Enlightened and fearless people started asking questions! Probably these questions and the resulting demands for accountability from the local Elites – lead to the lock-out of the program, which was promoted by Elites and accepted by Do-gooders who turned a blind eye and kept a self-serving silence.

The Tanzanian Government’s duty

At October 23rd 2003 President Mkapa announced his government’s intention to treat 40.000 HIV positive Tanzanians by the end of 2004 ; this was repeated as a target for the year 2005 when it was also announced that the goal was to treat 500.000 people by the end of 2008 .
BLH was chosen as one of 20 “quick start” hospitals following the intensive lobbying by the MDA and the procurement of a cd4 counter by partners in the HAART project.
The task of clearing the cd4 counter through Dar es Salaam International Airport and Tanzanian customs was a challenge; it took several weeks to get it cleared by the National Board for Private Laboratories .
The government provided NACP training for two nurses, a pharmacist, two clinical officers and a laboratory technician, while the NACP training for the expatriate MD was paid for by EAWM. On the 17th of November, 2004, an assessment visit was done by the regional NACP team and the clinic was approved and an institutional “strengthening plan” completed.The government provided following antiretroviral drugs, after a delay of about a year, at the end of 2005:
d4t (30/40), EFZ, NVP, 3TC and ZDV
Apart from antiretroviral drugs, the government did not provide any additional financial support to the program.

The Minister of Health and the Prime Ministers Office were informed about the violent lock out of the expatriate staff and the local team as well as the subsequent human rights abuses by Makete/Iringa police. The Prime Ministers Office asked EAWM to contact TACAIDS on the matter which was done on 17th December 2006 .
Tanzanian state authorities, up to today, have not responded to EAWM, though several letters were written and equipment worth about 70.000 Euro is lying idle in Bulongwa and not being used for the benefit of patients.
To date it is not officially known by EAWM if responsible state authorities reacted in any official way to the illegal lockout, the police intimidation, or to the local corruption charges that have been clearly documented, though it was repeatedly reported by the media and publicly said by representatives of government institutions and the Lutheran Church that developing funds and funds to fight HIVAIDS haven been embezzled.


The Implementation – Searchers in the field

Officially, the HAART project started 2004, as it was believed that the drugs would be available by that time. However, efforts to find funds, to coordinate with other programs and to clear up hurdles to the importation of the cd4 machine as well as the beginnings of intimations of the upcoming management and financial scandals within the hospital’s leadership - led to delays in the whole project’s timeframe –such that the Care and Treatment Clinic (CTC) could only open its doors in December 2005.
Almost immediately, two key aspects of the project diverged from the planners’ written approach:

Firstly, the training of stakeholders was largely boycotted by BLH and the diocese, as from the beginning no additional allowance was paid for training during working hours . The increasingly intense lack of cooperation from the hospital’s secretive management impaired many of the program’s pillars. With the BLH and SCD it was always unclear exactly who was responsible for decision-making. Community stakeholder training therefore could not be organized in the proposed way.
Nevertheless, the staff working with the CTC - who went on serving with their usual hospital duties as an additional burden - took part enthusiastically in the in-house training that was part of the implementation of the project. They were not expecting additional payments. The patients and their supporters (“msaidizi wa karibu”) tremendously increased treatment literacy during adherence sessions that preceded antiretroviral treatment. These sessions were increasingly done voluntarily by members of the self-help HIV patient group PIUMA. Voluntarism covered gaps that were created by the lack of cooperation by the SCD/ELCT.

Secondly, and more positively, the Involvement of PLWHA was much easier to implement and contributed much more to the patient’s uptake, adherence and well-being than had previously been thought possible; the sick and suffering Have Nots proved that they could really contribute to their own health care. Very often, they put to shame the stigmatizing and greedy health staff and church employees who, as part of the local Elites, were mainly interested in the HAART program as a way to access funds and allowances rather than as a way to solve a health catastrophe.
PLWHA volunteered to be interviewed for a locally produced HIV awareness video and carried out many public speeches and village outreach events whereby they sensitized about 2,000 people in an organized way, distributing condoms and advertising the CTC. As a result, PIUMA was funded as a self-help group by the patients and their supporters with very little financial input. The patients proved that treatment is a political act in the best sense of the word – done properly, a treatment program can empower the Have Nots. PLWHA learned that HIV/AIDS is not a death sentence or a punishment from God.