Masai, a population that is migratory in nature, pastoralist and strongly patriarchal reside mostly in the Manyara region, where they are well known for their grounded beliefs and customs experienced through their strong sense of culture, traditions, and lifestyle. Some of these customs, such as the use of traditional herbs when sick and using birth attendants to deliver children, tend to affect the health seeking behavior of the Masai community, which can increase their risk of acquiring HIV or TB.
The USAID Afya Yangu Northern Project uses the Boma to Boma approach as a means to enhance HIV and TB services at hard to reach communities living at households located more than 20 kilometers away from health facilities. The project works very closely with the Community Health workers and Laigwanan- the most respected local leaders and most influential to Masai society, to deliver HIV, TB and gender related messages to the community during the implementation of the Boma to Boma approach.
Through this approach these influential leaders are used as a communication channel to prompt behavioral change and deliver appropriate project messages to the Masai community who have been identified from a list of elicitated clients at the target health facilities (by the healthcare workers). After the CHWs and Laigwanan’s have done their communication role to the listed clients, the second visit involves healthcareworkers to visit the boma to provide HIV and TB related services at their homes.
In Tanzania’s northern region situated between lake Manyara and the Great Rift Valley, a middle-aged mother, Yasinta, sits calmly outside a household 42 kilometers from Kijungu Dispensary, in the Kiteto district.
The bubbly mother lives with her husband, children and other relatives in one compound surrounded by seven huts (bomas) made from mud and tree trunks sit close to each other. A few meters from the huts are mountains, thorny trees, rocks and the dusty grounds.
When a team from the USAID Afya Yangu Northern visited the boma, families gathered around with joy as they welcomed the team with their traditional Masai dance. It was a great warm up for them to get to know each other.
When the family saw Esther, one of the healthcare workers with the team, they became enthusiastic and spoke in their native language saying, “Esther!! Our hero, God used you to save the life of our relative, Yasinta”.
The team was eager to know more, so they asked Yasinta to tell her story;
Although Yasinta was emotional, she was also enthusiastic about sharing her story. “Where do I even begin”, she remarked. “The moment when I was sick, was the hardest in my life. After being sick for so long and after using all the traditional herbs, but my condition deteriorated as I suffered from vomiting and diarrhea. My family did whatever they could to save my life. When they saw their efforts were not bearing any fruit, they lost hope and decided to make peace with the fact that I was going to die.
Just one random day, we received a visitor–a woman on a motorbike who seemed to have travelled very far. Her face was covered with dust. The woman, who introduced herself as Esther, was easy to get along with. She was charming and seemed to understand our culture. When she asked to meet me, I was puzzled. How could she have known me? I had never seen her before. I was severely ill in bed.
She asked if I was a traditional birth attendant and I was even more confused because that’s the work that I had been doing before I became sick, helping pregnant women deliver babies. How could this woman know so much about me? As Esther helped me out of bed, she explained that she’d been referred to me by another sexual patner from the Kijungu dispensary where she works.
Esther explained to the family about HIV and an approach where household, family members (including children) and partners of people diagnosed with HIV are offered HIV testing. Yasinta agreed to be tested and was found to be HIV positive. She was immediately enrolled on treatment and provided with anti-retroviral (ARV) drugs.
As the days went on Yasinta started to feel well and strong, and is now an inspiration to other community members. Her health improved drastically. The family is now happy and are grateful to a USAID’s project for reaching out to their household. Esther, together with the CHW at Kijungu dispensary, continue to follow up on Yasinta and her household members.
Keen to protect others from going through the odious experience she went through, Yasinta now reaches out to other Masai community members. She opened the door for the community to be reached by HIV and TB care services. For instance, just as the team visited Yasinta’s household, another woman who had been coughing rigorously was referred to the team for TB testing.
Through her story, Yasinta and her family are helping to improve the nomadic community’s health seeking behavior who’re ordinarily known to treat themselves using traditional herbs.
Yasinta is just one out of the 130 people living with HIV who were identified within three months with this program in the Kiteto district at Manyara region.
The USAID Afya Yangu Northern Project is implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in partnership with EngenderHealth, Amref Health Africa, Matchboxology, D-Tree International, the Ministry of Health (MOH) and Presidents Office, Regional Administration and Local Governments (PORALG). The project seeks to increase access to quality, comprehensive client centred and integrated health services among children, women and families in Tanzania’s six regions of Arusha, Dodoma, Kilimanjaro, Manyara, Singida and Tabora.