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Public clinics in Zimbabwe save lives with TB, diabetes and HIV treatments

the pilot clinics have become lifesavers for the poor – but only if they happen to live near them.

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Blessing Chingwaru could barely walk without support when he arrived at the specialist Rutsanana clinic in Harare complaining of chest pains and fatigue.

Weighing a skeletal 37 kilogrammes (5.8 stone), the HIV-positive motor mechanic knew something was wrong.

He was immediately given a number of tests and told the bad news: He was also suffering from advanced-stage tuberculosis. Dual infection by HIV and TB is a notorious killer.

Blessing Chingwaru (R), 29, an HIV positive TB scratches his head as he sits during a medical consultation with nurse Angela Chikondo at Rutsanana Polyclinic in Glen Norah township, Harare, on June 24, 2019. (Photo by Jekesai NJIKIZANA / AFP)

“My health was deteriorating and I kept wondering why,” Chingwaru, 29, recalled at the clinic.

Within hours of the diagnosis, Chingwaru was given free treatment and nursing care.

In a country where more than a dozen people die each day from TB-related sicknesses, it was a rare example of efficient public healthcare.

The Rutsanana Polyclinic in Harare is one of 10 pilot clinics in the country offering free diagnosis and treatment for TB, diabetes and HIV.

The clinic, which opened in 2016, is staffed by 24 nurses and currently treats 120 TB patients. 

Among the million-plus people living with HIV in Zimbabwe, TB is the most common cause of death, according to the World Health Organization (WHO).

HIV-positive people, and others with weakened immune systems, are particularly vulnerable to contracting the infection.

After Chingwaru’s initial visit in February, doctors had feared for his life.

But following five months of careful treatment Chingwaru has gained 15 kilos.

“Everything I need, I get here,” said Chingwaru, forming fists with both hands to show off his regained strength.

Economic and financial challenges

In a country where public health services are faced with extreme challenges, containing the spread of TB has been a struggle.

Zimbabwe has been stuck in economic and financial crisis for a long time and many of its doctors are underpaid and under-equipped.

Although TB treatment is free, the annual number of TB infections in Zimbabwe remains among the highest in the world.

The contagious infection is usually found in the lungs and is caught by breathing in the bacteria from tiny droplets sneezed or coughed out. 

As HIV-positive people are so vulnerable to TB, the clinics have followed the advice of WHO officials to link TB testing and treatment with HIV prevention programs.

‘Catastrophic costs’

Close to the main gate of the Rutsanana clinic, a green self-testing HIV tent has been erected to encourage people to check their status.

The clinic also offers voluntary HIV counselling and antiretroviral treatment. 

Sithabiso Dube, a doctor with the medical charity International Union Against TB who heads the TB and HIV programme, said people with diabetes also have a higher risk of developing TB, so patients are tested for both diseases.

“Instead of going to seek diabetic care at one clinic and TB care at another, they are able to get these services in one place,” Dube told AFP.

Because services are free “they are able to cut down on what we call catastrophic costs to the TB patients,” she said.

Largely funded by a US Agency for International Development (USAID) programme, the pilot clinics have become lifesavers for the poor – but only if they happen to live near them.

The vast majority of the population have no access to the one-stop clinics.

As a result there are plans to scale up the programme, with another 46 similar centres to be rolled out across Zimbabwe.

Rutsanana clinic matron Angela Chikondo said the programme was crucial to minimising complications among TB and diabetes patients.

“If one is on TB treatment and also has diabetes, and the diabetes is well controlled, chances of recovering are very high,” she said.

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Africa’s rare giraffes face ‘silent extinction’ threats

Giraffe numbers across the continent fell 40 per cent between 1985 and 2015, to just under 100,000 animals

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Africa's rare giraffes face 'silent extinction' threats
A giraffe is seen at Maasai Mara National Reserve in Kenya. (AFP)

For most of his life as a Samburu warrior, Lesaiton Lengoloni thought nothing of hunting giraffes, the graceful giants so common a feature of the Kenyan plains where he roamed.

“There was no particular pride in killing a giraffe, not like a lion… (But) a single giraffe could feed the village for more than a week,” the community elder told reporters, leaning on a walking stick and gazing out to the broad plateau of Laikipia.

But fewer amble across his path these days: in Kenya, as across Africa, populations of the world’s tallest mammals are quietly, yet sharply, in decline.

Giraffe numbers across the continent fell 40 per cent between 1985 and 2015, to just under 100,000 animals, according to the best figures available to the International Union for Conservation of Nature (IUCN).

But unlike the clarion calls sounded over the catastrophic collapse of elephant, lion and rhino populations, less attention was paid to the giraffe’s private crisis.

“The giraffe is a big animal, and you can see it pretty easily in parks and reserves. This may have created a false impression that the species was doing well,” said Julian Fennessy, co-chair of the IUCN’s specialist group for giraffes and okapis.

Africa's rare giraffes face 'silent extinction' threats
Conservationist Symon Masiaine (L), who study and carry out awareness on giraffe plight and conservation, search for giraffe clusters at Loisaba Conservancy in Laikipia on August 5, 2019. (Photo by TONY KARUMBA / AFP)

The rate of decline is much higher in central and eastern regions, with poaching, habitat destruction and conflict the main drivers blamed for thinning herds of these gentle creatures.

In Kenya, Somalia and Ethiopia, reticulated giraffe numbers fell 60 per cent in the roughly three decades to 2018, the IUCN says.

The Nubian giraffe meanwhile has suffered a tragic decline of 97 per cent, pushing this rarer variety toward total extinction. 

Further afield in Central Africa, the Kordofan giraffe, another of the multitude subspecies, has witnessed an 85 per cent decrease.

In 2010, giraffes were a species of “least concern” on the IUCN red list. But six years later, they leapt to “vulnerable”, one step down from critical, catching many by surprise.

“This is why, for the giraffe, we speak of the threat of a silent extinction,” said Jenna Stacy-Dawes, research coordinator at the San Diego Zoo Institute for Conservation Research.

Mysterious giants –

Despite this, an international effort underway to put giraffes squarely on the global conservation agenda has divided professional opinion.

Six African nations are pushing to regulate the international trade in giraffes under the UN Convention on Trade in Endangered Species (CITES), which meets from August 17 to 28 in Geneva. 

Those advocating for the change, including Kenya, want the giraffe classified as “a species that, although not necessarily currently threatened with extinction, could become so if trade in their specimens were not closely controlled”.

Critics, however, say there is little evidence the international wildlife trade is responsible for dwindling giraffe numbers. A lack of reliable data has long hindered efforts to protect them.

“Compared to other charismatic species like elephants, lions and rhinos, we know very little about giraffes,” said Symon Masiaine, a coordinator in the Twiga Walinzi giraffe study and protection program, which began in Kenya in 2016. 

“Nowadays, we are still far behind, but we are making progress.”

Almost nothing is reliably known about giraffe populations in Somalia, South Sudan and eastern parts of Democratic Republic of Congo, where collecting such information is perilously difficult.

But even research outside conflict zones has been patchy.

Arthur Muneza, from the Giraffe Preservation Foundation, said the first long-term study of giraffes was not carried out until 2004. Data on giraffes is often gathered as an afterthought by researchers focussing on other wildlife, he added.

“Without reliable data, it is more difficult to take appropriate conservation measures,” Muneza said.

It was not until 2018 that the IUCN had enough statistics to be able to differentiate the threat levels facing many giraffe subspecies.

The reticulated and Masai giraffes, for examples, were classified as “endangered” while the Nubian and Kordofan were “critically endangered”. 

Trophy hunting –

Under the proposal before CITES, the legal trade in giraffe parts, including those obtained by trophy hunters on Africa’s legal game reserves, would be globally regulated.

Africa's rare giraffes face 'silent extinction' threats
A picture taken on August 5, 2019 shows reticulated sub-species of Giraffe at Loisaba Conservancy in Laikipia. (Photo by TONY KARUMBA / AFP)

Member countries would be required to record the export of giraffe parts or artefacts, something only the United States currently does, and permits would be required for their trade.

But observers say the limited information available suggests most of this trade originates from places where giraffe numbers are actually rebounding, like South Africa and Namibia, where game hunting is legal.

Muneza says there isn’t a clear enough picture that the legal trade is linked to declining giraffe numbers.

“The first step should be to conduct a study to find out the extent of international trade and its influence on giraffe populations,” he said.

Those supporting the proposal before Geneva talk of a “precautionary principle” — doing something now before it is too late.

For Masiaine, the Kenyan giraffe researcher, any publicity is good publicity for these poorly-understood long-necked herbivores.

“It means that people are talking about the giraffe,” he said. “And the species really needs that.”

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Practitioners worry as Nigeria’s tradition of facial marking declines

Traditional practitioners, known locally as “oloola” are worried about the decline of facial scarification, but critics remain opposed to it

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Practitioners worry as Nigeria's tradition of facial marking declines
A Muslim lady bearing tribal marks on her cheeks poses in Lagos. - The incisions have traditionally been performed in an array of styles by different ethnic groups in Nigeria. The scarring is done by burning or cutting of the skin during childhood. From the Yoruba in the southwest to Igbo in the east and Hausa in the north, the marks serve different purposes: identification, healing, spiritual protection, beautification. (Photo by PIUS UTOMI EKPEI / AFP)

When six-year-old Naziru Abdulwahab was abducted from northern Nigeria, his kidnapper transported him across the country and tried to sell him — but the potential buyer backed out. 

What saved the boy from the child-smuggling rings, police said, was the traditional facial scarrings on his cheeks that he had been marked with at birth.

Fearing they would make him too recognisable, the would-be purchaser refused to buy him.

After suspicions were then raised by local residents, the trafficker was arrested and the child rescued.

The incident in June shone a spotlight on the practice of tribal markings that has been fading since the 1980s in the fast-changing country of nearly 200 million people. 

Traditional practitioners, known locally as “oloola”, said it showed the benefits of the practice that critics have long argued is unsafe and child abuse.

Practitioners worry as Nigeria's tradition of facial marking declines
A man bearing tribal marks on his cheeks speaks in Ibadan, southwest Nigeria. (Photo by PIUS UTOMI EKPEI / AFP)

“Our taste for foreign things has robbed us of our customs,” Mashopa Adekunle, an oloola in the southwestern city of Ibadan, told reporters. 

“Nobody wants to put tribal marks on his child anymore. People see the practice as archaic, fetish and unhygienic.”

On the battlefield – 

The incisions have traditionally been performed in an array of styles by different ethnic groups in Nigeria. 

The scarring is done — both to boys and girls — by burning or cutting of the skin during childhood. 

From the Yoruba in the south-west to Igbo in the south-east and Hausa in the north, the marks serve different purposes: identification, healing, spiritual protection, beautification.

Prominent figures, including ex-president Olusegun Obasanjo, have tribal marks on their cheeks.  

“In the days of inter-communal wars, tribal marks helped to identify fighters. You would know who were your friends and enemies in the battlefield,” said Adekunle. 

He agreed that the traditional practitioners needed to move with the times if they wanted to remain relevant — pointing to the growing numbers of Nigerian youths embracing western-style tattoos. 

“The oloola have to do more to convince their critics that their tools are safe for use,” he said.

‘Facial mutilation’ –

Opponents have pushed for a country-wide ban on facial markings.

In 2017, the Nigerian Senate debated a bill for the “prohibition of facial mutilation” that would have introduced punishments for those who perform it and protection for those at risk. 

Proponents of the move argued that the “barbaric” practice left people disfigured for life and put them at risk of contracting HIV. 

The proposed legislation is currently bogged down in parliamentary procedure.

The practice of facial markings has been waning for around 40 years, said the Oloola Descendant Association in Ibadan, whose members barely carry out one case a month now, compared to about 10 in the 1980s.

Sefiu Yusuf, the association’s head, insisted that there was still a role for traditional methods, as he showed reporters his metal instruments wrapped in white handkerchiefs at his dark clinic.

A man holds native instruments for tribal markings at the family compound of the Oloola Descendant Association, traditional practitioners of tribal markings in Ibadan, southwest Nigeria. (Photo by PIUS UTOMI EKPEI / AFP)

He inherited his position from his father and said his family had long been known for performing circumcisions. 

“Only yesterday, a boy was brought here because our patrons believe in our ability,” Yusuf told reporters, at his dilapidated home in the centre of the city. 

“Even doctors and nurses seek our help when they have complicated cases.” 

He dismissed criticism that his practices were unsafe.

“It’s a smear campaign by NGOs and people in government to… put us out of business,” he said.

For another Ibadan-based oloola, Babatunde Hamzat, the decline of the tradition has had serious consequences for the Nigerian society. 

He said its loss had contributed to the high levels of crime in the country. 

“In the time of our fathers, a child with tribal marks would not want to commit any crime for fear of being identified,” he said. 

“But nowadays, people commit crimes with levity since there is nothing to identify them with.”

‘Preserve family identity’ –

Trader Dauda Lawal, 60, proudly sports the facial marks his parents gave him as a child and says he was happy to do the same to his offspring.  

“Being the first son, my parents gave me tribal marks. Though the practice is dying, I still made sure my first son got it to preserve the family identity,” he said. 

Practitioners worry as Nigeria's tradition of facial marking declines
Head of the Oloola Descendant Association, traditional practitioners of tribal markings Sefiu Yusuf, speaks about the benefits of the customs in Ibadan, north of Lagos. (Photo by PIUS UTOMI EKPEI / AFP)

Lawal claimed his wife married him because of the facial marks he bears. 

But he is not sure if his son will follow suit.

“I will be happy if he does a similar thing to his own son because it’s part of our culture that should not be allowed to die,” he said.

That positive view of facial marking is not shared by everyone.

“I can never allow tribal marks on my child’s face because the practice is old-fashioned and unhealthy,” said Lagos beautician Damilola Ajayi.

She said that she was firmly opposed on both health and aesthetic grounds. 

“In these days of HIV/AIDS and other communicable diseases, it’s risky to use unsterilised instruments such as the ones used by the oloola on a child’s body,” she said.

“I also cannot date, not to talk of marrying, a man with tribal marks. It’s disgusting.”

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Religious festival boosts interfaith unity in Senegal

It’s not only the Christians that partake in Muslim festivals. “When a Christian dies, all the neighbours go to the church for the funeral”

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Religious festival boosts interfaith unity in Senegal
(Ozkan Bilgin / AFP)

When Senegal’s Muslim families gather for the biggest Islamic religious feast of the year, they often encourage the Christian minority to join them in a tradition of tolerance.

Many Roman Catholics in Dakar were invited Monday to join Muslim friends for Tabaski, the local name for the Eid al-Adha or the Festival of the Sacrifice, which commemorates Ibrahim’s willingness to slaughter his own son if God commanded it.

For Senegalese student Grasse Diop, his preparations to welcome Christian friends were placidly watched by Dembel, a family sheep destined for imminent slaughter like the ram God told Ibrahim to sacrifice as reward for obedience.

“They come every year for the Tabaski and I go to the Christmas mass. We spend all our religious feast days together,” said Grasse, whose name is derived from Grace, a Christian one.

The family courtyard in Dakar’s Ouakam district was turned into both abattoir and kitchen. Women sang as they cut up the freshly killed meat while children played by bowls containing discarded entrails.

“Jacques, Marie, Joseph… All my Christian friends are wishing me a good Tabaski,” Grasse said amid a flurry of calls on her mobile phone. “When I visit them, I feel at home. There’s no difference.”

“When a Christian dies, all the neighbours go to the church for the funeral,” added her brother Pape Doudou Diop. Though a Muslim like more than 90 per cent of the population, he said he regularly goes to church for communion.

Once their guests settled around a huge platter of barbecued food, Christians could not be told apart from the Muslims, though Yves-Martin Kemden wore a special long robe to honour his hosts during his tenth Tabaski.

“It’s a custom,” the young dog breeder said. “Here, you’re always invited by a neighbour even if you don’t share the same religion.”

‘Indivisible’ –

Hardline Islamist militants have made their mark in other parts of West Africa, trying to impose their more intolerant and often violent vision of Islam on communities in countries like Nigeria and Mali.

For those ultra-conservatives, other religions and even other branches of Islam are often seen as apostates.

Sociologist, Fatou Sow Sarr believes Senegal’s religious harmony dates back to the preachings of leaders of the widespread Mouride brotherhood, who taught tolerance towards Christians from the 19th century on.

“You find Christians and Muslims in the same family and they intermarry. Religion comes second to blood ties, so the communities have never been antagonists,” she said.

“Today, there’s more risk of dissent among Muslims because of conflict between the Mouridic communities and Wahabi influence than between Muslims and Christians,” Sow Sarr said, distinguishing between Senegal’s predominant Sufi order and a more conservative Islamic branch.

In their courtyard sheltered by palm trees, the Ndoye family was packing boxes with mutton to take to Christian friends no longer able to get around.

“Our cousins invite us at Easter, making sure not to cook pork,” smiled Karim Ndoye, a house painter in his 50s who added that one of his grandmothers was Catholic. “It’s family, we’re indivisible.”

At the clergy house of Dakar Cathedral, shaded by a riot of bougainvillaea flowers, octogenarian, Father Jacques Seck made ready to join Muslim friends for the Tabaski.

A self-styled “Muslim Christian”, the elderly priest is known for sprinkling his sermons with verses from the Koran and urging dialogue among religious communities.

“This religious tolerance is at the root of Senegalese society,” he said. “The good fortune of this country is that it’s rare for a family not to have members from both communities. The diversity built the nation.”

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