When the Money Fades: Remembering Upendo Leprosy Home and the Cost of Aid Cuts
Years ago, I spent a morning at Upendo Leprosy Home, a small rehabilitation center on the edge of Arusha, Tanzania. The air was warm and still. People moved quietly through their routines — some working, some resting, all part of a rhythm that felt both fragile and steady.
The word Upendo means “love.” And it fit.
Upendo was built for people once pushed out of their communities because of leprosy — a place where medicine met belonging, and where life began again, one small task at a time. It wasn’t grand, but it worked. People healed. They learned new skills. They laughed again. Now, years later, I find myself wondering what happens to places like Upendo when the money begins to fade.
A Shifting Tide
For decades, Tanzania’s fight against leprosy — and other diseases the world mostly forgot — depended on funding from USAID, PEPFAR, and other international donors. That money kept clinics open, stocked medicine, and paid health workers who traveled long dirt roads to find new cases before nerve damage and stigma set in.
But now, the flow is slowing. Across Africa, USAID’s cuts are already forcing hospitals and local programs to scale back care for HIV, tuberculosis, and leprosy. Tanzania’s National Tuberculosis and Leprosy Programme is trying to do more with less, stretching thin resources across a population that only grows.
For smaller centers like Upendo, every dollar matters. A few thousand less can mean closing a workshop. A nurse laid off. Outreach programs disappearing. The hum of work replaced by stillness.
When Silence Returns
One of the photos I took that day shows a ripped schedule pinned to a wall. One word is visible: “Silence.”
At the time, it seemed like a reminder of the calm expected in a clinic courtyard. But looking at it now, it feels heavier — like a warning. When aid runs low, the first thing that returns isn’t always disease. Sometimes, it’s silence.
Leprosy is curable, but the stigma isn’t. When the funding dries up, early detection slows. Medicine runs short. Outreach stops. And people slip quietly back into the margins — unseen and unheard.
That’s the danger when aid disappears: not just the loss of resources, but the return of invisibility.
Faces That Stay With You
Most of the photos from that day are of children — curious, open, always moving. They stepped into the frame without hesitation, laughing when they saw their faces appear on the camera screen. While their parents worked or rested nearby, the courtyard became theirs — a space filled with movement, noise, and ordinary joy.
One photograph I return to shows an older woman standing against a pale wall, her patterned kanga catching a bit of light. She had nodded when I asked to take her picture. Her hands, shaped by years of treatment, rest easily at her sides. She stands with quiet assurance — steady, present, whole.
Another image holds a boy mid-laugh, his hand at his forehead as if caught between shyness and surprise. Around him, the courtyard hums — children running, calling, filling the day with sound. They weren’t patients, but families finding steadiness in a place that once held only fear.
When I look at these photos now, I’m reminded that foreign aid isn’t abstract. It’s not a figure in a report or a line in a budget. It’s continuity — the quiet, patient work that keeps care within reach. It’s the difference between being seen and being forgotten.
What Remains
As the U.S. rethinks its aid commitments, small centers like Upendo are left in a kind of limbo. The need hasn’t gone away — only the money.
What happens when the spotlight moves on? When the funding fades, but the people remain?
Maybe the word Upendo — love — still means what it did back then. Quiet, persistent, and human. Even when the money fades, it’s what keeps the doors open, for as long as they can be.