jake lyell photography (blog)

“I went to see the witch doctor for the pain in my bones and legs. He said he was powerless to help me, that I was bewitched by someone more powerful than he. He referred me to another witch doctor. I gave up going after that.” That was many years ago. Elizabeth Ramazan, pictured above, has in her lifetime begun to witness a change, albeit not sweeping, in her village’s approach to healing. At over 70 years of age (she doesn’t know it for certain), she has walked one and a half hours to the medical dispensary organized and funded by Light in Africa at the Lutheran Church in the village of Chekereni in northern Tanzania.

Mrs. Ramazan queues with about 80 other men, women and children who have heard via announcements in their churches, mosques and village meetings that free medical care will be given in Chekereni on this day. The care is basic: an interview with the a doctor, a blood pressure reading and a perhaps a listen to the lungs through the stethoscope. Then it’s on to the nurse to have the recommended prescriptions filled. Below, nurse Grace Boniface (white shirt) fills prescriptions with the help of volunteers at LIA’s dispensary in Kilombero Village.

The ailments found here are all but predictable: parasites for the young, arthritis and hypertension for the old, malaria for all. After 10 patients come through, the dispensary seems to be operating more like an assembly line. Can the simple doling out of all this medicine after a five minute consultation really be effective?

I ask the patients themselves. “This is the only place I receive medical treatment,” says Mrs. Ramazan, who has sought help at this dispensary for five years now. “Nowhere else.”

Mrs. Rolvana Masawe who walked with her two year old child, Kevin, from the village of Kawaya, has been attending for three years: “Here it is easier to get medicine, and we trust the medicine… they’ll sell you anything, ” she says, referring to the sometimes expired or knock-off pills sold in the pharmacies in town. “The first time I came here the doctor prescribed medicine for my daughter and she became well.”

The availability of proper medical care is scarce in rural areas of Tanzania, where more than 80% of the country’s almost 40 million people live. For this reason Light in Africa holds mobile clinics in remote villages like Kilombero and Chekereni, villages that have no doctor or medical dispensaries of their own. They are no substitute for a primary care physician. However, the villagers here have no other option. Below, a woman from the Maasai tribe awaits a consultation outside the dispensary in Kilombero Village.

Perhaps these dispensaries are most effective because of the regularity with which they occur. Every month Light in Africa holds a dispensary in either Chekereni, Kilombero or Mererani, covering each village at least four times a year. By making regular visits, the overall health of the community can be evaluated and more serious health problems can be identified.

Of course, not all ailments can be cured with the popping of a pill. Rebecca Makombe waited in line like the other 174 people that attended LIA’s medical outreach dispensary in the village of Kilombero in Simanjiro District. At 15 years of age, she’s walked with crooked legs the majority of her life because of the poor water quality in her village. She and her mother have come to the dispensary this day to see if LIA could be of any help to her.

There’s something in the water in Simanjiro District– an overabundance of fluoride- where Rebecca (shown above) and many others live who develop crooked legs in their youth. Light in Africa currently houses four children from this district who have recently undergone or who are awaiting operations to correct bone deformities.

Today is Anitovja Suiliman and her son Mwacha’s (both pictured above) first time at the Chekereni medical dispensary. She comes clutching prescriptions from KCMC hospital in Moshi dated four years ago. Now tattered and worn, they lay softly in her hands more like scraps of cloth. Mwacha has a deteriorating eye condition and has been unable to attend school for years now. He sought treatment at KCMC hospital, a four hour drive one way from their home by public transport, four years ago. Only now do they have enough money to fill the prescription. They have come today to ask for funding for the transport and hotel so that they may return to KCMC.

Both Rebecca and Mwatcha’s treatments are currently being funded by volunteers at Light in Africa. Mwatcha receives medicine and regular checkups at KCMC, while Rebecca is currently boarding at a LIA guest house awaiting her operation. Below, LIA volunteers and staff struggle to get to the Kilombero dispensary on time.

When LIA holds a dispensary, anywhere from 75 to 200 people turn up for medical care in the span of a few hours. The fact that so many people seek the help of modern medicine in rural areas is significant. While few will ever admit to a westerner that they seek help from witch doctors, they are still very much in practice in Tanzania.

“Traditional medicine is difficult to categorize,” says Simon Msango, 83, whose parents were both witch doctors. “One kind helps you with herbs that can be found and sometimes they work. Another tries to help you using chickens’ blood or albino body parts. These also create enmity between people by saying that one has bewitched another.” Mr. Msango refers to the killing of over 40 albino Tanzanians since last year, carried out by men hired by witch doctors. According to some witch doctors, the use of albino body parts in potions can bring about riches or the healing of diseases. Of course not all traditional healers dabble in sorcery, now banned as a practice throughout the country after the recent spate of albino murders.

Close to two-thirds of people living in East Africa consult a traditional healer first when trying to cure an ailment. Such healers are highly regarded in rural communities. In many cases, modern medicine simply isn’t available to patients, or if it is, is unaffordable. Hospitals and dispensaries are concentrated in urban areas, sometimes many days’ drive from a rural village, compounding the relatively high cost of treatment. Those living in Kilombero, for instance, are a 90 minute drive from Mererani, the nearest town with a doctor. That’s if a car happens to be going; no public bus does. Arusha is farther afield. A bus leaves on weekdays from a neighboring village at a cost of 3,000 Tanzanian Shillings ($2.30) for one way.

The majority of what is dispensed here are over-the-counter pain killers, de-worming tablets and anti-malaria medication. The anti-malarials are the most expensive, and also the drugs that are furthest out of reach for the populations in Kilombero and Chekereni. Malaria is also the gravest of illnesses should it go untreated, killing more people in Sub-Saharan Africa each year than any other disease. When I contracted malaria two months ago the test and treatment combined cost me 8,800 TS – not even seven US dollars, but far too much for a family living off the land.

As Western countries constantly wrangle with how to fix the cracks in their own health care systems, most Tanzanians’ access to any health care in any form is limited at best. Very few government programs exist. Looking on the bright side, there’s one giant clean slate upon which to write for anyone who dares to pick up the chalk.