The 40 year old man is lying in bed with stomach and muscles pains, fever, cough and headaches. Symptoms which can be attributed to various diseases. We ask the man a few questions about his lifestyle and medical history. What then catches our immediate attention is the man’s profession. He is a local fisherman and is fishing nearly daily in the lake Victoria, the biggest lake in Africa. To the doctor at the hospital the diagnosis is clear even before the stool sample would confirm it hours later: Schistosomiasis. 

Schistosomiasis, or also known as bilharzia, is a disease caused by parasitic worms and it’s one of the most important poverty-related neglected tropical diseases. More than 230 million people are infected worldwide, whereby the 30 million people living at the shores of lake Victoria are at special risk. 

People can get infected when their skin gets in contact with contaminated freshwater in which certain types of snails which carry the parasites are living. The parasites penetrate the skin of the people, for example fishermen, children playing in the water or women washing clothes. 

Symptoms of schistosomiasis are not caused by the worms themselves, but rather by the body’s reaction to the eggs. Undiagnosed and untreated, people develop a chronic form of Schistosomiasis, which can seriously and permanently damage the internal organs, including the digestive, urinary and nervous system as well as the heart and lungs. In children it can lead to reduced growth and problems with the cognitive development. 
Once diagnosed, the treatment is relatively easy with Praziquantel, a medication taken for 1-2 days. However the rate of reinfection is high, due to the importance of the lake for many people in this region. 

The male ward in the Shirati KMT hospital is divided into three cubicles with six to seven beds in each one. Patients from age twelve onwards with different diseases and conditions are lying here next to each other and are supervised by Dr. Chirangi, his Team of doctors and the ward nurses.

The next patient, who was involved in a motorcycle accident, broke his spine and is unable to move his extremities. Lacking a CT scan or MRI, the hospital in Shirati is unable to proceed with a more specific diagnosis nor can it evaluate on any treatment options. The only chance is the transferral to a hospital in Mwanza, five hours away by car. 

Road traffic accidents are widely common in Tanzania and the unpaved, bumpy roads around Shirati, night driving without lights and drunk driving are the prime factors of many accidents and the main reason for admission to the hospital.
Many villages and houses are only accessible by motorcycles, also called pikipiki, which make them the main means of travel in this area and carry passengers around as taxi service. Few drivers are wearing a helmet and some never acquired an official driving license. 

But also bike accidents do occur. One young man fell of his bike, as the breaks suddenly blocked. Besides multiple and large abrasions on his head and body, he additionally broke his elbow joint. The X-ray shows the difficult fracture and the doctors suggest a transferral to Bugando Hospital in Mwanza. However the patient decides to go with his injury to a traditional healer in his village, also called a bone-setter. The term alone, about someone without medical training resetting bones, honestly gives me the creeps.

Traditional healers are still widely common in rural Tanzania and their methods very controversial. In terms of fractures most people are often left with a lifelong disability or inability to move the treated side adequately. However deeply rooted cultural beliefs and lack of money to afford an operation consistently draws many patients to traditional practices.

These are just two examples of diseases and conditions often being present on the male ward. However there are so many more. Some rather harmless, others life-threatening. Every day there are newly admitted patients coming onto the ward. Many of them will be discharged a few days later with just a drug prescription in their hands and a smile on their face, all while someone in the other bed might be still fighting for his life.