Lusugga Kironde, professeur spécialisé sur la gestion du foncier à l’Université Ardhi à Dar es Salaam, Tanzanie, présente, dans cette contribution, ses observations sur les différentes réponses locales aux enjeux sanitaires de la pandémie de la COVID-19. Le gouvernement tanzanien a de nombreuses fois été pointé du doigt pour son relatif silence concernant l’impact de la COVID-19 dans le pays, la dernière publication officielle de taux d’infection datant du 29 avril. Le récit de Lusugga Kironde se base ainsi sur une revue de la presse nationale, sur des conversations informelles avec des proches et sur le suivi de l’information diffusée sur les réseaux sociaux. Son témoignage reflète, dans un contexte de crise mondiale, les discours sur le rôle de la médecine dite traditionnelle, plébiscitée aussi bien par l’institut de recherche publique Institut Médical de Recherche Médical (NIMR) que par le Président tanzanien lui-même.


ADDRESSING THE COVID-19 EPIDEMIC: THE ROLE OF TRADITIONAL MEDICAL PRACTICES IN TANZANIA

When COVID-19 started to spread in Africa, there was every belief that it will not reach Tanzania, but reach it did, and the first case, in March 16, 2020, was reported to have come via a passenger traveling from abroad and entering the country through Kilimanjaro Airport in Arusha, in the north of the country.

The government’s reaction to this, starting on 17 March, was to use all possible means to mount a campaign, that required people to avoid hand-shaking and embracing, to wash their hands regularly with clean running water or with sanitizers, to keep distance from anybody who had signs of a cold or was coughing, to avoid crowding and to report any case of suspected infection with the virus. Gatherings at weddings and funerals were proscribed. Public buses were required to adhere to level sitting (i.e. nobody should be standing, as was practice). Mosques, churches, and temples were allowed to continue functioning but were required to respect prescribed cautionary measures. Schools, colleges and universities however were closed from March 18 onwards. Those coming in the country and suspected of carrying the virus were quarantined for 14 days. Isolation buildings were set-up throughout the country.

On top of these measures, the Government asked people not to panic and also put their faith in God. At least in large urban centers, there was some kind of panic though, as those who were able, stocked face masks, sanitizers and hand gloves as well as drugs like aspirin and supplements for vitamin C and Zinc, sending prices of these items skyrocketing and leading to a shortage.

Picture 1 : Hand Washing facilities in Dar es Salaam (©L. Kironde, 2020)

By and large, precautionary measures were adhered to and hand washing facilities could be seen in most places with public gatherings including churches, mosques, commercial and government buildings, markets and bus stands (Picture 1). Strict lockdown measures enforced in some of the neighboring countries, such as Kenya, Rwanda and Uganda, were not undertaken in Tanzania. But there was considerable economic downturn in sectors related to tourism, air transport and the hospitality industry, with serious spillover effects.

In the early days, people suspected to have been infected together with their families or workmates were isolated, and those who died were quickly buried by public authorities with minimal attendance of the general public including relatives.

Local responses to a global crisis

Face masks were a must under some circumstances and in public areas. Access was denied to some areas for people not wearing face mask. They were not cheap though, since the recommended ones (N-95) were costing around 15,000 Tanzanian shilling (US$7). Surgical masks were cheap but of a single use and most unsuited to the needs and pockets of the ordinary public. People were desperate, some using handkerchiefs as face masks. The government’s response was to allow entrepreneurs, including ordinary tailors, to produce face masks using suitable but readily available materials including kitenge, which is a common fabric used to tailor clothes and other textiles (picture 2). According to the Minister for Industries, twelve industries and institutions are currently manufacturing hand sanitizers, face masks and other medical protective equipment, and 55 small industries are producing face masks out of cloth, especially the local Kitenge [1]

However, since there is no cure or vaccine yet to treat COVID-19, the Tanzanian president encouraged people to turn to traditional remedies. This has proved to be successful and there are many testimonies of people who were in bad condition, recovering from COVID-19 symptoms after using traditional medication.[2] The President told the nation that his own daughter had been infected with Covid-19, but recovered on the basis of herbal treatment. Much as those who reported recovering may not have been tested beforehand, they had all know symptoms of COVID-19.

Elements of Herbal Treatment

Herbal treatment comes in two versions:One, is self-steaming. This involves covering yourself with a heavy blanket or cloth to inhale steam coming from a pot of hot water mixed with a number of herbs particularly kashwagara, mango, guava or eucalyptus tree leaves, aloevera, and mchaichai (lemon grass). The National Institute for Medical Research (NIMR), however, warned against using too many herbs and recommended only three. Steam inhaling should be for around ten minutes a session, taken three times a week for prevention and many times a day for a cure. As a result, the kashwagara (lemon basil), better known as a medicinal plant in the Kagera region is now a household name throughout the country ever since it was mentioned in parliament by Professor Anna Tibaijuka, member of parliament for Muleba South. Also people are talking of kupiganyungu meaning, metaphorically, to undertake steam therapy. It is believed that this measure has protected many people from getting or succumbing to the symptoms of COVID-19. Many testimonies have been given in the media of how kupiga nyungu has helped.

Picture 2: Aged Kashwagara caught recently in some unbuilt land in Dar es Salaam (©L. Kironde, 2020)
Picture 3 : A bouquet of herbs collected and ready for boiling for steam inhaling therapy (©L. Kironde, 2020)
Picture 4 : Kashwagara leaves harvested for sale. The price of Tshs 10,000 is a wee to high (©L. Kironde, 2020)

The other form of traditional medication taunted is to take, daily or several times a day (depending on the circumstances), a hot drink made of a mixture of lemon, ginger, garlic, onion, turmeric, and hot pepper. Again, it is said that this mixture has helped a lot to treat people of symptoms of COVID-19 (Appendix)[3].

Besides the above two traditional medication approaches, there has been advice that people with severe symptoms of COVID-19 should also take Acetylsalicylic Acid B.P. especially at night since it is a blood thinner than can help in the case of blood clots. As a result, the product Junior Asprin has disappeared from pharmacies. Also vitamin C and Zinc supplements became rare in the various pharmacies as people sought to boost their immunity.

Poor households have complained of the rising price of lemon and ginger, as well as of the problem of affording the firewood to heat water and its ingredients. Government institutions have also rooted for traditional medication, some like NIMR, coming up with ready-made mixtures. NIMR moreover has made its formula public and this has helped households to make the mixture at home (picture 7).

Picture 5 : A herb-based NIMR CAF mixture used to treat come complication related to COVID-19.

Public policy is now no longer to detain suspects of COVID-19, (except those in very serious conditions), but to let them be cared for from home where the above traditional remedies could come in handy. The President has ordered a higher budget for research in traditional medicine to address many ailments afflicting the population including COVID-19[4]. All isolation wards or buildings have been returned to normal hospital use.[5]

Public policy has also been to tone down the fear of COVID-19, since there is a likelihood that it is going to be with us for a long time. Instead, people are being encouraged to work hard, but take necessary precautions. Universities were reopened on June 1, 2020 and schools are set to open on June 29, 2020. There has been relaxation allowing gatherings for sports, funerals and weddings.

Furthermore, there is a general feeling among the public, led by the President, that the war on COVID-19 is being won, and that with the traditional medication described above, there is something one can do to prevent or treat cases of COVID-19. With that kind of confidence, people are now going about their business as usual, and should anyone fall sick, frantic efforts are made to treat them using herbs and steam therapy.

Lessons learnt from the Tanzanian Case

In conclusion, there are at least three points of interest which the addressing of COVID-19 needs to take into consideration.

One is the need to decrease the fear among the population, since this can prevent them from undertaking their daily activities, some of which are essential for their survival. People have to live with COVID-19, but take necessary precautions to protect themselves and others.

The second point is encouraging local content in addressing COVID-19. Tanzania has encouraged the local manufacture of face masks, sanitizers, and hand wash facilities. This has helped by not only making them cheap but also having them in abundance and therefore, reachable for the majority of the majority of the population. The move has also helped some economic sectors working.

The third point is the role of traditional medicine and practices. This has not received notable recognition from the international discourse on COVID-19[6], but it is clear that it is playing a crucial role in strengthening preventive and curative preparedness of the population. There is urgent need to study and have a stand as far as traditional medicine is concerned.

This last point may need to be a national development agenda. Traditional medicine has to be elevated to play a positive role in preventive and curative undertakings since this can reach the majority of the population. Unfortunately, as we develop, we destroy forests and water sources, both important repositories of herbs and plants that are key in traditional medicine. We need to see to it that serious steps are taken to conserve forests and environmentally sensitive land for, among others, their importance as source of useful medicines.

In many urban areas there is a dearth of “greenery”, as public open spaces, botanical gardens or river valleys get converted to the concrete of construction (picture 8). We can easily talk of access for low income populations, to herbal remedies but these may not be readily available as land is continually being cleared of useful plants. A post-COVID-19 urban world should see deliberate steps taken to increase public open spaces, to create or conserve urban forests and botanical gardens, and to preserve hazard land. Some of these plants with medicinal properties should be planted as a matter of policy, in public and private spaces to increase their availability and usage.

APPENDIX

Presenting three cases that illustrate the usefulness of traditional medicines in combating COVID-19

  • In the first case a lady, hawking bed sheets for a living, caught a serious cough and started to have breathing problems. She rushed to the hospital. The medical staff immediately concluded that this was a COVID-19 case but, as they were preparing to take her to a detention center, she ran away and locked herself in her room so that housemates do not get a clue that she was a COVID-19 suspect, otherwise the whole house would be under quarantine and inmates could be taken to a detention center. At night she would walk out, collect herbs from a nearby wild area and embarked on a serious self-steaming and drinking hot water mixed with lemon, ginger and garlic (we will call it “The Mixture”). She did this for about a week, ran out of money, appealed to kith and kin for assistance through her mobile and luckily, some sent her some money. During the second week, she started feeling better and was able to resume her hawking, though with difficulty. She has now fully recovered (Victim, HM, Interviewed by me in Dar es Salaam, mid-May 2020).
  • The second case was of a family of five. The father, mother and one child caught signs of COVID-19, suffering serious head and skin ache. The wife went to hospital, but was advised to stay home and nurse herself. The trio embarked on a full course of steam inhaling therapy, and drinking “the mixture”. They got better after some 10 days (Story related to me by the father, Mr TMN, in Dar es Salaam, towards end of May 2020).
  • The third case involved a retired lady, who for two weeks was suffering from all kinds of weaknesses, and ailments and could not eat anything. She visited three hospitals and nothing could be identified to be wrong with her, except her “usual” high blood pressure and high blood sugar. She was then advised to go on the traditional therapy. After the first week, she started heavy coughing and getting heavy things from her throat. Intensified engagement in the therapy saw her recover at the end of the second week. She recorded an audio to tell everybody what happened to her and what people should do, heaping praise on the traditional therapy and how it brought her from hell (Her story was posted on a WhatsApp Group based in Dar es Salaam, Mid-May 2020).

[1] « Coronavirus battle intensifies », The Exchange Africa, 28 May 2020. https://theexchange.africa/countries/coronavirus-battle-intensifies-in-tanzania/

[2] « Magufuli Touts Herbal Remedies », Daily News, 12 June 2020. https://dailynews.co.tz/news/2020-06-125ee31942212a3

[3] « Medics probe role of herbs in decline of Covid-19 Cases », IPP Media, 28 May 2020. https://www.ippmedia.com/en/news/medics-probe-role-herbs-decline-covid-19-cases

[4] See Note 2 above

[5] « Hospitals heave sigh of relief », Market Watch, 4 June 2020. https://www.marketwatch.com/press-release/hospitals-heave-sigh-of-relief-2020-06-04?mod=mw_more_headlines&tesla=y

[6] Indeed, some quarters have regarded recourse to traditional remedies as “bogus” as can be gauged from this video titled: « Some Tanzanians Resort to Bogus Steam Treatment for Coronavirus », Voa News, 8 June 2020. https://www.voanews.com/covid-19-pandemic/some-tanzanians-resort-bogus-steam-treatment-coronavirus