The AIDS Epidemic in Tanzania

On my way to the kitchen, I walk past rows and rows of stone sheds that serve as both homes and disorderly shops, offering a variety of produce/merchandise. The pathways are so littered and covered in potholes you find yourself looking down most of the time so you avoid stepping in something. There are people everywhere, standing in doorways and on their dirt porches, excited to greet you. During the days you most often see women with the children, as they are typically the caregivers. It is rare to see the father at the home with the child in the day.

I want to share some attention-grabbing information to throw some context over why WHE chose Tanzania as its initial start up location for probiotic yogurt kitchens.

The country of Tanzania is facing devastating effects from the growing AIDS pandemic, as evidenced by a national prevalence rate of 7% --other issues include prevailing poverty, recurring drought, and soil degradation. The majority of the twenty million people worldwide who have already died from AIDS have been African. Each day in Africa, 6,000 people die from AIDS, and an additional 11,000 are infected with HIV. With 25 million citizens who are HIV- positive, the countries in the Sub-Saharan region are facing a crisis of unprecedented proportions.

Aside from the direct physical impacts, HIV/AIDS takes a toll on communities as it leaves family members and orphaned children to deal with ostracism, stigma, and the inevitable cycle of poverty and disease. The larger impact of AIDS will yield food crises, increased number of orphans, and depleted human capacity (UNAIDS, 2004). Whole societies are affected by disruptions in schooling, work patterns, and human productivity, limiting their ability to develop or maintain previous progress (Macintyre, Brown, and Sosler, 2001; Elder, 2001). HIV/AIDS continues to diminish social networks, leaving entire societies unable to cope with the crippling and debilitating health and social effects of the disease (UNAIDS, 2004).

The pandemic in Africa is also gender based. Particularly, young women aged 15–24 years are approximately 2 to 5 times more likely to be infected than men of the same age. Generally, women are more vulnerable and severely affected than men. Women aged 15–49 years are about 1.3 to 2 times more likely to be infected than men (WHO, 2005; DHAPP, 2005).

“Nowhere is the epidemic’s ‘feminization’ more apparent than in Sub-Saharan Africa, where 57% of infected adults are women, and 75% of infected young people are women and girls” (UNAIDS, 2004). Specifically, in Tanzania, of the 1.6 million infected adults between the ages of 15-49, more than half of those infected, 840,000 are women (UNAIDS, 2004).

Progress with the Yogurt Kitchen

Last Monday was a big day for all those involved working with the kitchen. SIDO –Small Industries Development Organization—came by for a scheduled inspection to check the general hygiene of the kitchen and its processes for making the yogurt. SIDO provides business services on demand to promote the development of private small enterprises.

Now that we are in the stage of developing the distribution segment of this business, we are trying to obtain a license to sell our product in various stores and restaurants. However, before we can do this we must have our product approved by the health authorities. We initially looked into obtaining approval from the TFDA –Tanzanian Food and Drugs Authority—but this proved to be more difficult than we anticipated. The TFDA deals with larger enterprises, so the kitchen fell short of meeting a few of its qualifications on account of its smaller size. We then sought out SIDO’s assistance in authorizing our product. We went to their office, explained Fiti Yogurt’s business model in conjunction with its social objectives in hopes of catching their interest to partake in this process. The meeting went well and they agreed to come to the production facilities and complete a health inspection.

Once approved by SIDO, they will recommend our product to TBS – Tanzanian Board of Standards –so Fiti Yogurt can obtain a seal of approval. This behaves similarly to how an FDA approval would work in Canada. Once SIDO has a good understanding of the procedures they will write the Mammas a letter recommending them to the market.

The meeting went very well on Monday and the inspectors seemed to enjoy our product. The Mammas had two fridges full of yogurt and were very enthusiastic when interacting with the company representatives. The inspectors were also pleased with the way the yogurt was being packed. We are waiting to speak with them again later this week to receive their feedback from the inspection.

This last week Jesse and I focused our efforts on creating more accurate record keeping templates to document the kitchen’s yogurt production as they expand to grocery stores and additional markets. We will keep track of production rates over the next little while and look into creating growth charts for the women, so they can understand where existing production is relative to projected targets. This will assist the Mammas in running the kitchen as a business with targets, growth and planning.

The Mammas are no longer running their side operation during the summer months –the breakfast kitchen—so we are hopeful they will be ready and motivated to commit themselves to growing sales and distribution of the yogurt. Right now they have one junior mamma selling 12 L per day in the main market downtown Mwanza. She sells out every day, illustrating an existing market for our product. However, the kitchen only had one portable tub to transport the yogurt and the women did not understand the need for external distribution as a fundamental component for upping our sales. The outcome of our meeting today was positive—everyone concluded that an emphasis should be put on getting our product out into the market so as to generate a brand name that resonates with different communities and increases our overall market share.

We also have existing funds remaining from the Charity Ball Grant, so next week we begin subsidizing yogurt consumption for 25 people living with HIV/AIDS.

On Wednesday we will be meeting with the Director of the Kivulini Women’s Rights Group to discuss getting other groups involved with the expansion of additional yogurt kitchens. We know there are several groups in the Mwanza region that are interested, so the more difficult aspect will be locating funds to get them up and running.

We worked on a proposal for a grant donor—that supported the Touch foundation—looking for an entrepreneurial-based project in Mwanza, but they found another project. Locating start-up funds is quite difficult in Mwanza, so I have been looking into the option of applying for a loan from organizations that provide micro financing. The primary concept with micro financing lies within the initial group formation of the individuals applying. The composition of the people within the same group is very important as it determines how effectively each member can cater to his or her own needs. When applying in a group you also generate this pressure among the social collectors to pay off any debt—a mechanism that has proven to work quite well considering default rates are averaging well under 5 % in micro credit scenarios within the MF industry.

Yesterday, I had a meeting with the Director of Catholic Relief Services in Mwanza to discuss microfinance in Africa. CRS is an American organization founded to assist the poor and disadvantaged outside of the country. They operate in over 100 countries. Their Tanzanian offices focus on their AIDS Relief program. This program aims to provide high-quality antiretroviral therapy and other medical care to people living with HIV. Majority of its funds come from the U.S President’s Emergency Plan for AIDS Relief (PEPFAR).

We exchanged information about the project I am working on here and its viability as a candidate for microfinance. He has a lot of experience working in the micro finance industry so his insights were extremely valuable and greatly appreciated.

Wiki Mbili (Week Two in Swahili!)

Donations

I discovered clothes and various other donations from organizations in Canada—set up to provide help for those in need—are often not received by the end consumer free of cost. Large trucks unload these donated goods in urban areas where they are subsequently purchased by vendors and resold in privately owned stores. The apartment is right across from a second hand market, so I have had the opportunity to visit a few times and found value village tags still in tact with stamps iterating “not for resale”. I understand to a certain extent this infuses some money into the Tanzanian economy; however, it was unsettling to know that profits were being made off of what was intended to be someone’s contribution.

Water Situation

After Boyd posed several questions inquiring about Mwanza’s water supply, I immediately looked into the situation and here’s what I found out. Overall, Mwanza has an extensive supply of water resources on account of its proximity to Lake Victoria – one of the largest fresh bodies of water in Africa –but it is distributed poorly. Timing is a concern for communities located in the more rural areas of Tanzania as the country experiences a dry spell over a large course of the year (June to October), which frequently results in a lot of its natural water reserves drying out. These communities living in rural areas surrounding the city of Mwanza commonly rely on neighborhood water taps that come from privately owned wells. Individuals are forced to pay a fee to share this water, but when water is unavailable they will travel to Lake Victoria. Wells necessitate an investment of around $ 1, 600 USD.

The sewage system is messed up. The water and sewage facilities are in disrepair and/or not integrated. It was built so long ago that it fails to serve even 1/5^th of the population. Something like 3 % of people in Mwanza have a flush toilet, so this has led to people defecating in bags and throwing them in Lake Victoria, introducing a multitude of diseases to the water. Majority of people living in Mwanza depend on septic tanks, pit toilets (i.e. a hole in the ground) or on the outdoors. The pipes, intended to pump waste out of the city, broke a long time ago so large masses of raw sewage pour into a river canal feeding into Lake Victoria near the downtown district every day. This explains the rancid smell that overpowers the downtown area where I live. Meanwhile, a mile away you have the pipes retrieving water from Lake Victoria and distributing it for domestic use. This piped water serves the majority of the people living in Mwanza. Tourists are forewarned not to even step on the sand that constitutes the waterfront, as there are numerous parasites and worms chillin in its depths.

Social Ways

When we were living at the University, the other interns and I met the director of the sociology department. He is an extremely intellectual man that surprised us initially with his fluent English. He asked us to come and assist his students in studying the development, structure and functioning of human society in Canada. I am really looking forward to this as I hope to also learn about the social problems/successes experienced here in Tanzania.

On the topic of societal norms - I noticed men of all ages hold hands here and found this to be a unique social attribute. This type of behavior is not characterized as homosexual in Tanzania, which is contrary to how it would be viewed in the Western world. However, I soon learnt that homosexuality is an unfathomable concept here and punishable by death in certain areas.

In addition, it is unacceptable for men and women to engage in public displays of affection – this is in part due to the significant role religion plays in Tanzania. There is minimal conflict surrounding the topic of religion—so long as there is some type of God people believe in. The concept of being ‘undecided’ does not exist as everyone must have a chosen faith.

There are several other things I have taken note of here that are definitely different. I don’t know if these can be considered social differences, but they are interesting/annoying. Firstly, there is no such thing as credit. Everything is paid up front (e.g. pay as you go phones, no contracts)—generally in cash. You wouldn’t be able to get a credit card here.

Customer service is non-existent in the hospitality industry. Everything takes at least 5 times longer than it normally would back in Canada. For instance, it takes a full day to photocopy several sheets of paper. Going out for dinner occupies a full evening. I waited almost an hour and a half for a banana split–convinced they were taking the time to churn the ice cream in the back—I was sadly disappointed when I received a banana cut in half on my plate a couple of hours later.

The temperature is ridiculous here. It is always clear skies and no wind. Just stagnant, boiling air. The soaking wet laundry took less than 2 hours to fully dry at 7 am this morning.

It’s so loud everywhere, all of the time. Dogs bark throughout the night—I feel like that movie 101 Dalmatians is going down outside my window. Prayers from the mosque are broadcasted over the sound system at 5:30 in the morning. There is constantly music playing from a broken speaker right outside my window. I am convinced it is the same dude that keeps returning. I am so tired at the end of the night though that I have grown accustom to it—and I bought earplugs.

Everyone wants to grab your attention. As a foreigner you’re hissed at, yelled at and sometimes grabbed at. On one rare occasion, this guy at the market would not stop harassing me/touching me in inappropriate ways so I elbowed him hard in the face—he then left me alone. I don’t condone violence; however, this was warranted. The harassment is not a question of safety, it is just irritating and something that I have yet to get used to.

Theft is forbidden here and will generate such chaos that people are sometimes beaten to death. I was told if something is stolen from you and not of paramount value, don’t say anything. Yesterday on our way home from the fabric store, my roommate and I encountered a riot that had broken out across the street from our apartment. Crowds of people were screaming and yelling at something. There was such a commotion we immediately entered the building and went up to the balcony to observe. This one man had stolen a woman’s cell phone and taken refuge in the store people were now aggressively cornering. Men were gathering huge boulders and running into the crowd. Then, a jeep filled with men no older than me pulled up. These guys were armed with huge machine guns strapped to their chests. I saw them pump their AK 47s as they unloaded off the vehicle and was terrified. The man immediately emerged from the crowd and was taken abruptly in their jeep and they sped away. Definitely one of the more entertaining spectacles I have seen so far. I don’t know if this was some type of neighborhood watch team, but they seemed to be greatly appreciated by everyone. I am hesitant to say they were police as they were not wearing any type of uniform and were quite young.

The Yogurt Mammas

We conducted our first meeting with the Yogurt Mammas this past Monday and it went extremely well. The focus of the meeting was to teach the Mammas how to package and seal the yogurt containers with the new supplies and sealer machine recently purchased in Nairobi, Kenya. This meeting was viewed as a milestone in terms of progression for this venture. For the past several years the Mammas in conjunction with various interns have struggled to find proper packaging for yogurt distribution. The lack of packaging has held the women back from selling the yogurt in locations outside of the main production facility in Mabatini. The meeting ended with two of the Mammas successfully packaging two containers in their first attempt –leading to an eruption of clapping and cheering from everyone in the kitchen.

We returned on Tuesday to perform some further research –narrowing in on personal testimonials from the women about the project. I am mesmerized by these women and how far they have come with this project. I am now beginning to understand how these types of projects simultaneously help people abroad and inspire and educate those contributing their efforts. There is no individual beneficiary in these types of situations.

Two of the Mammas, when asked to recall their favorite moments with the development of the kitchen, spoke about the interns from Western. They exclaimed how excited they were when students arrived and how appreciative they were of the change Western Heads East brings them. The women strive to join the “yogurt production industry” and soon generate enough revenues to employ further women in efforts to empower even more Mammas.

This illuminated that the women have minimal entitlement issues and want to help out their local communities as much as possible. The mammas’ eagerness to grow and begin mass-producing the probiotic yogurt was interesting. Expansion is not simply an objective listed on paper for this venture, but a personal goal held by the Tukwumuane Women’s Group as well.

Growing the Venture

There are various components that come into play when assessing the readiness of this operation in terms of expansion. We have explored the idea of expanding via social franchising but this option has its limiting factors. After much research, it is evident social products/services must have a strong brand and competitive presence in the marketplace before they can be replicated. Before we can consider an expansion, it is important to gauge how successful the current business model has been so that we don’t expand Fiti Yogurt too soon. We also must locate other womens’ groups that will be able to commit to a supportive franchisor/franchisee relationship. Another important requisite is that this group has some type of business experience or knowledge, or would be willing to undergo training.

Right now, one of the things I am concerned with is the pairing of such an aggressive social objective with employees that have limited business expertise. Past records have revealed that after interns depart, the women cease to continue with whatever change was recently implemented. For a project that aims for sustainability as one of its primary goals, this speaks to me as an alarming factor embedded in the current operations. Their lack of business knowledge is a disadvantage and makes it difficult for the women to properly evaluate the different business ideas presented by others like myself. Even some introductory business classes would allow for them to better lead this venture into becoming a more commercially viable social business. Franchising is a good strategy for replicating social businesses; however, it is a questionable route for an operation that is somewhat in the start up phase and trying to grow.

My first week in Africa!

Arrival in Mwanza

It feels surreal to have finally arrived in Mwanza and contribute to something so profound. It seems like just yesterday I received the news that I had been awarded this opportunity to join Western Heads East – the University of Western Ontario’s response to the HIV/AIDS epidemic in Africa. Today is Saturday June 5th and I am ecstatic to have finally accessed the Internet to recount some of my initial experiences after joining the team!

After three days of lengthy red eye flights and uncomfortable airport waiting times, the other interns and I finally arrived in Mwanza, Tanzania –more notably known as “The Rock City” on account of its several natural standing rock structures covering the town’s scenic coastline. We were fortunate to have been kindly greeted by one of the other interns Marta – who has been here for two weeks already. She was able to impressively barter with the taxi drivers in Swahili, a feat I can only hope to accomplish during my three-month stay. It has been a couple of days now and we have settled into our rooms at the ST. Augustine University of Tanzania – our residence until we are able to move into the intern apartment situated downtown Mwanza.

Transportation

During our stay, the faculty members here have been truly helpful in answering any of our questions and showing us around, facilitating our transition into a new, unfamiliar environment. One of the more significant culture shocks I’ve encountered here is the conduct of everyone on the roads. The cars drive without any restrictions, on either side of the road at ridiculous speeds while dodging the hundreds of pedestrians, bicyclists, and animals. Our primary mode of transportation has been the “Dala Dalas” –large van-like vehicles that are always brimming with people—sometimes goats, chickens and bad smelling fish. They charge a flat rate and behave somewhat like buses, in the way that each one has a uniform route, except instead of numbers they have identifying names such as “Cheese Eater”.

Munchin’ in Africa

Before I came on this trip I had some preconceived notions of what the food was going to be like, but I was proven wrong. The food is quite good. One afternoon we had the opportunity to visit the market downtown – which stands as my most chaotic and unparalleled experience to date. We bought pineapples, papayas, avocados and bananas for lunch after bartering in Swahili with the local vendors. I haven’t hesitated to indulge into all kinds of food here, which might be sketchy, but I figure if I am guaranteed to get sick from one of the hundreds of dangerous things during my long stay of 3 months there is no point in trying to be cautious with things I can’t avoid.

Knowing Kiswahili

Knowing the native language of this country is more important than I thought it would be. Very few people are able to speak English, so learning the greetings and some basic phrases helps a lot. I am making an effort to learn the appropriate greetings so I can make an effort with the locals. They are very appreciative of foreigners’ attempts to speak Swahili and remain patient in waiting to hear what it is you are trying to say, mindful that it might not always be correct.

People’s attire in this country is something I am fascinated with. The older men and women dress in conservative and traditional apparel, regardless of the scorching temperatures. Men are most often clad in dress pants and shirts and the women are always covered in long, lively colored dresses. It is considered indecent exposure to wear anything that is above the knee or exposing your shoulders. A few of us bought some beautifully patterned fabrics at a store in town today to have tailored into dresses with the intention of assimilating their style into ours. It is somewhat uncomfortable how much a foreigner stands out here. People relentlessly stare, yelling “Mzungu” –this means foreign person in Swahili. The term does not hold any negative connotation; it is just so uncommon to see a foreigner here that the majority of locals yell it with eagerness to express their excitement about your presence. Most people rush to utter any word or phrase they know in English to try and have a conversation with you.

Another aspect I found interesting about Tanzania is how every single person has a cell phone. I guess because it is too expensive to invest in the infrastructure needed to support landlines, this is their alternative for communication.

On Wednesday, we visited the kitchen for the first time and went to make chapattis with the Mammas at the other location they have set up near the primary and secondary school in Mambatini – a rural area located on the outskirts of Mwanza.

I am curious to see which of the two operations is exhausting the majority of the funds given to the womens’ group. After spending a couple of weeks in the kitchen I hope to become better informed of these operative factors so I can learn more about the key benefits of micro-finance in enabling the scalability of women-led community-based enterprises.

After spending some time documenting the financial operations of the venture, I plan to locate and document micro-finance programs available in rural Tanzania that would be suitable for the Mwanza-based project. It will be interesting to look into what micro finance models are available and effective in rural Africa that focus on women led community based enterprises already.

Side Work- stuff I’m doing in Mwanza

On a side note from the project, I started volunteering at a baby orphanage on Thursday during my spare time. The project stems from a British organization that initiated funding for children under the age of five without parents in Tanzania and a few other locations in Africa. When we got there we met a few of the other volunteers that stay in a residence on the property and they introduced us to the children. These children have been brought to the center because their mothers do not have the funds to support them or have died during birth. The home consists of a playground and a nursery indoors, followed by one room crowded with cribs. The kids were amazing. I am already looking forward to going back next week.

My Research with Western Heads East

I want to take the time to describe the organization I am interning with, their mission statement and my responsibilities to Western Heads East because I don’t think my family or friends understand what I am doing here in Africa.

Western Heads East is an innovative initiative that responds to a key global issue – combating HIV/ AIDS. The program engages students in applying research to real problems for direct humanitarian benefit. In 2002, the United Nations Special Envoy issued a challenge for Canadian Universities to take an active role in addressing the HIV/AIDS crisis in Africa. UWO responded by creating a community development project in Mwanza, Tanzania, a highly underserviced area of Subsaharan Africa with one of the highest HIV/AIDS infection rates in the world. The project involves students from a variety of faculties working to address the nutritional and economic needs of those directly affected by the pandemic.

The cornerstone of the Western Heads East initiative is a nutrition program based on probiotics. Probiotics are “good bacteria” that deliver health benefits to their host. They have been shown to

1. Alleviate a risk factor for HIV infection in women

2. Lower mortality and morbidity from diarrhea in patients with AIDS

Since 2004, Western has been sending interns like moi to work with women’s groups to teach probiotic yogurt production, support local project development, and seek subsidies to provide yogurt free of charge to people living with HIV/AIDS. The original project is situated out of Mwanza, Tanzania, where interns have been working with a women’s group who are now licensed as an NGO called Tukwamuane. They have become an important segment of the Mwanza community and aim to become the Regional Headquarters for East Africa to provide training to women in other communities within Tanzania and in neighboring countries.

Another main objective behind this grassroots project is the empowerment of women – in this case I am referring to the “yogurt mamas”. The yogurt mamas have grown to contribute to the health of their communities, draw an income for their families, stimulate significant economic development and to become a hub of social support within their communities. The yogurt mamas from the Tukwamuane Women’s Group consist of 10 females who work together at the community kitchen in Mabatini, just outside of the Mwanza city centre.

Plans for the Future

Right now we are assessing the possibilities of project expansion within the Mwanza area through an increase in production and distribution at the current site in Mabatini and through the development of a larger production facility. An increase in production and distribution will assist in maintaining the distribution of the probiotic yogurt to people living with HIV/AIDS and will generate enough profit to sustain the project on its own without external assistance.

Why Yogurt?

Yogurt was chosen as the means for delivering the probiotic bacterium for the WHE project because Africa has a long history of fermented foods. It is also quite easily digestible and nutritionally dense as it is a good source of protein, fat, carbohydrates, and calcium.

My Job

So on to my part… I am responsible for outlining a micro-finance model for the replication of the community-based enterprise in other rural communities in Tanzania. I will also be working with local institutions to assist in the design and the implementation of a micro-finance model to enable the development of additional kitchens for the production of probiotic yogurt.

In the biggg picturee, I will be documenting the requirements and benefits of micro-finance for scaling up the Mwanza-based kitchen as a social franchise. I’m going to be focusing on the processes and accounting practices for managing the credit by individual members of the kitchen and by the new kitchens.

One of the more challenging aspects I am anticipating, is the resistance of the women to want to change anything. They seem to really enjoy the way things are and are not keen on expending their time training other women. Thus far, I am understanding this to be somewhat of an entitlement issue…they are proud of the business they have created and don’t want other women’s’ groups to copy them.

Future Notes- things to consider

- What are the funding relationships in place, what would be a model that would be practical for micro financing * keeping in mind that we’re shooting for intervention

- How do you sell this business model to a micro financing organization so that you could ensure if another group wanted to start a kitchen, what would be the terms, the spelling of the terms they could fund that organization.

- How compelling is this business model to a funder, what are its breakeven points, what would be a sequence that would make this model fundable for a new kitchen elsewhere. Not direct intervention to the project; translate the objectives in the project to be understood by micro financers.

- Someone reads it and understands what the business is doing, written it in a market plan, market assessment, distribution, and business plan for the firm --sequence of the franchise, location of the franchise, etc.