Contents of the report:

Foreword
The Situation in 2003: “Everybody knows somebody”
The “Write Up“– Planners on the run
Introduction of the players I: The Have Nots
Introduction of the players II: The Do-Gooders
Introduction of the players III: The Elites
The Obstacles – Vested Interests of the players
The Tanzanian Government’s duty
The Implementation – Searchers in the field
The team – no success without the Patient
Treatment as Preventive Meassure
Medical Treatment before the lock-out
The Treatment and Care Situation after the Lock-out
Special Treatment Situations
Children and Pregnant Women
The Media and the Poor: The Flow of Information
The Role of the Internet
Technology: CD4 Counters - a business opportunity for Elites?
Theft and Systemic Corruption: The International Alliance
Incidences of Human Rights Violations: Lock-Out
HIV/AIDS Treatment as a matter of course in a Self Determined Health System
A Bright Future: Have Nots on the road to Accountability, Responsibility and Self-Reliance
Dependable Partners: PIUMA
Epilogue: The Unknown Health Worker
Expenses
No more money needed for the Have Nots


Foreword

In the spirit of responsibility and transparency, writing a report is essential for anyone who invests resources in the resolution of a particular problem. However, it is a challenge for a foreign mission to write a report about work on a problem which usually would be tackled by the responsible experts and state agencies in the “focus country”.
Due to the vast burden of HIV/AIDS in Makete District, the Evangelical Association for World Mission in Austria (EAWM) was invited by the Evangelical Lutheran Church of Tanzania (ELCT), in particular by South Central Diocese (SCD) of Makete District, to implement a program originally called “A Comprehensive Approach to Treat HIV/AIDS due to the Invention of Modified DOT-HAART (Directly Observed Therapy with Highly Active Antiretroviral Therapy)”.
EAWM insists that it strictly followed all agreements with the local church partners and it made every attempt possible to obey the laws and the constitution of Tanzania. Due to a violent (and still officially unexplained) unlawful attack of elements of the Lutheran Church of Tanzania SCD/ELCT on patients and EAWM staff, the successful program was forced into a new direction, focusing on Human Rights and advocacy rather than rapidly scaling up HIV-AIDS treatment and further improving quality of care. Due to a consequent lack of data, EAWM is not in a position or willing to write a comprehensive report or a success story, but is rather giving a blunt account of its views based on the facts available.
During the course of the project, EAWM has learned that there remains a great deal of emancipation and liberation needed in order to save the lives of people who need decent health care in this world! There is need for liberation from worldwide, unfairly protected business interests but equally so, liberation from segregation and oppression within societies. There are huge gaps between Elites, Do-gooders and the neglected and uniformed Have Nots.
EAWM has learned that an informed and enlightened society promoting Human and Constitutional Rights, implementing ethical standards, obeying local laws and keeping agreements is the basis for a decent health care system! EAWM believes that treatment and care is a universal right for EVERYBODY who needs a nurse, a doctor, a healthcare worker, a relative or a fellow patient in order to be guided, served, kept safe, and eventually to die with dignity.
If, in some respects, the view of EAWM does not match with the view of a brother or sister anywhere in the world, we openly invite her/him to challenge us and engage with us in a fruitful dialogue. We have learned about the admirable tradition in many African villages of valuing discussion and divergent opinions. It is our hope, that this very African gift to the world will be used to open wise new directions in order to foster positive development.

Austria, April 2007, Dr. Rainer Brandl, MD
EAWM Consultant

Report about the ARV treatment program, achievements and failures

available: eawm@magnet.at

61 pages (c) EAWM, May 2007

The Unknown Health Worker (a tribute to somebody)

The fabled East African askari (Kiswahili for “soldier”) served in the armies of colonial masters, fought his own brothers and sisters, and died as an unknown soldier protecting the wealth of foreigners.

Nowadays, the unknown health worker fights at the front line, exhausted and sometimes dying a similarly unheralded death, but ultimately only protecting the interests of the Do- Gooders and Elites who use their sacrifice to prime the pump of foreign donor money. (“Need of more health workers”)

Consider the story of a clinical officer on the frontline, a member of the health corps, part of the small group fighting all over the world for decent care and adequate treatment! She knew a lot about HIV/AIDS and was one of the very few counselors in rural Tanzania before the introduction of antiretroviral treatment in Makete.

She cared for others, held their hands during the slow, agonizing death that was the lot of an AIDS patient in her part of the world. She was keen in treating opportunistic infections and learned everything about ARVs in a short time, becoming a skillful treatment counselor. She was a good clinician and had a child and a husband.

She was pregnant and tired and developed severe anemia. Shortly after delivery, she was tested and found to be HIV positive. She had a rather low CD4 count and started taking drugs. Unfortunately, she developed full-blown extra pulmonary tuberculosis as a form of immune recovery syndrome. She made it through additional TB Therapy but could not work for 6 months. Slowly, her health improved. Her husband refused to be tested and ran away from her and their children.

She went on working and pushed herself too hard, she took night duties in a Lutheran Hospital that had been completely bankrupted by corruption and theft where she got weaker and weaker. The hospital’s managers and her corrupt colleagues, the diocese and the donors did not care. Their lives were not at risk!

Her ARV compliance went from bad to worse, as with many health staff throughout the world, who end up caring more for others than for themselves. She had neither time nor energy to deal with the moral bankruptcy of the Elites and Do-Gooders in her surroundings. Finally she left but was ill-treated by relatives and died in a bigger hospital – it was too late. Her family started fighting over who would receive her death benefits. Her last-born died of AIDS a short time later.

It seems the only ones who really missed her, were her fellow patients living with HIV/AIDS.
We commend and we remember her, the unknown health worker; for a few hundred dollars a year, she worked herself to an early death in an unmarked grave.

See my opinion below following the article!


"Spend more wisely to tame brain drain 2007-05-15 09:39:23 By Editor SOURCE: Guardian

A just-released report by the United Nations Development Programme paints a stark picture of the roll the brain drain is having on Africa. The term `brain drain` gained currency decades ago and refers to the skilled personnel that keep fleeing Africa and other parts of the developing world in hope of finding greener pastures elsewhere, particularly in Europe and North America. The authoritative report says the drain has been costing Africa an annual 200,000 professionals for the past sixteen years. The continent has, meanwhile, been spending a monstrous USD4 billion a year employing 150 expatriates to plug the human skills� gap created by this exodus of its own qualified sons and daughters. Foreign embassies in Tanzania are daily swamped with young Tanzanian talents scuttling for visas to leave the country. For some of those fortunate enough to land overseas scholarships, it is usually goodbye Tanzania. This is as pathetic as it is bothersome when one considers that the local experts flee after having been educated and trained on taxpayers� money. It is especially saddening seeing Tanzania in this sorry state when the economies of some advanced countries are driven by smart Tanzanians living abroad, including doctors and engineers. In a very important way, the brain drain is a self-inflicted calamity that has assumed alarming proportions and it would serve nobody any good if we fail to make our own human capital feel comfortable enough at home to stay. Africa is faced with insidious poverty, diseases and many other social and economic problems. Few of us have ever imagined that fly-by-night power supply and chronic water shortages are a sufficient incentive to make talents hate their motherland. In the midst of omnipresent unemployment, most of our urban centres harbour ever-swelling hordes of young professionals who have long lost hope of finding a decent job. The only logical way they see themselves ending their frustrations is stowing away or turning to crime. Without consistent creation of decent jobs, many of our brothers and sisters in the Diaspora would swiftly resist temptations to return home. UNDP Administrator Kemal Deris calls for an urgent adoption of economic strategies and policies that would enable Africa to make its pattern of growth pro-poor and economic-centred. Measures to eliminate poverty and produce more bread and butter in Africa would act as incentives to Africans in the Diaspora to return home and help in development initiatives. But many African economies will just not refrain from unnecessary public expenditure and massive embezzlement of public funds so as to retain their human capital even by offering better engagement terms. With the continent experiencing the pangs of the erosion of its human capital largely thanks to socio-economic deprivations, stable democracy and human development are hard to attain and figures inspiring economic data will not mean much unless the citizenry gain from the growth factors through decent jobs and decent life. African leaders must create this conducive environment to develop, maintain and retain its human capital." - ends

The money spent to get expatriates there does not always mean that these people are skilled, though many are very enthusiastic and want to help "the poor" for very small sallaries, others just come because they are paid better than home for working under "dangerous" conditions far away from home.

For example: How can an employee of the NMZ (Hamburg Mission, Germany) work in the ELCT diocese in Makete in the years 2003/2004 in in the treasury (as treassurer) and in 2005 an external audit by Tanzanian auditors found out that more than 400.000 Millions were lost from different departments of the diocese?

What happened here?

This probably well paid Expatriate or Missionary was:

1) Not skilled enough to do books or to find out that there were huge losses ? (The Tanzanian expert working there as General Secretary during the last two years (2005/2006) found out in no time that there are "problems" at the diocese. This did not make his life in the church easier, reportedly he was rather threatened instead of supported and thanked for helping to clean the temple.

2) Not willing or able to follow the Tanazanian laws, the constitution or human rights? In so many ways these regulations work against stealing, embezzlements, missmanagement and suppression of the poor and for the right use of ressources to support development. On paper you will find human right support in every NGO or Faith based (e.g. Church) organisation in the world, when it comes to implementation and to fight for the right of your brother and sister.... it obviously starts to get very complicated.

3) Scared to report to the responsible Tanzanian Authorities or her own Mission about the fincanical chaos indicating fraud ? Sometimes expatriates use the excuse that they do not want ot interfere with the souvereignity of the host country or organisation.... is this the right way, even if you work there as an expatriate and even if you learn that the countries laws are violated?

4) Could not read or write?

5) Was not able to do accounting work?

6) Participated in the irregularities, benefitted...?

7) Did not go to work?

8) Was living in a potemkin workplace?

9) was sick all the time...?

10) was.....

In any way it is very strange that a lot of donor money - probably given by the poor kind hearted pensioner in Europe to help the poor orphans in Makete (he is touched when he sees the children of Africa suffering on his TV screen) - ended up in paying a good salary to this "expert" expatriate, the rest ended somewhere ... we do not know... we just know it did not help the poor or their developmement... An expatriate who just messed up without being made responsible! In Germany things would have gone quite differently. Why can expatriates be sent to "poor" countries just to mess up and sometimes earn a good salary?

What is the need and help of such expatriates? Maybe somebody can explain this to me?

I think if Tanzania needs expatriates it should employe them and controll them and should make sure that they are skilled. Mistakes can happen, but have to be corrected and I do not know how to justify such losses.
No open word by the sending missions. No call to the poor to be forgiven. No sign to correct, no sign to find out where the money went. No open announcment ot the responsible authorities - this would be a big scandal in Europe - just Africa?

No clear word and action in the LMC/ELCT reports. Not from the missions, the donors, the country, the churches...

Why are so many of the TV pictures showing poverty in Africa and rarely the pictures of the intelligent enthusiastic young Africans who are keen to challenge their world and develope their societies?

(Do not take me wrong here, I do have a LOT to critizise for many people I met in Tanzania and who were keen to leave Africa, or keen to steal, though always complaining about poverty and that they cannot do anything and that they are poor and colonialsimus is to blame, the worldbank and many other forces but themselves... But I met a lot of others too, very intelligent people - you can meet them everywhere in the world - who tauhgt me a lot about enthusiams and intelligence and idealism - they are not given a chance, sometimes they are blamed - even by foreigne expatriates, unprofessional mission secreatries do not talk to them for example - but issue the next cheque to another "project")

Of course many people in Tanzania are spoild by NGO money, being in the "humanitarian business", they have all colours, all nationalities, different educations, habits,....

The money of the poor european pensioner - and for him 10 US$ a months are a lot - rarely ends up with the poor Makete orphans - these serve just as a billboard to ask for the next donations.

The Makete bishop still drives his new very expensive A/C 4WD, bought from donations - the orphans die, the Makete monies are still not fund - a huge part was given to help the poor!

So, to bring an expatriate is sometimes costly and does not solve problems.

It is a business and the poor have nots serve as advertisment for the next donation. That's their role: To stay poor, so that Do-Gooders and corrupt Elites (from all over the world, citizens and foreigners) can go on to benefit from the business with poverty.

The Have Nots provide them a job, who helps whom here?

Argumente Afrika:

Manchmal wird gesagt, dass man das mit der Korruption nicht so eng sehen müsse. Die "Extended Family" (Großfamilie in Afrika, die sich bis auf entfernte Verwandte, Schulkollegen, Nachbarn) ausdehnt, die fordere eben ihren Tribut. Gesellschaftlicher Druck.

Da stünde einer in der Kirche, der Zugang zum Geld habe schon unter immensem Druck, die anderen mitzuversorgen, es werde ja "immer wer krank".

Also könne es schon sein, dass Spendengelder auch bei anderen "Aufgaben" landen, als den vorgesehenen Projekten. Belegt kann nicht werden, dass das alles bei der "kranken Großmutter" des Bischofs landet. Menschen aus der Community sprechen einen andere Sprache, aber mit denen redet man lieber nicht. Warum es ein Vorteil ist, dass manche Afrikarefferenten perfekt Kiswahili sprechen will mit nicht in den Kopf.

Gelder landen: In der Schulbildung der Kinder der Geldeliten, in teuren Hochzeiten, in Autos, schönen Villen am Strand in der Hauptstadt, in der medizinischen Behandlung der Reicheren und Reichen, im Studium im Ausland...

Ich frage einen Alten, einen der in der "afrikanischen Tradition" groß geworden ist, ob das so sei mit den Bedürfnissen, der armen Großfamilien und ob deshalb aus den Projekten für die Armen nichts werde, die dann irgendwo unbemerkt krepieren...

Er ist Wirtschaftstreuhänder und Steuerberater in der Hauptstadt, aber im traditionellen Dorf am Land groß geworden. Er wird wütend und meint:

"Auch in Afrika sind Abmachungen gültig und die Verwendung von Dingen oder Geld für andere Zwecke als ausgemacht ist Diebstahl - Punkt - basta - sawa!"

Man habe solchen im Dorf früher die Hände gebunden und sie in die heiße Asche gesteckt, Diebe seien das, Druck der Großfamilie hin oder her, arm seien sie nicht!

Argumente Europa:

Manchmal ist der gesellschaftliche Druck, der Konsumentengroßfamilie so groß, dass Gelder schon mal anders verwendet werden müssen als abgemacht. Man braucht schon ein paar 100.000 um richtig repräsentieren zu können. Gesellschaftlicher Druck.


Andererseits in Österreich sind die Zeitungen voll mit vermuteter Korruption um die Eurofighter Beschaffung, da werden dann Steuergelder verwendet um die Schmiergeldzahlungen zu finanzieren - irgendwie. Die werden dann nämlich auf den Kaufpreis aufgeschlagen - irgendwie.
Andererseits in Tansania sind die Zeitungen voll mit vermuteter Korruption um die Beschaffung eines Flugradars, nun werden angebliche auch Schweizer Bankkonten geöffnet, wegen Zahlungen zur "Geschäftsanbahnung", diese werden dann auf den Kaufpreis aufgeschlagen und die Steuergelder und auch Hilfsgelder verschwinden dann in solchen Geschäften - irgendwie.

Derselbe internationale Waffenkonzern, der steht auch hinter den Deals in Tansania und in Österreich - irgendwie. Eliten, die profitieren kaufen sich dann schöne Autos für ihre Großfamilien - irgendwie!

Die Tansanische Wochenzeitung Rai - ein bissler wie der Spiegel oder das Profil (der Chefredakteur hat seine Magisterarbeit über HIV/AIDS und die Waisen in Makete geschrieben) berichtet auf der Titelseite über die Beschaffungsskandale um die CD4 Maschinen und HIV/AIDS Tests. Ähnliche Muster! Es werden die genannt, die im Ministerium Zugang zu den Geschäftsbeziehungen hatten und versuchten Konkurrenzprodukte vom Markt zu verdrängen. Ich habe über die PARTEC Produkte berichtet, die auch PIUMA besitzt und die NOCH stillgelegt sind, deshalb sterben Menschen, damit können sich Missionen nicht beschäftigen - irgendwie.

Korruption und Tod der Armen sind eng verknüpft.

Der Mission EINE Welt in Bayern, der KPS, dem NMZ fällt dazu noch immer nichts ein. (Die Mission EINE Welt entschuldigt sich nun bei mir persönlich für falsche Aussagen, nicht aber bei den Armen, die unter der Korruption leiden müssen. Das NMZ droht irgendwie komisch ein wenig mit Rechtsmitteln gegen mich, wegen Diffamierungen, die ich von mir gegeben haben soll, die KPS schweigt und in der Fortschreibung des LMC in Tansania, indem alle mit Sitz und Stimme vertreten sind, für das Jahr 2007 werden wieder Spendengelder ausgegeben, wie in den letzten Jahren - es wird die Wahrheit gebogen, dass sich die Balken biegen - wer schweigt und weiß stimmt zu).

PIUMA hat beschlossen, Mitglieder aus dem eigenen Führungsgremium, die versucht haben 20 Euro zu unterschlagen, zumindest für ein paar Monate, aus ihren Funktionen zu nehmen, auch wenn diese mutig und wichtig gewesen wären im Kampf um Gerechtigkeit. Die Kraft und Konsequenz des ehrlichen Umgangs mit Prinzipien!
Sonst? Der Ankauf des fahrenden Testzentrum wird vorbereitet, das dann auch als fahrende Klinik verwendet werden könnte, damit die Menschen nicht mehr bis zu 70 km zur Klinik laufen müssen - fahrende Klinik mit den CD4 Countern, die zur Zeit noch in der tödlichen Korruption feststecken.

Aber für Tansania besteht mehr Hoffnung, als für manche Geber, die Gelder in undemokratische Systeme stecken und diese aufrechterhalten, versteckt unter dem Namen Kirche.