Epilogue: The Unknown Health Worker

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, which 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.

Table of the expenses of the whole program are availabel in the hard copy or pdf file at eawm@magnet.at.

No more money needed for the Have Nots

In early 2006, external audit reports by independent auditors from Iringa[i] and Mbeya[ii] confirmed embezzlements of about 300.000 Euro[iii] in 2003/2004 within SCD and more than 150.000 Euro stolen from the Lutheran hospital’s income from government subsidies, patient fees, locally generated income and donations.
That means the hospital lost more money to theft than the amount given as a yearly income in the monitored health reports done by ELCT for the years 1997 – 2001[iv] (where the total budget was always less than half of the amount which disappeared in the years 2003/2004 from the hospital).[v]
If the hospital’s normal budgetary resources were used properly instead of disappearing down black holes of embezzlement, it would be possible to run a much bigger CTC out of existing resources. As a matter of fact, this could be with an appreciable increase in current staff salaries.
The Tanzanian government is in the process of steadily increasing its health budgets and salary scales, which again mean the quality could be further increased.
The BLH pharmacy and other departments were not managed properly[vi] and consistently showed a loss rather than an expected profit – even though drugs were often provided free by donors. It would be easy to reduce existing patients’ fees and very poor patients could be treated for free, through the proper management of the poor patient’s fund or enrolment in state/private sector and community-controlled social insurance models.
Money is not the problem. The problem is theft, corruption and mismanagement by the Elites which is, in turn, uncritically subsidized by Do-gooders while the Have Nots themselves are not provided decent health care or information about real health care investments and the scandals that prevent these resources from reaching those in need.
If hospital equipment [vii] would be used for patients and community services instead for private business, if agreements would be kept, and if no expatriate staff and volunteers[viii] would be needed, the given cost could probably be cut in half.
The cost situation might change again when viral resistance occurs and patients would have to switch to second line regimens as this will lead to a rise in costs.
Compared to the costs of corruption that benefits the Elites and Do-Gooders, community based Antiretroviral Treatment and Prevention and Care is inexpensive and very possible at a large scale!


[i] Ashvin Solanki & Company, certified public accountants in public practice registered tax & management consultants P.O.BOX 1537
[ii] MOSES AB & COMPANY, certified public accountants in public practice, P.O. BOX 2412
[iii] External audit reports state that 413.189.212,80 Tanzanian Shillings were not properly accounted in different departments of the diocese, and taking in account the fluctuating exchange rates and the depreciation of the Shilling the amount reaches probably about 300.000 Euro for the years 2003/2004 and as virtually no books exist the figures might be higher. For the years 2005/2006 there is no audit report publicized.
[iv] “MONITORING AND SUPERVISION OF MANAGED HEALTH CARE PROGRAM (HEALTH SERVICES AUDIT) ELCT South Central Diocese Monitored health Audit” Dr. Peter Iveroth, Health Programs Director, ELCT and Mr. Gideon Mbalakai Health Programs Coordinator, Mr. Nathan L. Mollel, Auditor ELCT, ELCT 17th -20th of September 2002
[v] We think that the discussion about the responsibility of donor agencies and will be worth a separate probe report of an independent team as the spirit of uncontrolled …
[vi] The pharmacist of the hospital and other hospital employees are running their private pharmacies in the surroundings, which is considered as incompatible with their duty.
[vii] It was agreed to use hospital structures and transport systems in order to provide an hospital embedded program, none of these things materialized, but money from the program was used to subsidize even staff doing duties not mentioned in the program.
[viii] The expatriate and volunteer costs were very low compared to the pay level in Europe and compared to other programs where many Elites and Do-Gooders work for high salaries in poor countries. Some flights were covered privately and not all the transport costs were reimbursed.