The Front Line COVID-19 Critical Care Alliance (FLCCC) shared on their Twitter feed a firsthand perspective, written by Helen T, from Tanzania during the covid-19 era.
I have made 3 trips to Tanzania in the covid-19 era, on medical mission trips to care for children with heart disease: November 2020 (before President John Mugufuli died), March 2021 (during the week of national mourning right after President Mugufuli died), and July 2021. I can substantiate Helen T’s observations that their approach to covid-19 has been profoundly different than the rest of the world.
I shared my unexpected observations during my first trip in November 2020 in an e-mail to a friend who wrote back, "So interesting that you are there witnessing that firsthand in Tanzania. The coverage I hear about Tanzania here is that the government is hiding covid numbers and they are doing mass burials in the night.”
Reading more coverage that disagreed with my eyewitness account, I shared the update I had written for our nonprofit with a magazine editor I knew personally. His response:
“Thanks for your note regarding what you saw. We value your personal experience in the tertiary care hospital and what you learned from the president's medical advisor, but also information from a wide variety of sources.
O. reported facts last week—the country hasn't reported a case since last May, it is in non-compliance with the African CDC on its protocols, has been accused by neighboring countries of exporting the virus, and now is refusing vaccines. As she wrote in last week's World Tour, the Catholic Church is now openly denouncing the official policy, and the opposition is gaining support as it opposes it. M. read O.'s report prior to publication and checked it. We don't see that it is inaccurate.
I've pasted in below a summary from a new CSIS report on Tanzania.
summary: Tanzanian president John Magufuli is dragging the East African nation deeper into authoritarianism. His first term consisted of assaults on Tanzania’s political opposition, civil society, and media—as well as nationalist economic policies that stifled foreign direct investment. His second term, emboldened by his October 2020 reelection against a backdrop of voter suppression, portends a tightened grip on information, increased alienation of foreign businesses, and a deepened isolationist stance, especially as Magufuli casts doubt on the efficacy of the Covid-19 vaccine.”
We spent the week prior to our second trip to Tanzania in March 2021 serving in Kurdistan, Iraq. We learned there that Tanzanian President John Magufuli had died. We knew we would be arriving to a nation in mourning but decided to proceed with our trip. The observations I wrote from that week in Tanzania follow.
We arrived in Dar Es Salaam on Sunday morning and spent the day at a hotel in order to rest before our evening flight to Dodoma. Our departure from the hotel was delayed by the arrival of dignitaries for the president’s national memorial service the following day. The president had died in Dar Es Salaam. A Tanzanian newspaper article from when he was studying for his masters revealed he had hypertrophic cardiomyopathy. This is a condition that is not easily treated, despite even surgery, which he had had, and leaves its sufferers at risk of sudden cardiac death, especially if they suffer from a rapid heart rate, which it sounds like he did from being in atrial fibrillation. Unplanned by us, his body was to be transported to Dodoma simultaneous to the time that we were traveling there.
The road to the airport was lined with thousands of people waiting to see his funeral motorcade, which was not far behind us. As team members checked in our luggage, I stood with airport employees watching the motorcade’s coverage on TV. As we waited at our gate, we were watching more coverage of the motorcade’s arrival at the airport when my husband was the first to notice a breach of the airport grounds by at least hundreds of people. This was fascinating to watch over the next hour before they were peacefully dispersed by the military. Our flight was not much delayed considering and we arrived in Dodoma right after the flight carrying his body. A large military contingent was still at attention on the tarmac as we deplaned and we watched them march away before we could greet our hosts.
We quickly learned that the following day was a national holiday of morning. We stayed at a guest house, so had that whole day to interact with our hosts. They spent most of the day watching the many hours of coverage of the funeral and I sat with them for quite a bit of it, peppering them with questions.
Our hosts were all quite aware of the negative coverage of their president, but agreed that most Tanzanians loved and supported him. Their opinion of his greatest accomplishment was tax reform for the poorest in the country, as well as easing of restrictions on the opening of businesses. Their perspective was that the poor and middle classes loved him, while the rich and elite did not because they had lost power during his administration. They were divided on whether he had suppressed freedom of speech or the press or whether his recent election was fair. I felt like I could be in a living room in America having a similar conversation on politics. On our first trip, everyone I had talked to on a smaller host team and in the hospital supported him and his handling of covid-19, so I was glad to find some difference of opinion. The majority of the people in the room supported him, but I noticed they were much less outwardly enthusiastic than they had been in November when there was dissent in the room. Those against him spoke more and more loudly than those who supported him.
Interestingly, Dr. A., a cardiac surgeon, was the most vocal against him, literally claiming he hated him, though they were of the same political party, but absolutely supported his handling of covid-19. In short, Dr. Magufuli became suspicious of false-positive covid tests when their hospitals were not overwhelmed. He believed restrictions on the population would be more detrimental to their health than covid-19 so, after a time of national prayer in May 2020, he removed restrictions and stopped reporting covid cases. My observation in November 2020 was not that covid-19 was being ignored, as there were prominent public health signs and a successful hand sanitation campaign, but there were few masks and no social distancing. After some prominent covid deaths in the country, including amongst governmental officials, there were many more masks and temperature screenings this time than in November. When I asked whether the president had ever denied there was covid-19 in the country, they were unanimous in saying no. When I asked whether it was possible to be tested for covid-19 in the country, they said yes. (We were able to test this ourselves as we needed covid tests in order to fly from Tanzania to Istanbul.) When I asked the health professionals who actually work in different hospitals throughout the country, including in Dar Es Salaam and Zanzibar, whether their hospitals were ever overwhelmed or they had heard of mass burials at night, they said no.
I interviewed many physicians in both Kurdistan and Tanzania and found they are more aggressive in treating covid-19 than I’ve observed in the U.S. While there is good evidence for prophylaxis and early treatment, many are sent home after a positive test in the U.S. with only instructions to return if they get worse. As I’ve witnessed firsthand in the U.S., covid-19 is incredibly devastating and hard to treat in its late stage. They are quick to place patients on a treatment regimen in Kurdistan and Tanzania if they even suspect covid-19. Patients are treated empirically, assuming they have covid-19 if they present with respiratory symptoms, and physicians do not necessarily pursue a confirmatory test. We witnessed this with one of our patients this week as she presented with a severe respiratory illness and they placed her on a treatment regimen that covered both covid-19 and bacterial pneumonia. Our ministry friend who is so sick in Kurdistan delayed treatment because of distraction with ministry concerns and likely denial of vulnerability, but received an impressive and aggressive treatment regimen once care was started. My only regret is that care started late. That is my usual regret with poor covid-19 outcomes. As an aside for the curious, out of the nine of us who traveled in the last two weeks, six have either had covid-19 or the vaccine or both. The other three are on a prophylactic regimen.
At the end of President Magufuli’s funeral in Dodoma, his body was transported to Benjamin Mkapa Hospital, so we all walked and stood with the crowds as the motorcade went by. He was obviously loved by many. His body was taken to various locations across Tanzania throughout the week and he was finally buried in his birthplace on Friday, a national holiday. Coverage of all these events was constant on TV throughout the week.
When I noted many more people in masks in public buildings upon our return in July 2021, I was told by a regional health care director that it was not because public health conditions had changed but rather that pressure to comply in order to receive international funding had changed. Helen T offers a perspective that fills in some gaps.