Near and Far: Healthcare Staff Committed to Reaching Rural Tanzanians and Their Children

Isabella Nyamizi, a medical doctor and project assistant working with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) got out of her car as the road conditions worsened. She began the walk to a client’s home in Damwelu, a village in central Tanzania. Nyamizi was accompanied by community health worker Magreth Ndudumka; village chairperson Elias Charles; and John Mwendaa, MD, a fellow physician from the nearby Itigi Health Center.  Nyamizi primarily works to identify and treat tuberculosis (TB) patients, especially children, and connect those found with TB to treatment while providing preventative treatment to eligible children. Here in Damwelu, Nyamizi is following up on a referral for a child presumed to have TB. 

Finding TB Clients 

Two months before, Ndudumka had guided the medical team to the village to collect TB samples. As a community health worker, she works closely with TB clients in the area to educate and provide them with treatment support.  

“We stayed there for two days for the aim of conducting TB screening. After the screening results came out, we successfully managed to identify a 5-year-old patient named Anna,” said Ndudumka. “We took Anna’s sample and went to test it at St. Gasper Hospital; her tests results came out positive. After that, we decided to start following up on Anna’s health.” 

TB is a highly transmissible, chronic airborne disease caused by a bacteria known as mycobacteria tuberculosis. The bacteria are transmitted through droplets in the air when an infected person coughs, sneezes, talks, sings, or laughs, making it easily spread through close contact in small enclosed spaces. Nyamizi explains that crowded households create a prime opportunity for TB transmission between family members.  

“According to the national TB guidelines when we identify a person to have TB disease, their household must be visited and the family members are asked if they have signs and symptoms of TB and tested so as to know if there are other infected family members,” says Nyamizi. 

Ndudumka returned to Anna’s house to follow up on her health and check on her family members and found that the whole family was sleeping in the same room. “As a community health care worker, I had the responsibility of coming back to the health center and reporting what I saw to the doctor.”  

Now Nyamizi and the team are following up to test the other members of Anna’s household for TB. After being approved and welcomed to the village by the chairperson, Elias Charles, the team continues on to Anna’s house. The chairperson accompanies the team and introduces the doctors to the grandfather.  

“As a community health care worker, I had the responsibility of coming back to the health centre and reporting what I saw to the doctor.”  

Dr. Mwendaa sits down with family members who are feeling unwell and walks them through why testing for TB is important, and how to provide a sample. He tells them to be aware of TB symptoms such as fever, cough, night sweats, weight loss, and loss of appetite. He also meets all the children in the family, paying particular attention to children under the age of five, who may have been exposed to TB through Anna. Children are among the groups most at risk for TB and must be closely monitored for symptoms such as malnutrition, irritation, and failure to thrive.  

“One child, Msambili, is 4 years old,” Dr. Mwendaa says. “We have checked her and she doesn’t seem to have any indications that she has TB, so she needs to start preventive therapy medication to protect her from TB. This medicine is very good and children under 5 years can use it.”  

The following week, the sample analysis reveals that both Anna’s mother and grandfather have TB. The team promptly returns to the household to initiate medications for the adults, check on Anna’s progress, and continue to monitor other children in the household.  

Anna’s family is relieved to find they are not bewitched, and there is real hope for good health and a prosperous future for them. 

Reaching Everyone with Health Care 

Many of those living in rural villages do not have a nearby health facility or do not have the means of reaching the closest clinic. Despite this obstacle, the district sees health as a human right and aims to reach these people with clinical services, even if it means bringing it to their homes. Community health workers help bridge the gap by providing health-enhancing communication and support in between physician visits,  

“The places we go to are very remote and sometimes geographically the roads are impassable,” says Issaya Siame, a driver for the project. He drives the team to the closest location that is safe for automobiles and then the team walks the rest of the way. 

This initiative utilizing contact investigation, treatment, local service delivery, and community health support has helped identify TB clients and protect children from possible infection, in addition to improving health literacy in communities that have otherwise been especially hard to reach with both education and services.  

As we continue moving through the community, we should also not forget children under 15 years of age.

TB is an opportunistic infection that disproportionately impacts people living with HIV, which also exists in these communities. In fact, one-third of all identified TB cases in Tanzania are among people living with HIV. If gone untreated, people living with HIV are much more likely to suffer severe illness or die.  

Through the remarkable partnership between EGPAF, the Itigi Health Center, and local village authorities, these cross-functional teams have been able to reduce the impact of TB on both nearby and remote communities. With TB disproportionately impacting those living with HIV and those facing malnourishment as a result of poverty, this project addresses these intersections by integrating TB services with HIV testing and nutritional assessments.  TB laboratory tests and treatment are offered for free in both government and private facilities, and the country is now fairing very well in ensuring more than 90% of cases are successfully treated as a way of controlling TB transmission. The project also pays special attention to children, as they are especially difficult to identify with TB, and children between the ages of 0 and 14 represent 14% of all TB cases in Tanzania. 

“We should increase our efforts both the government and other non-governmental organizations involved in fighting and investigating TB and help people who are infected,” Nyamizi says. “But as we continue moving through the community, we should also not forget children under 15 years of age. We should do active TB screening so that when we suspect TB, we can follow all procedures of taking their sample for testing in the laboratory and identify if they have been infected, and then we should initiate medication quickly, so we can prevent unnecessary deaths that occur through TB.” 

“That can be controlled through our unity.”