Normally, the temperate climate in northern Tanzania is very pleasant. Today, however, dense, cold fog is drifting through the city of Arusha. Arusha is considered to be highly developed and is a popular destination for tourists. But we are visiting the Unga Limited district - a slum. The district is named after a large industrial area and is home to the poorest of the poor. Simple shacks stand closely together, built from whatever the people could find. An open sewerage system carries waste water along the unpaved paths. Crime and violence are the order of the day. Nobody lives here by choice, but only because they can't afford to live elsewhere. People here eke out a living with odd jobs and petty crime. As a result, the rate of HIV infections is high, and consequently the rate of cancer and strokes. However, nobody in Unga Limited can afford to see a doctor or even go to hospital.
Comfort and spiritual encouragement
The volunteers of the Selian Hospice palliative care team, which is supported by DIFÄM, are out and about in these bleak surroundings. They look for patients who need palliative and spiritual support in the last stage of their lives and provide invaluable help for those affected. The team not only cares for people personally, but also offers them and their relatives so-called Day Care Days: In addition to a church service and a hot meal, there is space for dialogue. Healthcare workers provide the patients with the medication they need. Pastors and social workers listen to people with all their worries and offer comfort and spiritual encouragement as best they can. The patients are often dealing with unresolved family problems that arise in the course of their illnesses. And there is the sheer despair of terminally ill patients in the face of death.
An unexpected visit
Today is one of those Day Care Days in Unga Limited. The building in which the event takes place is very simple - a hut, like hundreds of others in this neighbourhood. Only a few people are there for the official start, but little by little the room fills up. When everyone seems to be there and the service is about to begin, there is a roar from outside. A man appears at the entrance. Two helpers support him to his right and left. He is obviously finding it very difficult to walk. A glance at his young face explains why. It is paralysed on one side, like his whole body.
Applause for the hardships
The young man's name is Roberto. Like so many people here, the 34-year-old is HIV-positive and has already contracted AIDS. As a result, he suffered a severe stroke. Painful spasms cramped his hands and feet into grotesque shapes. Completely helpless, he was waiting to die in his dark hut. That's how the Selian Hospice palliative care team found him - and offered help. They started HIV therapy and treated the painful spasms with medication. When Roberto felt the need, they prayed together. The team also summoned the family together and explained to them how Roberto could be helped with regular physiotherapy and occupational therapy exercises. And the family went along with it - which is not common in this culture. The family members trained with Roberto. At the same time, they gave him the feeling that he was not alone and that someone was looking after him.
They were obviously very successful: a few months after the palliative care team's first visit, Roberto is now standing in the doorway for the Day Care event. When the other participants see him and realise how much his condition has improved and how much effort he has made, there is spontaneous applause. Roberto is exhausted. The 300 metre walk here has been tough on him and the strain is clearly visible. But under the applause and encouragement of the parishioners, he literally blossoms and a half-smile flits across his face.
Inuka – rise up
Roberto's example shows what a big difference palliative and spiritual care can make for those affected. The daily exercises and training have mobilised him. But it is the spiritual encouragement of his family and the community that gives him the strength to get up. Despite his serious illness and despite his pain, he is able to enjoy his life. He can no longer speak and can only walk with a lot of support. But he can sit outside his hut - where life happens. He is part of the community again. Roberto will not live very long. His illness is too far advanced and treatment according to Western standards would not be possible for him anyway. But for his last weeks and months, he has regained some quality of life - and his dignity.
