009). Over 80% of HIV transmission in Tanzania occurs through heterosexual contact, approximately 18% through mother‐to‐child transmission, and 1.8% through medical transmission or traditional practices. Women in Tanzania make up 56% of the HIV‐infected population. With more than 1.8 million births and 6.8% HIV prevalence at antenatal clinics (ANC), approximately 100,000 HIV‐positive women deliver HIV‐exposed infants annually.

In 2010, the USG and United Republic of Tanzania (URT) signed a Partnership Framework (PF) outlining the two nations' joint commitment (2009‐2013) to a durable and effective response to the HIV and AIDS crisis in Tanzania. The Partnership Framework in Tanzania is representative of the core principles of PEPFAR II and focuses on building capacity for a greater country‐led response, increasing Tanzanian ownership of the HIV/AIDS response, scaling up effective prevention interventions, and laying the foundation for more sustainable country programs. The Partnership Framework is consistent with Tanzania’s National Multi‐Sectoral Framework on HIV/AIDS (NMSF 2008‐2012), and the Health Sector Strategic Plan III (HSSP 2009‐2015), and is intended to align the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) with United Republic of Tanzania (URT) national priorities.

Under the National Multi‐Sectoral HIV/AIDS Framework 2008‐2012 and the Health Sector HIV/AIDS

Strategic Plan III 2009‐2015, the Government of Tanzania (GOT) has laid out an ambitious plan to implement several key HIV/AIDS interventions. This document outlines key clinical HIV/AIDS services program such as Prevention of Mother‐to‐ Child Transmission of HIV (PMTCT), Counseling and

Testing (CT), TB/HIV, Facility and community based HIV/AIDS care and support programs for PLHIV such as Home‐based care and nutritional support services. Other supporting documents include the

National Care and Treatment Plan which aims to provide treatment services to over 440,000 people living with HIV/AIDS (PLWHA), the Pediatric HIV/PMTCT Scale up Plan, the TB and TB/HIV

Collaborative Policy and Implementation Plan and the National Guidelines for Home‐ based Care Services.

The 2010 PEPFAR/Tanzania Annual Progress Report (APR), indicates the USG currently provides care and support services to over 900,000 PLHIV of which over 250,000 HIV positive clients are on treatment (ART) and 150,000 clients receive community based care and support services. Over

1,300,000 pregnant women received HIV testing and over 60,000 HIV‐positive pregnant women received antiretroviral prophylaxis.

Most of the USG‐supported HIV/AIDS services are implemented through grants to international partners who in turn support the URT/ Ministry of Health and Social Welfare (MOHSW) in both the mainland and Zanzibar, as well as local partners to roll‐out interventions at regional, district and community levels.

CHALLENGES

Despite successes in enrolling Tanzanians into care and treatment programs and saving lives, the national HIV/AIDS program faces formidable challenges. Long‐term financing and sustainability are especially problematic as the current program is almost completely donor‐funded. Under PEPFAR Phase One, national HIV/AIDS services and programs were launched as an emergency response, implemented primarily through NGOs and international technical assistance partners with foreign donor funds. Tanzania’s endemic health delivery system weaknesses ‐‐the absence of viable health systems and health information systems; a severe lack of human resources; absence of basic infrastructure, shortages of drugs, and commodities; and inadequate financing – have been temporarily patched through PEPFAR and Global Funds inputs but the health delivery system as a whole remains fragile and overly dependent on donor support. Despite enormous inflows of donor funding and international technical assistance, the national HIV/AIDS program continues to suffer from a lack of patient follow up outside the clinical setting, and inability to enroll target populations into care and treatment programs and a significant loss of retention of HIV positive patients on antiretroviral treatment (ART).