A five-year-old boy, his hunchback spine testifying to his battle with tuberculosis, picks up his aluminum walking frame and determinedly weaves between the hospital beds just to show that he can. A 39-year-old woman whose arms and legs contracted into a fetal position a year ago, takes a few steps from her own metal bed to show that she has regained her health. The face of Marian Hassan Duale, a 60-year-old woman who was brought to hospital in a coma, lights up as she described the “miracle” of her own recovery.

Their ‘savior’ is a 60-year-old Italian doctor named Annalena Tonelli, who has braved beatings, kidnapping, banditry and death threats to wage a 33-year-long, one-woman battle against tuberculosis, AIDS, illiteracy, blindness, malnutrition and female genital mutilation in the middle of nowhere in the Horn of Africa.

In recognition of her lifelong and lonely crusade, Dr. Tonelli was recently awarded the 2003 Nansen Refugee Award, a prize created in 1954 to honor individuals or organizations that have distinguished themselves in work on behalf of refugees. The Award was named after Fridtj of Nansen, Norwegian polar explorer and the world’s first High Commissioner for refugees and includes $100,000 to be donated to a refugee project of the recipient’s choice.

Dr. Tonelli, Annalena to her patients and a new Mother Teresa to some visitors, works alone, personally raising the $20,000 cash needed every month to fund medical projects and pay a staff of 75 at her hospital. She broke her vow to ‘stay hidden’ and avoid publicity to accept the Nansen Award in the hope it would refocus the international spotlight on the chronic problems of Somalia, long since overshadowed by other world hotspots.

GRUELING DAYS

A slim woman with grey hair pulled into a bun and covered modestly with a shawl in the manner of the local women, Dr. Tonelli has trained herself to sleep only four hours a night. She begins her workday at 7 a.m. consulting with her foreign-trained Somali physicians. As she then makes her daily rounds, Dr. Tonelli chats with her patients in fluent Somali. Children call her ‘grandmother’ and snuggle close as she explains that these now thriving toddlers were brought in as severely malnourished babies, weighing—at six months old—less than a newborn should. She ends her rigorous routine in the early hours of the next day, writing letters of thanks to private benefactors.

Almost seven years ago she made her home in Borama, an arid town where a fierce wind funnels desert sand into tornado-like formations, a place with far more goats and camels than cars. Her hospital treats some 200 inpatients and another 200 outpatients. Eight of the wards were built for her by UNHCR, including the only two-storey building in town, still under construction.
She spurns the comfortable life and repeatedly emphasizes her lifelong passion to a visitor. “ I am desperately in love with TB patients,” she says at one point. Later, she adds, “I want to be poor up to the last day of my life.”

She lives simply, eating the same food—meat only twice a week, more often maize meal or rice and beans—that she feeds her patients. Her home has a television so that deaf children can watch videos in sign language, but she never watches it herself. She learned about the war in Iraq only from the Somali doctors on her staff. The doctor owns just two modest caftans. Her sandals were given to her by a patient, and her headscarf was a gift from her staff. She feels her poverty is essential to breaking down walls between herself and the people she serves. “I would never be able to render service if I had clothes and furniture and all the things which are normal for our society,” she says.

INEVITABLE CLASH

But don’t talk to her about sacrifice—it’s a word that makes her laugh. A devout Roman Catholic, she says: “The word ‘sacrifice’ has no meaning in my life. I don’t hide it has been a very hard life in many senses, but it has been a life of joy, a life of happiness, gratification, a privilege.”

It’s the life she wanted from the age of five: “My longing, my yearning, my pining from the time I was so small was to serve people who are suffering.”

She has found plenty of them in her long years in Africa. Fresh out of law school at 26, she moved to northeastern Kenya to teach Somali nomads and it was there in 1970 that she became aware of the plight of people stricken with tuberculosis. She was touched not only by their physical suffering, but also by the emotional pain they underwent at being outcasts because of their disease, one that flourishes in conditions of poverty, overcrowding and malnutrition.

In addition to her law degree, she went on to earn diplomas in tropical medicine, community medicine, and control of tuberculosis and leprosy though she is not a fully qualified physician.

In the 1970s, a new drug reduced TB treatment to six months, rather than 12 to 18, which had been standard before. Dr. Tonelli pioneered the “short-course” TB treatment in Africa, an approach that since has been adopted as a model by the World Health Organization (WHO). What makes her treatment so effective—she claims a cure rate of 96 percent—is that she forces many of the Somali nomads to live in her compound until they are truly cured. Outpatients are tracked diligently.

Since 1986, she has made her home in Somalia, first in the capital, Mogadishu, where she supplied food to thousands of starving residents, and later Merca, in southern Somalia, again treating tuberculosis patients. After being repeatedly beaten up, and kidnapped once, she fled; the woman doctor she trained to replace her was killed a year later. She then responded to a request by WHO to continue her fight against tuberculosis, this time in relatively peaceful Somaliland.

She expanded her activities, helping to treat and prevent HIV/AIDS, an opportunistic disease which preys on weakened TB sufferers. She set up a school for deaf and disabled children, and sponsors twice a year visit of surgeons from a German charity who have restored the vision to 3,700 people suffering from cataracts. She is also passionate about the fight against female genital mutilation and says she has persuaded nearly all the traditional circumcision practitioners in Borama to give up the practice and join her campaign.

Even at 60, Dr. Tonelli shows no signs of slowing down. If she’s ever forced to leave Somalia, “I will help people who suffer somewhere else,” she says quietly. “The world is full of people who suffer.”

Mohamed Ali Mousa

Ottawa, Canada
 

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