In 2008 in Morogoro region, Tanzania, mass drug administration
(MDA) to school-aged children to treat two neglected tropical diseases (NTDs)
– urinary schistosomiasis and soil-transmitted helminths – was suspended by
the Ministry of Health and Social Welfare after riots broke out in schools
where drugs were being administered. This article discusses why this biomedical
intervention was so vehemently rejected, including an eyewitness account. As the
protest spread to the village where I was conducting fieldwork, villagers accused
me of bringing medicine into the village with which to ‘poison’ the children
and it was necessary for me to leave immediately under the protection of the
Tanzanian police. The article examines the considerable differences between biomedical
and local understandings of one of these diseases, urinary schistosomiasis.
Such a disjuncture was fuelled further by the apparent rapidity of rolling
out MDA and subsequent failures in communication between programme staff
and local people. Rumours of child fatalities as well as children’s fainting episodes
and illnesses following treatment brought about considerable conjecture
both locally and nationally that the drugs had been either faulty, counterfeit,
hitherto untested on humans or part of a covert sterilization campaign. The
compelling arguments by advocates of MDA for the treatment of NTDs rest
on the assumption that people suffering from these diseases will be willing to
swallow the medicine. However, as this article documents, this is not always the
case. For treatment of NTDs to be successful it is not enough for programmes
to focus on economic and biomedical aspects of treatment, rolling out ‘one size
fits all’ programmes in resource-poor settings. It is imperative to develop a biosocial
approach: to consider the local social, biological, historical, economic and
political contexts in which these programmes are taking place and in which the
intended recipients of treatment live their lives. If this is not done, the world’s
poor will continue to be neglected.