Malaria in Tanzania

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What is it?

Malaria is a life-threatening disease transmitted through bites from infected mosquitoes. Mosquitoes breed and spend the first part of their life cycle in water sources and thrive in hot, humid conditions. Malaria thus poses a severe water-related public health threat in Tanzania, including in the Rorya District where Maji Safi Group works, particularly affecting children under five, newborns, and pregnant women.

The malarial parasite matures in the human liver and then enters the bloodstream attacking the red blood cells. Severe malaria can especially lead to anemia and death. Cerebral malaria, a common manifestation in severe malaria, can lead to long-term and potentially lifelong disability. Malaria is a major cause of absenteeism from school and work in sub-Saharan Africa.

Addressing malaria requires a robust health system that is often not available in rural regions in sub-Saharan Africa. Detecting the disease requires microscopy, and treatment requires proper drugs, based on the severity of the illness and the age of the patient. Inadequate access to healthcare in high malarial regions has led to unnecessary morbidity and mortality, particularly in pregnant women and children under five, as well as drug resistance, as non-malarial fevers are often treated with malaria drugs, and improper dosages of drugs are applied. Resistance to first-line treatment drugs, such as sulfadoxine and pyrimethamine, has been increasing worldwide and has been demonstrated in children in Tanzania.

Malaria Facts:

  • 2003 was a high point in deaths due to malaria in Africa with 960,000.
  • Although deaths have overall declined since 2003, they began trending up again in 2017.
  • In 2020, there were 602,000 deaths due to malaria in Africa.
  • Malaria parasites thrive in temperatures between 77°F (25°C) and 86°F (30°C).
  • Malaria parasites are unable to complete their growth cycle in temperatures below 68°F (20°C).
  • In sub-Saharan countries, global warming is increasing the land area with the ideal temperature zone for malaria parasites to thrive.

The Burden in Tanzania

Malaria places a severe burden on the health system in Tanzania, contributing to almost a quarter of all outpatient visits and a high number of expensive hospitalizations. Over 93% of Tanzanians live in malaria-endemic regions. According to the U.S. President’s Malaria Initiative (PMI), there are seven million malaria cases and over 25,000 deaths annually. Consequently, the disease hinders socioeconomic development and perpetuates the cycle of poverty.

Launched in 2005 by President George W. Bush and expanded under President Barack Obama, the U.S. President’s Malaria Initiative (PMI) started as a five-year initiative with the goal of reducing malaria deaths by 50% in 15 African countries. Thanks to the bipartisan support of Congress and the generosity of the American people, PMI now works in 24 partner countries in sub-Saharan Africa and three in Southeast Asia, thus working to address about 90% of the global malaria burden.

Link- https://www.wanda.be/en/a-z-index/malaria-kaart-afrika-/

Prevention and Treatment Efforts

Tanzania has taken pro-active measures to address the issue and reduce the malaria burden. The Tanzanian government’s National Malaria Control Program (NMCP) plays a crucial role in coordinating efforts to prevent, diagnose, and treat malaria. In addition, international organizations, such as the Global Fund, the World Health Organization (WHO), and the United States President’s Malaria Initiative (PMI), have collaborated with the Tanzanian government to provide funding, technical assistance, and expertise. Combating malaria requires an integrated and comprehensive approach encompassing various strategies, including the distribution of insecticide-treated bed nets, indoor residual spraying, preventative treatment for pregnant women, and ensuring access to rapid testing as well as timely and effective antimalarial treatments.

Maji Safi Group’s Community Efforts to Prevent Malaria

Maji Safi Group has contributed to these efforts to reduce the burden of malaria in the Rorya District through education and awareness campaigns on malaria prevention and proper use and maintenance of bed nets. In addition, MSG has provided testing for malaria in annual health screenings and prompt access to free treatment. Maji Safi Group’s WASH in Health Care Facilities Program has also helped ensure that local health centers have access to insecticide-treated bed nets for all in-patients and that healthcare workers, patients, and their families have access to educational materials on malaria prevention, testing, and treatment.

The Future

This year, the first ever malaria vaccine will be distributed to 18 million children in 12 African countries, but not including Tanzania, after a pilot program in Ghana, Kenya, and Malawi showed the vaccine to be safe for significantly reducing severe illness and deaths in children.

WHO: The RTS,S/AS01 (RTS,S) is a vaccine that acts against Plasmodium falciparum, the deadliest malaria parasite globally and the most prevalent in Africa. RTS,S is the first malaria vaccine recommended for use to prevent malaria in children in areas of moderate to high malaria transmission. Click HERE for more information.

While supply is currently limited, a framework has been developed to help expand the distribution as the Vaccine Alliance GAVI, the WHO, UNICEF, and other international organizations work to increase the vaccine supply and expand distribution to more high-burden countries like Tanzania. In combination with community-based prevention, education, and surveillance efforts, the malaria vaccine could greatly help reduce morbidity and mortality in children. Maji Safi Group’s community-based health education and its use of Information Communication Technology (ICT) to disseminate health information will be well-placed to aid in this effort and make a real difference in reducing the burden of malaria in the Rorya District and surrounding areas.

 

A nurse prepares to give the malaria vaccine RTS,S to a baby in Ghana. Photograph: Cristina Aldehuela/AFP/Getty Images.

Tanzania’s efforts to reduce the burden of malaria demonstrate a significant commitment to public health and the well-being of its population. Through a comprehensive approach, encompassing prevention, diagnosis, and treatment, Tanzania has made commendable progress in combating malaria. However, sustained efforts, continued investments, and collaboration with local communities and international partners are vital to overcoming the remaining challenges and achieving the ultimate goal of malaria elimination in Tanzania.

Maji Safi Group is there to help!

 

Typhoid in Tanzania

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What is it?

Like cholera and leptospirosis, typhoid fever is a neglected tropical disease (NTD) caused by the bacterium Salmonella Typhi. In the United States, typhoid fever is rare, with under 400 cases annually, mostly acquired in endemic regions of the world like Asia, Africa, and South America. In fact, people are not routinely vaccinated for typhoid in the United States, except before traveling abroad. Typhoid is extremely transmissible via the fecal-oral route through contaminated water or food, and people living in areas without access to clean water and sanitation facilities are most at risk. Children are at the highest risk of infection and experience the highest rates of morbidity and mortality from typhoid. Typhoid can cause high fever, headaches, abdominal pain, weakness, loss of appetite, and enlarged spleen and liver. Untreated, typhoid can become life threatening.

With 40% of Tanzanian households lacking access to safe drinking water and 60% lacking access to improved sanitation, many Tanzanians in both rural and urban communities are at high risk of infection from typhoid. Tanzania has an incidence of typhoid of over 79 thousand cases a year. The majority of cases occur in children under 15 years old. Typhoid fever is treated with antibiotics, including ciprofloxacin and ceftriaxone. Unfortunately, Salmonella Typhi is increasingly drug resistant. In 2016, multi-drug resistance of 89% was demonstrated in blood-culture studies in Moshi, Tanzania. Blood cultures are necessary to diagnose typhoid, and a full course of antibiotics is needed to treat, making the disease difficult to address in low-resource environments. Prevention through access to clean water, improved sanitation, and proper hygiene practices, especially handwashing, is critical to decreasing the risk of infection, morbidity, and mortality.

Maji Safi Group’s Community Efforts to Prevent Typhoid

Maji Safi Group incorporates typhoid prevention into all its sanitation and hygiene education programs in schools, homes, health care centers, and community venues, such as restaurants, stores, salons, etc. Since typhoid can be transmitted readily through food preparation, Maji Safi Group’s outreach to restaurants with hygiene education is a particularly important component in prevention. In 2022 alone, MSG visited and taught WASH lessons at 16 salons, 29 shops, and 25 restaurants for two days each. WASH lessons included hand washing, water filtering, treatment and storage, food preparation, and toilet facilities. In 2022, Maji Safi Group also distributed 477 handouts related to typhoid prevention.

The Future

The WHO has recommended mass vaccination with the newly developed Typbar-typhoid conjugate vaccine in endemic countries with a high burden of typhoid and high antimicrobial resistance. This new vaccine is more effective than previous typhoid vaccines. It requires only a single dose and can be used safely in children over six months of age, making it appropriate for use in conjunction with regular childhood vaccination programs.

Through education and community programs on the importance of using clean water, improving sanitation, and practicing proper hygiene education, Maji Safi Group is already instrumental in reducing the burden of typhoid in Shirati. If the Typbar-typhoid conjugate vaccine becomes a viable option in the medical landscape of the Mara Region, Maji Safi Group would be able to expand its programmatic impact by working closely with our partners at the District Medical Office (DMO), the Shirati KMT District Hospital, and the health centers and dispensaries we work with to explore ways to make this new option as effective and accessible as possible. When the medical community in the Rorya District conducts mass drug administration (MDA) campaigns, Maji Safi Group typically helps staff the outreach and provides onsite WASH and disease prevention education.

Maji Safi Group also has the capacity to react quickly to disease outbreaks through print media, village visits, radio broadcasts, social media, and a telephone hotline. After having helped government health authorities fight three cholera outbreaks in the Rorya District, an emergency response plan was developed by MSG and the DMO with funding from the LUSH Charity Pot program. During COVID-19, Maji Safi Group reached millions of people in East Africa through a social media campaign with factual information about preventing the disease and was one of the top 10 public health influencers on social media within East Africa.

Click HERE for more information about our ICT program.

Schistosomiasis in Tanzania

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What is Schistosomiasis?

Schistosomiasis, also known as bilharzia, is a parasitic infection caused by schistosoma parasites that use freshwater snails as an intermediate host. The parasite is transmitted to humans through contact with contaminated freshwater, typically in rural areas with poor sanitation. Schistosomiasis is endemic to regions with freshwater lakes, hydroelectric dams, and extensive agricultural irrigation.

Once inside the human body, the schistosoma parasites can lay eggs that cause inflammation and damage to the organs, including the liver, spleen, kidneys, and bladder. Symptoms of schistosomiasis include abdominal pain, diarrhea, bloody urine, and itchy skin.

Chronic schistosomiasis can lead to severe health problems, including anemia, stunted growth, diminished cognitive function, and increased susceptibility to other infections, including HIV. Of the neglected tropical diseases (NGDs), schistosomiasis is one of the most prevalent with over 200 million people worldwide estimated to be affected and 700 million people living in endemic areas, primarily in sub-Saharan Africa, but also in parts of South America and Asia.

Schistosomiasis risk factors are socio-economic, ecologic, and biologic; therefore, integrated efforts are necessary to control transmission. Communities affected tend to have frequent water contact, which can include fishers, farmers using irrigation sources, people doing household chores using freshwater sources, swimmers, and bathers.

Prevention and control of schistosomiasis involve improving sanitation, providing access to clean water, reducing snail populations, educating populations about risk factors and the nature of the disease, and treating infected individuals with medication, typically the chemotherapy drug Praziquantel. The image below demonstrates the life cycle of the schistosoma parasite.

 

The Burden in Tanzania and the Rorya District

Schistosomiasis has been studied in Tanzania since the early twentieth century. Ninety percent of schistosomiasis cases globally are in sub-Saharan Africa, and Tanzania has the second highest prevalence after Nigeria. During the 1970s and 80s, Tanzania built new irrigation systems and dams to provide water for agriculture for the growing population. These innovations, however, led to an expansion of schistosomiasis risk areas and the number of people affected. Over half of all Tanzanians live in high exposure regions. In addition, 40% of Tanzanian households lack access to safe drinking water, and 60% lack access to improved sanitation, putting them at high risk for exposure to schistosoma parasites. In 2019, around 15 million people, almost a quarter of the Tanzanian population, required treatment for schistosomiasis.

Schistosomiasis is widespread in the Rorya District, where Maji Safi Group works, as many people use Lake Victoria as a water source for household activities and for bathing. In addition, selling drinking water and fishing are major economic activities in the area. Using netting, traps, and hook and line fishing, fishermen frequently come in direct contact with infected water, and the same is true for their spouses and children who are also involved in the fishing process.

Click HERE to watch video (The Water Carriers).

Empowering Communities to Prevent Schistosomiasis

Mass drug administration (MDA) is one of the key interventions recommended by the WHO for prevention and control of neglected tropical diseases (NTDs). In Tanzania, Praziquantel is distributed on a large scale to schools and communities. However, knowledge about the disease and how to prevent or treat it is integral for reducing future cases. Many people still do not have access to treatment, and others prefer not to take the treatment due to a lack of information. This, added to the fact that one can become reinfected, shows why control is difficult using treatment alone. Studies have shown that interventions addressing behavioral and cultural dimensions of transmission are more effective at preventing and controlling schistosomiasis than those that use environmental and treatment interventions alone.

Maji Safi Group‘s Community Health Educator (CHE) model engages communities and facilitates behavioral change by teaching disease prevention and WASH education. Maji Safi Group’s CHEs receive specific training and travel to markets, schools, health care facilities, and fishing communities to teach about occupational hazards as well as causes, prevention, and treatment for waterborne diseases, including schistosomiasis. For over a decade, our full-time cadre of community-based educators have built relationships with Rorya communities and provided a trusted source for information and resources through numerous innovative, community-driven programs. MSG has also been involved in specific projects that addressed schistosomiasis.

2017

In 2017, a group of public health and social work students from the Brown School of Social Work at Washington University in St. Louis came to Shirati to learn about participatory tools alongside MSG’s Community Health Educators. The students and CHEs joined with leaders from the Tanzanian Fisheries Research Institute (TAFIRI) to visit Beach Management Units (BMUs), which are centers where fishermen must officially register in order to legally fish. They used participatory tools within fishing communities to learn about the issues they face around waterborne diseases, including schistosomiasis, and to co-generate solutions to reduce prevalence.

 

2022

Aligning with UN Sustainability Goals, Maji Safi Group partners with local institutions, like schools and healthcare systems, to promote sustainable health and development. In 2022, we collaborated with the Shirati KMT District Hospital to address schistosomiasis via several health care facilities (HCFs). Doctors and nurses did the testing and provided medication as needed, while Maji Safi Group’s Community Health Educators provided in-person education and distributed leaflets about schistosomiasis. So far, MSG has developed collaborations with seven health care facilities in the Rorya District and has reached close to two thousand people. We continue collaboration with the Shirati KMT District Hospital to monitor the progress and impact of this ongoing intervention.

Measuring Success

From 2015-2019, MSG did over 25,000 health screenings to gauge disease rates in the community and the impact of Maji Safi Group’s WASH education. The testing showed that the prevalence of schistosomiasis in Shirati exceeded the national average. In addition, the results consistently demonstrated high prevalence of schistosomiasis in community members, but also a significant decrease in prevalence among community members who had participated in MSG’s health and disease prevention programs in schools and the community.

Find out more about MSG’s five years of health screening data here.

The Future

While mass drug administration (MDA) has been and continues to be an important part of schistosomiasis control, the nature of the disease, the environmental and occupational aspects of transmission, and the fact that people can become reinfected necessitate the development of more targeted and integrated methods of control. Community engagement, a heavy emphasis on education, and multi-sectoral partnerships can motivate the behavior change, knowledge, and practices that reduce the burden of schistosomiasis in the communities where MSG works. Together with the Tanzanian and local government’s commitment to preventing and controlling schistosomiasis, we can help our partner communities reach their goals of health and well-being and help eliminate the poverty-trap of NTDs like schistosomiasis.

In the future, Maji Safi Group will:

  • Continue to acknowledge that locally relevant programs co-created with community input are key to reducing NTDs through community-driven initiatives and close collaboration with health authorities.
  • Collaborate with public health researchers at the universities around the world using genomic, epidemiologic, and ecologic factors to understand local ecosystems of infection and how to target prevention and control programs.
  • Continue to build WASH Hubs (community centers) where residents in the Rorya District can access clean water and where staff, drawn from the local community, can provide training and support on specific occupational risks and prevention strategies for farmers and their families regarding waterborne disease transmission.
  • Seek opportunities to cooperate with educational institutions in Tanzania and globally on schistosomiasis research projects and effective measures for control and prevention in endemic areas.

 

Maji Safi Group’s Multi-sectoral Development in WASH and Agriculture

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Maji Safi Group (MSG) seeks to help solve the persistent and devastating problems of rural poverty in Tanzania through holistic and cross-sectoral solutions like community centers (WASH Hubs) and the employment of local leaders as community educators (CHEs) in water, sanitation, and hygiene (WASH) and agriculture.

For 10 years, women have been at the center of Maji Safi Group’s work, leading the efforts to educate about healthy WASH practices and the importance of public health in the community, in businesses, at schools, with fishers, and at health care facilities. Careful monitoring through five years of annual Health Screenings have demonstrated the reduction in rates of water-related diseases in community members who have received this education.

Agriculture in Tanzania and the Rorya District

Tanzania, including the Rorya District where MSG works, is rich in arable land, water resources, and diverse agro-ecological zones. Despite this potential, food security remains a major challenge, with over 11 million (17%) Tanzanians facing chronic food insecurity (2023 population 64,701,175). Factors such as climate change, pests and diseases, and low agricultural productivity contribute to this problem. Supporting small-scale farmers to address these challenges is critical to ensuring sustainable agriculture and food security in Tanzania.

  • According to the Rorya District council, about 85% of district inhabitants depend on agriculture and livestock keeping to earn their income.
  • Both local and national government are focused on improving food security through improved agriculture practices and production.
  • The majority of residents get their water from Lake Victoria, the Mara River Basin, seasonal streams and ponds, or sources far from where they live.
  • Waterborne and water-related diseases, such as cholera, schistosomiasis, typhoid, malaria, bacillary dysentery, and amoebic dysentery, constitute a major health burden in the Rorya District.

Community Health and Improved Agriculture

For the past decade, Maji Safi Group has employed a cadre of full-time community health educators (CHEs) from the community who teach in various settings about disease transmission, hygiene, and healthy habits to improve personal and public health. Using the successful model of International Development Enterprise’s (iDE) Farm Business Advisors, Maji Safi Group will now start training Agriculture Extension Workers (AEWs) to teach effective farming strategies, introduce modern technologies, and work together to increase yields using sustainable methods. In tandem with the MSG’s lifesaving health education, improving agriculture will create more holistic and beneficial services for the communities we work with. Empowering female agricultural entrepreneurs, an important facet in improving gender equality and creating more equitable and sustainable food security in the region, will be emphasized.

Role of the WASH HUB

WASH Hubs | Maji Safi GroupComputer-generated design of WASH Hub. So far, MSG has established a borehole and built a laundry block and an office building. 

The vision of the WASH Hub is to create a community gathering point and a resource for reducing poverty, learning more productive technologies, creating sustainable agricultural practices, and improving personal and public health.

The WASH Hub provides a community center where residents of the Rorya District can access clean water, saving them time and minimizing the risk of waterborne diseases. Solar power will be used to sanitize water and to power pumps and other infrastructure.

The WASH Hub will also provide a gathering place where MSG’s staff, drawn from the local community, can provide training and support on community sanitation and household hygiene, enabling families to make the most of the WASH Hub in preventing illness at home. Our CHEs have already built considerable buy-in and trust in the community, and the program will be improved on an on-going basis through consistent application of learning from rigorous monitoring and evaluation of our efforts.

Together with MSG staff, the Ward Counselor officially opened the initial phase of our WASH Hub on March 7, 2023.

Critically, the WASH Hub will provide services to farmers. It will provide access to fertilizer, seeds, and support for improvements in crop irrigation. A greenhouse will provide food for a health food canteen and serve as a laboratory for demonstrating indoor growing techniques for local farmers. Farmers will be able to rent large equipment owned by the WASH Hub to make plowing and other tasks more efficient and increase productivity.

MSG will hire and train a team of Agricultural Extension Workers (AEWs) to support these efforts, using the community-based model we have developed over the past decade. The AEWs will consult with farmers about the products and services they need and provide extensive training to farmers to help them adopt more effective agricultural and agro-forestry practices that will improve yields and preserve and regenerate their lands.

Maji Safi Group’s WASH Hub model will bring people together to work collectively to improve health, reduce poverty, and improve food security. The AEWs and CHEs will be the key to integrating this multi-sectoral project for improvement in their communities.

Maji Safi Group’s 2022 Water Walks

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Text and photos by Erna Maj – Erna has served as Maji Safi Group’s Fundraising and Outreach Coordinator for several years. She thoroughly enjoys running our Young Global Citizen Program and visits our on-the-ground projects in Tanzania on a regular basis. 

Imagine

Imagine a health care facility (HCF) where there is no safe water source. To get there, you negotiate a seemingly endless slew of bumpy clay roads. Your HCF patients and staff are without clean drinking water, and not a single handwashing facility can be found at any point of care. No water for flushing in old latrines, nor trapdoors to keep odor out. It is even typical for doctors to burn medical waste on the ground or in dilapidated incinerators without much regard for the surrounding environment, and healthcare-acquired infections (HAIs) are all too common. While difficult to picture for some, these have remained the exact conditions for many residents across the Rorya District in Tanzania where Maji Safi Group has directed its efforts for years.

 

To help mitigate these problems, Maji Safi Group started a WASH in Health Care Facilities Program in 2021 to make health education and WASH infrastructure more accessible to hospitals, health centers, and dispensaries. To raise money for this work, we enlisted a few old legs and a whole lot of young ones!

Walking in Tanzania

In Tanzania, many women and girls walk long distances every day to fetch water and firewood for their families and to bring laundry and dishes to water sources for washing – carrying it all on their heads. These chores often keep girls out of school. If children do get to attend school, it is not uncommon for them to walk for a couple of hours a day. For most people, walking is the general mode of transportation; you see locals walking from the crack of dawn and deep into the night. Out of curiosity, we asked two women to wear a Fitbit watch for a day to get an idea of how far a housewife in rural Tanzania typically walks. The answer is 10 miles!

Old Legs – World Water Day

To celebrate World Water Day on March 22, Maji Safi Group’s cofounder and current president, Bruce Maj Pelz, longtime supporter Steve Taffet, and I walked. While walking 13.5 miles, I had plenty of time to ponder what it would feel like to walk 10 miles every day – not for fun or exercise or to enjoy beautiful mountain views, but out of necessity and carrying a heavy burden, putting pressure on joints, neck, and spine. When I am in Tanzania, I like to take a morning walk for exercise along beautiful paths between fields – often walking along women. I want to take in the wondrous views of Lake Victoria, they need to fetch water. The first time I visited Tanzania, people would stop me and ask, “Unapenda wapi?” (Where are you going?). When they realized that I was just walking with no apparent purpose or destination, they shook their heads and continued. After six visits, people know me. They still shake their heads, smile, and wittily say, “Unapenda kufanya masoesi!” (You like to exercise!). In the evening of March 22, I was definitely wondering if walking like that without a purpose is frivolous and a bit rude. But on March 22, I did have a purpose as many generous sponsors helped me raise $5,865. In addition, Bruce raised $425, and Steve Taffet raised $650.

Young Legs-  School Water Walks

The young legs were much more exciting than the old ones. Now that the schools have escaped the COVID-19 era, our Young Global Citizens have resurfaced. We were finally able to once again enlist their help and enthusiasm to spread awareness of our work and raise funds from grassroots fundraising. Our work with children and youths in Colorado is fun and constructive in that these young people learn about world issues, social responsibility, charity, empathy, and helping others through personal effort. To learn more about the history behind this work, please click HERE. This spring, we focused on water walks.

Flagstaff Academy – Longmont

At Flagstaff Academy, all 900 students and teachers from kindergarten through 8th grade with great enthusiasm walked loops around the school grounds. Some carried water, others had chosen not to. All classes had seen a slide show about Maji Safi Group’s work prior to the event and received stickers with Maji Safi Group’s logo. The students successfully raised $1,404 for WASH in HCFs!

Casey Middle School – Boulder

At Casey Middle School, students from the Leadership Class organized a water walk. Students could choose to participate for a couple of hours during class time. Twenty-seven youngsters chose to do so and walked 82.5 miles, raising $720! The Beleza Coffee Bar in North Boulder had generously saved gallon-sized milk bottles that were filled with water – water that cooled off the students on a hot, sticky day as the students could not resist a fun, little water fight along the way. The walkers were rewarded with Bobo’s Oat Bars, Maji Safi Group stickers, #Iwashmyhands Maji Safi Group wrist bands, and ice cream coupons donated by Ben and Jerry’s.

Whittier International Elementary School – Boulder

At Whittier International Elementary School, a few students from 2nd grade and all 3rd, 4th, and 5th graders walked for about 20 minutes each. For each loop, the students received a popsicle stick, so they could report their number of loops to sponsors. The final result is not known as the walk happened at the very end of the school year, so classes did not report their number of popsicle sticks to Maji Safi Group. But we do know that 3rd and 4th grade used over 1,000 sticks each! Whittier students raised $844!

Very Generous Sponsors

The Water Walks for WASH in Health Care Facilities also had two general sponsors. One donated $5,000 to honor our Young Global Citizens’ dedicated efforts to help others. The other donor matched all funds raised at 100%.

Results

Maji Safi Group is very thankful for this amazing generosity and to the individuals and all the Young Global Citizens who walked to make this fundraising project a huge success!

$9,908 = Raised by walkers
$5,000 = Donation
$14,908 = Matching donation
$29,816 =TOTAL

This is enough to do the following at a health care facility:

$750 = Hand-washing station at HCF
$1,500 = Hygiene and environmental cleaning education for HCF staff
$3,000 = Latrine block at HCF
$3,500 = Incinerator at HCF
$15,000 = Borehole supplying HCF (+ surrounding community) with clean H2O

 

 

Commendable WASH Career

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We will feature several guest bloggers from the Maji Safi Group (MSG) community this year to celebrate Maji Safi Group’s fifth anniversary. Our first guest is Craig Hafner, whose successful global WASH career has spanned over five decades. Craig has always advocated for the “software” side of the WASH sector, believing that the most lasting and meaningful changes occur when behavioral change is given priority. MSG has been blessed to have Craig’s mentorship during our first five years, and we look forward to continuing to work with him. We hope you enjoy reading about Craig’s vast experience and knowledge.

  1. What are your biggest takeaways from your 40 years in the WASH sector?

My WASH career started in 1978 when I was hired as the first WASH-sector specialist for the Peace Corps. Throughout my career, infrastructure has always been the first thing people wanted to fund and the easiest. However, there are huge issues with the sustainability of projects, and they have yet to have any real impact. For real influence, you need to change people’s behaviors. In the 1980s, the new big thing was the ultimate hand pump designed by engineering schools with a technical mentality. Additionally, much more money has gone into disease treatment and drugs rather than prevention, which is much cheaper in the long run.

Another major barrier for the WASH sector has been the institutional arrangements and the challenges of the overlapping industries that make this field so multi-disciplinary. For example, if you want to impact health, you can’t just have the Ministry of Water in charge of WASH – you also need the Ministry of Health and the Ministry of Education. If you don’t have this collaboration, it falls apart. This makes it difficult because it is hard to get people to communicate across ministries; there is a strong silo effect, and each church has its priorities. I am proud to have pioneered some of this collaborative work through the WASH and environmental health projects I worked on with USAID for 20 years. I believe many of our projects were exceptionally good, and we were the first multisectoral projects by USAID in the 1980s. USAID has since used this model with its major grants and continues to bring professional firms on board to perform different specialties.

  1. What seminal moments during your WASH career have shaped your thinking?

The first experience that interested me in WASH was carrying water as a Peace Corps volunteer in the 1960s at the school in Tanzania where I was teaching. After a few days, I hired a young man to fetch it for me and realized what a colossal problem water was. Later, while working in northern Kenya on a medical mission during my master’s work on the Turkana tribe, I also saw first-hand the impact of drought on people and the desperate need for clean and clear water.

Working with Gilbert White at the University of Colorado was career-changing. One moment I remember vividly is when Thomas Kuhn, 1962, gave me the book The Structure of Scientific Revolutions. It taught me about paradigms in thinking and how they shift when people look for new ways of approaching a problem every so often. I have always respected Gilbert White’s interdisciplinary approach to WASH and his focus on behavioral sciences at CU. One instance that stuck out was when I consulted for World Vision in the late 1980s in Ghana and visited their well-drilling rig. They had only done 2-3 days of outreach and preparation in the community after I had advocated for 9-12 months of education (which probably needed to be longer).

Two of my proudest achievements have been helping start Friends of Tanzania 27 years ago, which has been worthwhile and successful, and representing the Peace Corps when the UN launched their Water Decade in 1980 because they were going to solve the problem by 1990. But unfortunately, that did not happen, and I have seen many examples of unmet goals like that. For example, the Carter Center was going to eliminate the guinea worm disease by 1990, then 1995, then 2000, but is still working on it because of the difficulty of changing people’s behaviors.

 

  1. What aspects of Maji Safi Group have made you a supporter and advocate?

What first attracted me to MSG was attacking the lack of behavioral change in the WASH sector. I have thought for a long time that the fundamental issue around WASH is behavioral change, and I have not seen that much. Keeping in touch with various ideas and efforts has been intriguing, and I am excited to continue to follow MSG for two main reasons. One is to see if it will be successful, and two, will people look at the model and say that they need to adopt more behavioral change into WASH projects?

  1. What role do you think women play in the WASH sector, and how has that changed over your career?

This has been discussed in the sector since the early 1980s when Mary Elmendorf, a USAID consultant, advocated for women’s role in WASH. For a long time, people have paid lip service to it. First, it was that you have to have a woman on a project committee; then, it was that a woman had to be the treasurer; and then, it was that a woman had to be the committee leader. But it has been slow and gradual and has a long way to go, as with many feminine issues in society. Having women take over more responsibilities and taking more of a leadership role is very important. I have yet to see many successful female project managers of WASH projects, but I hope to see that continue to change.

MSG has always put women at the center of our WASH work at every level. Over 75% of our staff are women; as you can see, they mean business.

  1. Bill Gates has referred to behavioral change as the most challenging thing his foundation has tried to address. Why do you think that is?

To see how difficult it is, you can look at issues like people quitting smoking and questions about obesity worldwide. Getting people to alter their behaviors is a difficult thing to do. Many studies in many different contexts have gone into this for many years, but no silver bullet has been found. People have habits and are influenced by peers and society. Getting people to make fundamental changes to the way they live their lives has always been difficult.

 

  1. What do you think effective WASH behavioral change campaigns do?

I have been encouraged by Maji Safi Group’s progress since you started, and you seem to be making inroads, but while working in the WASH sector, I have not seen many success stories. For example, Dr. Valerie Curtis, professor at The London School of Hygiene and Tropical Medicine, has done some good work over the years, but good examples and successes on behavioral changes have been hard to come by.

 

  1. If you could change one thing about the WASH sector, what would it be?

Rather than keeping behavioral change as an afterthought or add-on to the technical aspects of WASH projects – maybe 5% of a budget – you should build WASH projects around community education initiatives and put 25-30% of the budget into behavioral change campaigns.

  1. What do you think good projects and organizations usually do well?

Good projects I have seen were planned with the community up front and were engaged in the community. This is key, so the community has a sense of ownership in the project, which leads to sustainability. Having effective management of the projects is also critical to make sure you have systems that provide good checks and balances for the expenditure of funds. If an engineer has a salary of $5,000 managing the budget of a $100,000 project, there is a high chance of mismanagement, so checks and balances are essential. I remember meeting a paramount chief on a trip in Sierra Leone who wanted another water project for his community. I learned the history of the village from him, only to find out that his porch was made with the pipes that were supposed to be for a previously provided community system!

Successful organizations have also had good outreach and a collaborative approach to dealing with the needs and interests of others. Learning from what other organizations are doing to solve similar problems is essential as well as being open to new ideas and approaches. There is no problem with taking the ideas of others and running with them and being flexible with how you are planning things. Staying in touch with the newest ideas and models to find best practices is important.

Finally, being willing to continue doing hard assessment on a regular basis, taking responsibility for failures, learning from your mistakes and being willing to move ahead is key. For WASH specifically, it has to be an interdisciplinary effort, and if you want to affect health outcomes, you need a collaborative approach that can’t be dominated by the engineers.

 

 

  1. You have been involved with development work in Tanzania for over 50 years. What are common mistakes you have seen organizations make?

Through my long-time involvement with Tanzania, I have noticed a lot of things, but in general, I think there has been a lack of community involvement and communication, which has led to a lack of ownership. I think the book Watering White Elephants, by Ole Therkildsen of the Scandinavian Institute of African Studies, 1988, is a real indictment of funding water projects that were not sustainable. One major difference I saw between WASH work in Tanzania and Malawi was that the people who were in charge of building water systems in Malawi were from the Office of Community Development, so there was much more local buy-in than there was in Tanzania.

Over the years, I have also seen the perverseness of organizations paying increasing sitting fees for workshop attendees, and this is especially prominent in Tanzania compared to other countries. I see it as a failure in development. To pay people salaries, per diem expenses and other allowances to get training is inhibiting. Dealing with the levels of corruption in Tanzania has always been a challenge, and as a country, Tanzania has often had a really low international rating.

 

 

What Are the Challenges Facing Gender Equality in Tanzania?

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Gender Equality 

All women should have access to equal opportunity and the ability to exercise their rights, such as access to quality education, productive work, land ownership, and making informed decisions regarding their sexual and reproductive health. These are central components to gender equality and giving women the ability to live in the kind of safe environment they deserve. Women need to be free to make their own informed choices and have the same access to education, resources, and opportunities as their male peers. Empowered women in Tanzania continue to work towards enabling the next generation to have healthy and productive families and communities. But there is still a long way to go. The Afrobarometer Dispatch reported in 2017 that even though around 75% of Tanzanians feel the government is doing fairly well at promoting gender equality, there are still several major barriers for women in Tanzania to overcome.

These barriers are social norms that make it much harder for a woman in Tanzania to have the same freedoms, education, resources, and opportunities as men.

  • Women lack time. Women spend more time on household chores than men. Not only are they the primary caregivers for children and in charge of running the household, they are also responsible for collecting water and firewood. Approximately 78% of women spend time collecting water daily, compared to only 33% of men. These tasks are not only unpaid, but are tiring, strenuous, and time-consuming, which leaves less time and  fewer opportunities for women to have paid work to help make their family’s life better.

  • Girls are less educated, resulting in fewer opportunities in the workforce. Even though primary level schools in Tanzania have achieved gender equality, and 80% of children attend school, many girls fall behind when they enter secondary level education (largely due to their menstrual cycle or early pregnancy). This results in women entering the workforce with less opportunity and lower levels of pay.
  • Women lack freedom when it comes to reproductive health. With high early marriage and teenage pregnancy rates in Tanzania, education and employment opportunities are often taken away from women. Pregnant girls are typically kicked out of school and become the primary caregivers in their homes. Access to information about birth control is often attacked by those in power, thus reducing a woman’s ability to choose how many children she wants to have and when, where, and with whom she wants to build a family.

  • Access to owning property, assets, and financial services is difficult to achieve. Because women have less education and fewer opportunities than their male peers, they often have smaller plots of land, own less livestock, and earn less income. It is also more likely that their land is for subsistence farming rather than making a profit. Most financial providers do not consider women a large target group, so they have less access to financial services. Most women have to start a business with their own savings because interest rates are too high for them.

Moving Forward towards Gender Equality

Despite the challenges women in Tanzania face, government improvements have been implemented, so more women can thrive and live a productive life that includes recreation and rest. If tasks, such as water and firewood collection and household chores, were shared with their male peers, or the time spent on chores was reduced with technology, huge amounts of time could be freed up for women to pursue employment and paid work. In fact, one study calculated that more than half a million jobs could be generated for women from reducing water collection time, about 225,000 from reducing fuel collection, and around 4 million from reducing time spent on food preparation.

 

Conclusion

While gender equality for women is something most Tanzanians support, there is still long way to go. Even though some progress has been made when it comes to removing the barriers women face, Tanzanian females still do not have equal rights and opportunities. MSG is committed to working towards changing this through our programs, so women have bright futures as leaders and change-makers. Our staff has always been over 75% women, and we are committed to helping other women and girls break the barriers they face when it comes to rights, opportunities, finances, owning property, and earning an income. Our programs specifically focus on menstrual hygiene health and women’s empowerment – factors that are changing the game for women in the areas where we work. We hope to continue to expand our work to reach more women and prevent these barriers from keeping them from reaching their full potential.

By empowering women we will also empower families!

 

Notes:

(1): Afrobarometer is a non-partisan, pan-African research institution conducting public attitude surveys on democracy, governance, the economy, and society in 30+ countries repeated on a regular cycle. They are the world’s leading source of high-quality data on what Africans are thinking. See https://afrobarometer.org/ for more information.

WASH & Health Care Facilities

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Health care facilities are meant to be places where people go to seek treatment for illness, not where they are at risk of contracting one. Yet, millions across the globe face an increased risk of infection if they seek treatment at health care facilities because of the lack of safe and improved WASH (water, sanitation, and hygiene). Many of these facilities are breeding grounds for infectious diseases and thus pose a major barrier to the overall health of individuals and positive health care treatment outcomes.

These problems have become even more evident over the past year as developing nations continue to battle the COVID-19 pandemic. WASH services are needed more than ever to protect patients and health care workers.

Recently, UNICEF, the World Health Organization, large development organizations, and national governments have made it a top priority to improve WASH in health care settings by doing a global assessment and making a plan of action to fix this atrocity.

The Problem

A severe lack of safe water, sanitation, hygiene, waste management, and environmental cleaning in health care facilities across most low- and middle-income countries poses a huge threat to the health of patients, visitors, health care workers, and especially newborns and their mothers. According to recent reports from UNICEF and the WHO, an estimated 896 million people use health facilities with no water service, and another 1.5 billion use facilities with no sanitation service.

There are major issues worldwide with WASH in health care facilities in low- and middle-income countries, and in the Rorya District, Tanzania, where Maji Safi Group is already working to tackle WASH issues in many different sectors, the problem is huge.

The following specific WASH issues were found during a recent study done in Tanzania amongst 96 health care facilities:

Access to Clean Water

Access to consistent, clean, and improved water sources remains an issue throughout Tanzania for many health care facilities. Though most facilities in this study (81%) have access to an improved water source, others are still relying on water from rivers and shallow wells, which can cause major health issues. Only 51% reported that they have access to water most days, with other facilities receiving water only some days of the week or even only seasonally. Only 23% of the facilities receive water that is treated at the source, and hardly any have a system in place to regularly monitor the quality of the water they are using. The lack of clean water places these facilities at a much higher risk of contamination and the spread of water-borne and infectious diseases.

Lack of Sanitation

In these health care facilities, it is also very common to find significant plumbing issues with drain systems in sinks, showers, and toilets. Cleaning is often very infrequent, and some facilities have floors that are not cleanable. It was reported that only half of the toilets/latrines observed were free from foul odors and sufficiently clean for use.

Hand Washing and Hygiene

Another major barrier to hygiene in these facilities is the poor quality of hand-washing stations and a lack of sufficient materials to use. One in four health care rooms did not offer hand washing at the point of care at all, and the stations found were some of the most unclean and poorly maintained parts of the facility. Only 56% of hand-washing stations in consultation rooms had water available, and only 51% had soap. This is a major hindrance to clean, safe health care. If workers are not able to clean their hands properly, there is always an increased risk for bacteria and viruses to spread.

Unsafe Waste Management

In many facilities, there were major gaps and deficiencies related to sorting, collecting, storing, and disposing of health care waste products. This can be extremely harmful to patients, visitors, and health care workers. The lack of proper management of waste is often the result of poor training and supervision.

Lack of Environmental Cleaning

In many facilities, the overall environment was not clean and kept to a proper standard to ensure safety. Cleaning systems and practices were not in place to make sure that surfaces were cleaned, sanitized, and sterilized properly. Tanzanian HCFs lack specific standards for cleanliness, leaving those in charge with no guidelines or minimum standards to abide by. Latrines are often blocked, bathtubs are clogged and/or not regularly cleaned, and water systems often leak or are broken. Standards must be put in place to regulate cleanliness in these facilities.

 

Maternal and Neonatal Care

One of the primary areas where WASH issues are rampant is in maternal and newborn care. Each year, more than one million deaths are related to unclean births, including 26% of neonatal deaths and 11% of maternal mortality.

The overall cleanliness of labor and delivery rooms and the availability of proper hand-washing stations and sanitation practices are essential to the health and well-being of newborn babies and their mothers. Without them, there is a much higher risk for infant mortality and/or illness in the mother or baby.

Education & Health Care Workers

Much of the problem with WASH in health care facilities stems from a major lack of education and training for health care workers. There are no education requirements in Tanzania for health care attendants, and many do not receive proper training on the importance of WASH.

Patients are not educated about proper hygiene either. The study found that only 33.5% of the respondents were informed of essential hygiene behaviors upon arrival at the health care facility.

While there is a huge gap in education, many health care workers are aware that they are at great risk for infection because of unsafe WASH practices – 86% of auxiliary workers reported their concern about common infections, such as HIV and tuberculosis, being passed at their facilities, and 41% of workers said they often lacked proper personal protective equipment (PPE).

 

The Mission

One of Maji Safi Group’s primary goals this year is to join the global movement towards improving WASH in health care facilities to complement our community-based education model.

Practical potential ways for improvement:

  • Perform a baseline assessment in more than 20 health care facilities (HCFs) in the Rorya District.
  • Partner with the District Medical Office and the Shirati KMT District Designated Hospital to create a 5-year plan for improving WASH in HCFs.
  • Implement a WASH Facility Improvement Team (FIT) model with partnering HCFs and provide capacity building and infrastructural improvements.
  • Advocate for the improvement of WASH in HCFs in the Rorya District and recruit partners from the private and public sectors.
  • Monitor and evaluate the effectiveness of our interventions and share our learnings with other district and regional governments.

Over the past decade, Maji Safi Group has proven the tremendous power of interactive, community-driven education in combatting diseases and promoting healthy lifestyles. In 2021 and beyond, we hope to be on the frontline of educating communities about WASH through the HCFs we partner with.

The UN Secretary General, Antonio Guterres, said this: “Water, sanitation and hygiene services in health facilities are the most basic requirements of infection prevention and control, and of quality care. They are fundamental to respecting the dignity and human rights of every person who seeks health care and of health workers themselves. I call on people everywhere to support action for WASH in all health care facilities.” 

 

Let’s continue to do our part.

 

Sources and further reading:

https://www.washinhcf.org/

https://www.washinhcf.org/wp-content/uploads/2020/12/WHO_UNICEF_GlobalProgressReportWASHinHCF_forWeb_2020V2.pdf

2016 Report PDF

Menstrual Hygiene Management

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It was 1968 when I started my period, and I was only 12. At that point in time, menstruation and sexuality were not surrounded by total silence in my rural corner of Denmark, but our mothers were not exactly chirping out information about budding teenage sexual desires and menstrual cycles. Menstrual hygiene management was focused on educational factors, however, many of that occurred beyond the household. We read books, heard about it from older sisters, girl-chatted among peers, and felt the vibes from the feminists who were burning bras, going to nudist island camps with their sisters, and championing the flower-power attitude towards sex. But without a doubt, the schools deserve most of the credit for educating us and keeping us safe from teenage pregnancies.

In Denmark, schools are not only meant to ensure academic qualifications, but they also play an important ‘civilizing role’ in that they are expected to provide the opportunity for all children to grow up as harmonious, happy, and genuine people for whom it is natural to consider other people’s welfare (Laura Gilliam and Eva Gulløv, Making children ‘social’: Civilising institutions in the Danish welfare state, Human Figuration, Feb. 2014). Source

Part of this paradigm is giving all students a profound knowledge of their bodies, respectful sexual relations, reproductive justice, STIs, contraceptives, and yes, basic information on vital menstrual hygiene management. Feeling a little bit awkward and mighty curious, we started sex education in sixth grade, and it was made very clear that teenage pregnancies reflected utmost stupidity and irresponsible behavior as we now had the knowledge to avoid them. I think my generation of teenagers – boys and girls – was the first to have the privilege of being empowered to control our own reproductive lives and understand the intricacies of desire, consent, and sexuality – the first generation of teenagers that was not told to abstain from having sex, but instead enjoy it responsibly, so our young lives, careers and dreams for the future would not be derailed by unwanted pregnancies or emotionally scarring abortions. Instead, we would be part of building a strong self, strong family, strong community, and a strong country.

DEFINITION: Teenage pregnancy or teenage childbearing is when a girl aged 15-19 is pregnant with her first child or gives birth.

Denmark’s sex education curriculum and even menstrual hygiene management are now among the most progressive in the world, so much so that the sixth week of the school year is dedicated entirely to all things sex and relationships. ‘Sex week’ — a play on the Danish homonym for ‘six’ and ‘sex’ — provides progressive and ambitious sex education to hundreds of thousands of young people. It is run by Sex & Samfund (Sex & Society), a non-profit dedicated to improving sex education in Denmark. And it works! Source.

This graph clearly shows how drastically the number of teenage births (Teenagefødsler) has decreased since 1973, and the teenage pregnancy and abortion rates are very low as well compared to most other places, including the US and many European countries.

 

Source

In 2017, only 474 children were born to teenage mothers in Denmark. The number of teenage pregnancies was, however, higher as some teenage girls chose abortion. In addition, the morning-after pill and pregnancy tests are available for over-the-counter purchase and very instrumental for early discovery of and prevention of pregnancy.

In the US, the birth rate has fallen dramatically over time as well.

 

Source

Source

In 2017, the CDC reported that a total of 194,377 babies were born to women aged 15–19 years, for a birth rate of 18.8 per 1,000 women in this age group.  This is another record low for U.S. teens and a drop of 7% from 2016. Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years.

menstrual hygiene management

The situation is very different in Tanzania. It has the 17th highest adolescent fertility rate in Africa, and according to the United Nations Fund for Population Activities, teenage pregnancy has increased 4% since 2010. In 2016, statistics showed that one in four teenage girls aged 15-19 had begun childbearing. In the Mara Region, where Maji Safi Group works, teenage childbearing is at a whopping 37%. Source

The many drivers and consequences of teenage pregnancy seem to be hopelessly intertwined protagonists in a vicious cycle, and their relevance to Tanzania seems taken straight out of a textbook: low education attainment, poverty (often resulting in transactional sex/prostitution), limited economic opportunities, gender inequality, male-dominated social norms, child marriage, and a dire lack of youth-friendly sexual and reproductive health services. It is also a huge problem in Tanzania that teenage mothers are not allowed to reenter the school system after giving birth.

When Maji Safi Group started working in Shirati in the Mara Region of Tanzania in 2012, menstruation was a taboo subject, and the access to female hygiene products and appropriate school bathrooms was so limited that menstruation contributed greatly to school absences and girls failing to succeed in school. We have helped change that!

Thanks to funding from private donors and grants from Beyond Our Borders and Dining for Women, we have built a nationally recognized Menstrual Hygiene Management (MHM) program that has taught thousands of girls about their bodies, puberty, menstruation, healthy relationships, etc., given them access to feminine hygiene products (pads, tampons and menstrual cups), and enabled them to look to our Community Health Educators as mentors with whom they can freely discuss and celebrate being young women.

Maji Safi Group’s approach is echoed in Tara Culp-Ressler’s suggestions of five simple strategies to reduce teen pregnancies:
1. Teach teenagers comprehensive sex education from middle school up.
2. Target messages to both teen boys and teen girls.
3. Involve the whole community.
4. Make contraceptives (especially condoms) widely available.
5. Encourage mentoring to create open discussion of sexuality and contraception.
Source

We teach both boys and girls at primary and secondary schools throughout the Rorya District. We involve the whole community by broadcasting shows about MHM on area radio stations.

We use singing, dancing, and street theatre to teach at large community events and our Dining for Female Hygiene get-togethers.
We paint community murals to educate all generations about MHM.

Through classes and Female Hygiene Health Clubs, our Community Health Educators mentor our students and encourage candid discussions of menstruation, healthy relationships, etc.

We give girls access to female hygiene products: reusable pad, tampons, and menstrual cups.

We refer people wishing to obtain contraceptives to the Shirati KMT Hospital in hopes that they will overcome old-fashioned cultural norms.

We are a member of the national Task Force on Menstrual Hygiene Management and attend many regional and national conferences.

We are having a profound impact on the MHM landscape in Tanzania, but it is a marathon, and we have not crossed the finish line yet! The ultimate goal is to create systemic change, so a progressive, comprehensive sex education program becomes a permanent component in all Tanzanian schools.

Maji Safi Group will continue to work towards that goal – because all young people should have the knowledge to control their own reproductive lives and fulfill their dreams.

menstrual movements tanzania

Memories and Projects from Our 2019 Summer Practicum

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This blog post is brought to you by Mekala Pavlin, a graduate student in Social Work at the Silberman School of Social Work in New York City, and Spencer Dirk, an undergraduate student in Public Health at Austin College in Sherman, TX. Mekala and Spencer were part of our 2019 cohort of practicum students from the US who spent a couple of months working with the MSG staff in the Rorya District. To learn more about our practicum program, please follow this link.

From left: Director of Operations Dorothy Ochieng, practicum students Katie Claar, Maggie Chen, Mekala Pavlin, Spencer Dirk, and Executive Director Max Perel-Slater.

Mambo! As we are sitting on the porch of Maji Safi Group’s office on our second to last day here in Shirati, today’s cool and gloomy weather reflects our sadness about leaving on Friday. Shirati and Maji Safi Group are truly special, and from the day we arrived, we were welcomed into the Maji Safi family, immediately feeling comfortable and cared for.

As we reminisce, our thoughts go back to one of our first days in Shirati. Although still fighting back some jetlag, we were to spend the entire day with the Outreach Program. We had no idea where we were going, but we were happy to be invited and start our time here, so we hopped into the Land Cruiser, and off we went. Two hours later, we found ourselves in Guchuma. Our first stop was the local government office, where the Community Health Educators (CHEs) asked for permission to teach the local residents about WASH-related issues and diseases. The local representatives were welcoming and gave their hearty approval for the outreach initiative. Somehow, it was already lunch time. At a restaurant, we had one of our first traditional meals, consisting of ugali and fried fish. We absolutely loved the food and enjoyed chatting with the CHEs while we ate.

Then the work began. We were paired with two CHEs who approached a group of men sitting outside a butcher shop. We were amazed by the confidence the CHEs had as they started discussing cholera with the group. We were equally stunned by how happily we were welcomed and how engaged the men were. They asked thoughtful questions and genuinely appreciated the knowledge they were receiving from the CHEs. After the conversation, most of the men even purchased WaterGuard (chlorine tablets) for treating their home water supply.

Next, we approached a large group of women who were selling tomatoes, cabbage and potatoes at the local market. Community Health Educator Judith Mbache started discussing urinary tract infections (UTIs) and fungal diseases with the women. We were impressed with her ability to instantly command the attention of the crowd and how she used humor mixed with personal experience to connect with her audience. Again, we were amazed by how responsive the crowd was to this sensitive subject. They asked great questions and were eager to learn more. We kept thinking how differently people in the US would have responded if stopped for a conversation of this nature on the street or at a market.

As the day wrapped up, and we waited for the other CHEs to finish, we shopped with Judith and Rosa for sugarcane, sardines and school supplies. As jetlag really hit, and we were dozing off during the car ride back to the office, the car unexpectedly broke down. We found seats on the side of the road under some papaya trees while waiting for a replacement part, chatting with Rosa for the better part of an hour. Considered how long we have been here, it’s interesting how much we can recall from our first days – it speaks to the incredibly memorable experiences we’ve had.

We both came into our practicum experience very interested in MSG’s Female Hygiene Program and curriculum. After expressing our interest in this area, Max and Dorothy explained that MSG had the opportunity to expand the Female Hygiene Program to six schools in the Serengeti Region. As part of this venture, baseline surveys were needed for female student participants, parents, community members, teachers, and male students. The surveys we wrote focused on assessing the knowledge these groups already had of menstrual hygiene management (MHM) and investigating methods to reduce both stigma and schoolgirl absenteeism related to menstruation. In order to write these four surveys for the five different target groups, we had to conduct in-depth research. We explored a variety of sources, many from world organizations such as UNICEF and Save the Children as well as smaller non-profit organizations in East Africa and other regions of the world. The volume of information available was large and took days to sort through. Once we had become familiar with published research on menstrual hygiene management, we immediately started drafting our own survey questions.

As the Serengeti Project includes giving out various menstrual products to female students, we realized that MSG could benefit from a comprehensive menstrual product pamphlet, describing all the different options women in the region may come across or use. This was a fun and interesting project that challenged us in many ways. Since we were already familiar with many of the products, it surprised us that it was so challenging to write step-by-step instructions for products that seemed so commonplace. We hope this how-to guide will help women navigate their monthly period more easily in the future.

Our time in Shirati with Maji Safi Group has been invaluable, and working on a project in an area that was unfamiliar to us taught us humility, the importance of relying on other people, and to think more deeply about our intentions. We will definitely miss buying passionfruit at the Monday market, the children that greet us screaming every morning as we walk to work, the endless chapatti (flatbread) and samosas we have had for dinner, the beautiful sunsets from Oboke Hill, and most of all the MSG staff’s friendly faces!