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Zanzibar relies on strong communities of care to confront COVID-19

Nafisa Jiddawi (left) of Wajamama Health Center stands in front of Mnazi Moja hospital with Deputy Minister of Health Harusi (right) in Stone Town, Zanzibar, after distributing masks and other personal, protective equipment (PPE) to health care workers, April 8, 2020. Photo by LULURAY PHOTOGRAPHY, used with permission.

Check out Global Voices’ coverage of the impact of COVID-19 on communities around the world.

COVID-19 has not spared Zanzibar, the semi-autonomous islands off the coast of Tanzania in East Africa. With its stunning beaches and historical cities, Zanzibar's two main islands, Pemba and Unguja, have attracted travelers from around the world for centuries.

Today, those streets and beaches are nearly empty as residents brace themselves for the coronavirus in this tightly-knit community of approximately 1.3 million people among the two islands.

On April 9, health minister Ummy Mwalimu announced the first cases of COVID-19 acquired through community transmission in Zanzibar. As of April 24, there are now 98 cases on the islands, according to an official government press release.

Zanzibar thrives on community and, in the spirit of umoja or “unity” in Swahili, a wave of community-based health initiatives has ramped up their presence on the islands to raise awareness and educate islanders about the highly contagious disease.

‘No-touch’ handwashing innovation

In mid-March, even before Zanzibar saw its first cases, many hotels on the islands who usually receive thousands of travelers from COVID-19 hotspots like Italy and Spain decided to shutter their doors and practice preventive measures like physical distancing and frequent hand washing, as recommended by the World Health Organization and the Centers for Disease Control.

On March 18, hoteliers along with the Zanzibar Tourism Local Development (ZTLD) group gathered on Zanzibar's East Coast to educate and inform community members about the virus and organized a plan to distribute hand sanitizer and water for home storage, in addition to educational posters.

Bwejuu-based hostel Mustapha's Place decided to keep their minds open even if their doors were closed. Mustapha's Place and ZTLD designed and built several “foot-operated, hands-free” handwashing stations and distributed them to strategic locations throughout the East Coast, an area comprised of small fishing villages.

Mustapha' s place is temporary closed, but our mind is open and creative! Desing and buiding "foot operated hands-free" hands washing stations. Together with our communities we fight the spread of corona virus, supporting each other, learning from one another. Big up #zanzibartourism&localdevelopment #staysafe #washstations #zanzibar #mustaphasplace #creativeminds #coronavirusinafrica #coronavirus

Geplaatst door Mustapha's Place op Woensdag 8 april 2020

Last week alone, ZTLD members delivered several “no-touch” hand washers to local mosques, police stations, health clinics, hospitals and several villages in the area.

Zanzibar Tourism Local Development group installs a “no-touch” handwashing system at Charawe health clinic, April 14, 2020, Charawe, Zanzibar. Photo by Shebbi Shabban, used with permission.

Fragile health systems, strong community

Wajamama Health Center, based in Stone Town, Zanzibar, praised ZTLD's “no-touch” handwashing innovation, “minimizing the need for turning the faucet on and off or even touching the soap dispenser … We are amazed by the ingenuity of each system and are grateful to see these efforts taking place,” they wrote on their Facebook page. 

Wajamama, which stands for watoto, jamii, mama or “children, society, mama” was founded by Nafisa Jiddawi, who saw a need to create a safe space for women to get high-quality healthcare informed by health and wellness practices.

Early on, Jiddawi and her team became first responders in the fight against COVID-19 on the islands, mobilizing to inform and educate islanders about the coronavirus when Zanzibar was first reporting its imported COVID-19 cases in late March 2020. Jiddawi and her team had distributed 100 handwashing stations around Unguja around this time.

They also reached out to local leaders on the latest information regarding handwashing, face masks and social distancing and encouraged citizens to keep calm and only share science-based information.

Tanzania's President John Magufuli was criticized for encouraging citizens to continue to congregate in places of worship despite strong scientific advice against gatherings. Magufuli closed schools and universities for 30 days but showed reluctance to impose an official lockdown, even after its first case on March 16. As of April 23, 284 people on mainland Tanzania have tested positive for the coronavirus, according to the BBC.

On April 10, Wajamama warned on Facebook: “This is NOT the time for conspiracy theories or get-togethers.” The following week, they wrote: “In our already fragile healthcare system and economy, limiting COVID-19 transmission in our community is our ONLY hope.”

A few days prior, Wajamama donated ample supplies of Personal Protective Equipment (PPE) for Zanzibar’s health care workers to the Ministry of Health, with support from the local Rotary Club of Stonetown and US funders.

They continue to work with local designers and community members to distribute reusable face masks to the community, including Recycle At Ozti, Kumi ZanzibarJenga Zanzibar, Zanzibar Apparels & Doreen Mashika, who joined the #mask4all movement.

Within ten days, Wajamama has been able to raise nearly $8,500 United States dollars toward its $10,000 goal to support COVID-19 response efforts.

Mental health and COVID-19

Most people in Zanzibar live below the international poverty line and subsist on less than a dollar a day, said Pamela Allard, a program advisor with Health Improvement Project Zanzibar (HIPZ).

COVID-19 has added a layer of stress to local communities in Zanzibar, compounding existing stress from chronic poverty, poor health care infrastructure and dependency on a tourism industry that has come to a grinding halt.

For over a decade, HIPZ has worked in sync with Zanzibar's Ministry of Health to support Makunduchi and Kivunge hospitals in rural parts of Zanzibar, where health care is sorely insufficient. HIPZ also saw a critical need to amp up their mental health support to tackle COVID-19 and tapped into their mental health radio program to provide critical coronavirus-related health information to local communities.

This is one of the only community-based health initiatives on the islands that have recognized the mental health toll that this virus can take on societies.

HIPZ mental health coordinator Haji Fatawi took on the role of radio personality and on April 23, he made a visit to the outlying island of Tumabatu to host radio health talks designed to sensitize communities to all aspects of the virus and its impact on everyday life.

Haji Fatawi, leader of the mental health team with Heath Improvement Project, Zanzibar, takes on the role of mental health radio personality with specific outreach related to COVID-19. Photo used with permission by HIPZ.

As COVID-19 cases began to appear on the islands on March 21, HIPZ immediately began to support training workshops at local hospitals to demystify the virus and dispel fears among health care workers, according to Allard in an email to Global Voices.

Many staff believed many patients may be carriers of COVID-19, and therefore the health care could be improved due to a lot of fear-based assumptions within the local staff.

Allard continued that HIPZ has had to reassess their programs with a laser focus on keeping frontline health care workers safe and supported:

With an already fragile health system, we have had to reassess everything and try to prepare for COVID-19, focusing on keeping our staff as safe as possible to perform the critical work that will most likely be required of them. We have refocused many aspects of our budget to support the staff, with PPE and soap, and equipment and innovative systems of patient flow at this time. We have been fundraising like mad, and are preparing for the potential weeks to come, knowing that the curve in Zanzibar may not  be as flattened as it is in other countries due to the living conditions and socio-economic challenges that face most of the Zanzibaris.

As politician Seif Sharif wrote in African Arguments, the month of April has proved to be a decisive time for Zanzibar and Tanzania when it comes to COVID-19.

Neither government has issued an official stay-at-home order or announced any major debt relief or stimulus programs. Yet, Zanzibar's Ministry of Health has been working around the clock — alongside these local, community-based initiatives — to keep Zanzibaris safe and informed.

In Zanzibar, where the majority honor the holy month of Ramadan that began on April 24, this next month will also be defined by this spirit of solidarity to keep people connected through communities of care.

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