The power outage in Zanzibar has persisted for three weeks now and, rumour has it, is set to continue for at least another month. It’s a huge problem for the islanders at their busiest tourist season. Everything has to be brought from the mainland, even water, because the bottling factory on the island has shut down from lack of power. The souvenir and craft shops are struggling because even the Italian tourists, who fling their dollars around with the same generous abandon that Berlusconi sprinkles his affections, are not going to spend a couple of hundred dollars on a carved sculpture that they can barely make out in the gloom.
Perhaps it is this desperation that makes the touts (appropriately called ‘papasi’ by the locals, meaning ‘ticks’) so very irritating. There are high levels of poverty and unemployment here, as elsewhere in Africa, but I still find it inexplicable that there are so many men seemingly with no better occupation than to hang around in the streets of Stone Town and the horrible port side hassling tourists. Naturally, there are no women among the groups of men who follow us around, annoying and sometimes abusing us – no, the women are working, looking after children, cooking, cleaning, doing the laundry, the shopping and everything else.
After one too many episodes of unpleasantness, we decide to leave the island and catch the ferry to Dar es Salaam, East Africa’s second busiest port, for a bit of peace and quiet. Here, it is cooler, there is a good strong sea breeze, power and fewer mosquitoes – although the bedbug problem is making up for it. Two of the people working here have malaria at the moment, so we’re still diligently taking our malaria tablets. There’s a research project in a district not far from us, looking at mosquito repellent use and effectiveness in local communities. The researcher heading the trial, from the London School of Hygiene and Tropical Medicine, says that the results of their 7 month controlled trial show a 75% reduction in malaria among those using DEET, compared with those using placebo. DEET is actually really cheap, if you buy it on its own, and simple effective lotions can be made just by mixing it with vaseline.
There’s still no malaria vaccine, so preventing bites is the only option for people who live in risky places. It’s a disease of poverty – in Europe it’s been pretty much wiped out. The Tanzanian government wants to start national spraying of DDT to get rid of the vector, but NGOs and other agencies are persuading it to wait for a less harmful agent. Trials are underway comparing DDT to agents from citronella to neem. Meanwhile, 2000 children die every day from malaria in Africa.
Aids is an even bigger problem than malaria in Dar, according to Tanzanian doctors I’ve talked to, who work at one of the hospitals here. Most patients in the ward are dying of Aids, even if their death is described as ‘from TB’. (I heard that trials are underway here for the first new tuberculosis vaccine since the BCG in 1920. Appropriate, I suppose, since Koch worked in the hospital in Zanzibar for some time.) One of the biggest problems here is preventing maternal transmission of HIV. The medics are having good success in preventing transmission during pregnancy and labour – all pregnant women are routinely screened and given drugs if necessary – but the problem is afterwards. Women are advised not to breastfeed because the virus can be transmitted through the breast milk, but they continue to do so because not breastfeeding immediately reveals their HIV status to everyone and the stigma is apparently a greater burden than the risk of infecting their child. Also, many of these women are too poor to feed their infants anything other than breastmilk.
The conditions doctors here have to work under sound horrific. There are shortages of everything, overpopulation is stretching resources in healthcare in combination with chronic underfunding. Women have an average of 7 children here – the hospital one of the doctors works at with her 12 colleagues sees 70 births a day on average. She says that she educates and advises women on birth control, but usually sees the same women returning within a year to give birth again. Clearly, national population control measures are not working. In South Africa, they launched a programme of condom distribution, but unfortunately, the instructions for use papers were stapled to the condoms. Oops.
Where we are staying, all the guests are Western tourists; the campsite is a favoured choice of the tour companies that do budget backpacker trips across Africa on a modified truck-cum-bus. It looks like quite a fun way to travel – certainly far easier than having to negotiate horrendous public transport and arrange your own route and accommodation, like we do – and everyone seems to get on well even though they’ve been cooped up on a truck together for 10 weeks. They are completely isolated from local people, though. They stay in campsites like this one, mix with other truck passengers and don’t even know where they have been – when I ask them, they say they’ve been to beaches and wildlife parks, bungee jumping and snorkelling, but they are hazy even about countries, having to check their passports for visas to be sure of the names. It’s a strange way to travel with activity sessions interspersed with tedious journey times during which, apparently, everyone sleeps because they have to be on the road at 5am every morning. I think it’s quite an expensive way of doing it – far better would be to go to Queensland for a couple of weeks, where you can do all the same things but with no long truck journeys in between, although, I guess there are no lions in Queensland…
We’re going to head south to Malawi for Christmas on the lake.