On the corner of a bumpy, red-soil road in the rural town of Iganga in eastern Uganda, there lies a small store. A handful of people mill around the entrance in the glaring sun, waiting their turn to enter. They are the main source of activity on this placid street, but their patient presence barely betrays the hubbub within.

 

Inside, almost a dozen people sit crammed on makeshift benches around two edges of the stifling room. Most of the remaining space is taken up by a shop counter, behind which are shelves piled high with vibrantly-coloured health products covered in Chinese characters.

 

A couple of customers compete with a baby wailing as they read out lists of products to the shop attendants who pick them off the shelves. Every now and then, the door in the corner opens. Someone steps out, usually holding a piece of paper, and the person sitting closest steps in.

 

Beyond that doorway is an even smaller room, windowless and illuminated by a single light. As I peer in, three people are undergoing diagnostic tests, a woman is standing on a machine that hums loudly as it vibrates, and a few more patients are waiting slumped along the wall.

 

Wasswa Zziwa Edrisa - or "Doctor Wasswa" as he is known here - stands in the centre wearing a fresh, chequered shirt on his back and an unwavering grin on his face. With the easy charm of a seasoned salesman and the swaggering self-assurance of Uganda's national bird and symbol, the crested crane, Wasswa welcomes me in.

 

"I will show you how we help so many people," he says, beaming. "Let me show you the machines."

 

"This is one of the scanners," he explains, pointing to a piece of kit that looks a bit like a 1970s radio. "It shows everything. We can see if you have diabetes, kidney deficiencies, liver problems, eye problems. Everything."

 

Wasswa explains that the test works using a traditional Chinese understanding of the body whereby different points of the hand relate to different internal organs. We watch as an attendant prods a patient's left palm with a metal tip, making a little meter light up. When the light goes green, he explains, it means that part of the body is fine, but if it goes orange it indicates a problem.

 

Next Wasswa points me to the corner where a woman is standing on a small machine and holding onto a pair of handlebars to which she is harnessed. Her whole body blurs in the dim light as the platform beneath her vibrates rapidly, its droning buzz filling the room.

 

Similar machines can be found in many gyms these days and are meant to help tone muscle, but the uses Wasswa presents are quite different.

 

"This is a blood circulation massager," he announces. "You see how she sweats. It opens the vessels and deals with paralysis. It helps people with stroke."

 

Wasswa then shows me another diagnostics machine, this one connected to a laptop. As the patient holds on to an appliance plugged into the computer, pictures of different organs flash up on the screen for a few seconds each as a dial next to it oscillates erratically. After a minute, a one-page document pops up, listing how well his organs are functioning.

In the airless room, Wasswa runs through a few more devices - a face pain remover, a blood pressure reducer, a necklace that removes radiation - before squeezing past bodies and chairs to get back to the first patient we met. By now his diagnostic test is complete. He tells me that he came to the store because of some mild pain around his mouth, but Wasswa breaks the news that there are more serious things about which he ought to be concerned.

 

"Ah, he has a problem with his spleen," says Wasswa, nodding knowingly. "At times, he gets constipation and some swelling in the legs and arms. There is also some paralysis in the legs. He gets headaches. At times he feels dizziness. His brain arteries need to be detoxified. He has kidney deficiencies. He has bad chest pain. He has high cholesterol. He has poor circulation. And he has problems with his stomach."

 

The roster of the young and healthy-looking patient's conditions seems extreme, but Wasswa is not perturbed.

 

"He needs to improve his circulation by using our machines and he will need to take our products. If he uses them, he will be fine," he reassures.

 

Back in the light and noise of the waiting-room-cum-pharmacy, Wasswa shows me some of these products. He picks goods off the shelves, ranging from capsules to toothpastes to body creams, and stacks them on the counter as he explains what they each do. "This takes away all the radiation in your body. This helps with diabetes. This treats ulcers. This is for slimming. This adds more white blood cells to your system. This is for people who are mentally disturbed," he says.

 

"These medicines are good for everything," he concludes finally, the pile of products on the counter now complete. "If you have cancer, we can help. If you have HIV, we can help. Even if you have a hernia or a tumour or appendicitis, you just take our products and they will disappear."

 

This small store in eastern Uganda employs a handful of staff and, according to Wasswa, receives dozens of patients each day. Wasswa is also frequently heard on local radio advertising his services and has made quite a name for himself in the area. He was previously a school teacher and says his parents were "peasants", but now, in his 30s, he is anything but. These days, Wasswa drives a shiny four-wheel drive, wears sharp suits and even goes on jet-setting trips around the world. All this makes him quite the exception in Iganga, but across Uganda, this young 'doctor' is by no means a solo pioneer and his store is by no means unique.

 

Similar stores can found all across the country, from Kasese in the west to Soroti in the east, and from Gulu in the north to Entebbe in the south. There are four such outlets in Kampala alone. These stores offer the same diagnostic tests, stock the same range of products, and above all their doors, there hangs the same innocuous green and orange sign which reads: "TIENS: Together We Share Health And Wealth."

 

TIENS - also known as Tianshi - is a multinational company based 10,000 miles away in the Chinese metropolis of Tianjin. It was founded in 1995 by Li Jinyuan, who has since become a billionaire from the venture. The company has established branches in 110 countries including 16 in Africa, employs over 10,000 staff globally, and reportedly enjoys net profits worth hundreds of millions of dollars each year.

 

TIENS first began tapping into the Ugandan market in 2003 and it has grown steadily ever since. There are now around 30 stores across the country, TIENS distributors regularly engage in outreach programmes to rural communities, and according to the company's national chairperson, Kibuuka Mazinga Ambrose, TIENS-Uganda has an annual turnover of around $6 million.

 

The company has even bought the most prominent advertising spot on the Health Ministry's official calendar, a particularly brazen move given that none of its outlets are registered health facilities.

 

Patients who come to TIENS seek help for a whole range of conditions - from malaria to paralysis - but they tend to tell similar stories of how they arrived here. Typically, they say that they first went to public facilities (some told me they had even visited two or three), but were either not seen to or found the treatment ineffective. TIENS is almost always a last resort. But in a country whose healthcare infrastructure is riddled with chronic problems and which, by some measures, ranks as one of the worst in the world, the last resort is often one that needs to be taken.

 

In many areas of Uganda, public health facilities are virtually inaccessible, while those who do manage to reach them may find their walls crumbling, their clinics under-staffed, and their shelves bereft of drugs. Although the government has promised to invest more in the sector, much of the country's healthcare infrastructure is in decay. Doctors and nurses are over-worked and underpaid, and although services are meant to be free, in reality patients face many hidden costs.

 

In this context, stores like Wasswa's - with its quick turnaround, attentive staff and fully-stocked shelves - offer an appealing alternative. The always conclusive diagnostic tests are highly convenient; attendants' claims about the healing powers of TIENS products may well be reassuring; and many patients say the fact the medicines travelled thousands of miles from China suggest they must work.

 

Many customers who use TIENS products also insist that they do work.

 

On the Friday morning after my tour of Wasswa's clinic, the courtyard next to the outlet is packed. Over a hundred people sit on plastic chairs facing forwards while latecomers lean against the back wall. A red tarpaulin sheet shields the crammed attendees from the sun and gives the whole atmosphere an eerie pink hue.

 

'Doctor Julius', a man in his late-30s with an intense glare and impatient demeanour, stands at the front. He has just finished explaining the healing powers of TIENS toothpaste - which as well as cleaning teeth, can be used to treat ulcers, angina and skin problems amongst many other conditions - and he invites attendees who have used the product to give testimony. Four hands go up immediately.

 

"I had terrible problems with my teeth," says the first speaker. "I went to see doctors but a new tooth had to be uprooted every week. When I started to use TIENS toothpaste, the pain went away."

 

The next patient tells a very similar story before two mothers relay how the toothpaste cleared up their respective children's skin rashes and burns.

 

Every now and then over the next few hours, many more attendees are invited to recount their experiences of using TIENS products. We hear how a man with back pain can now walk, how another man was cured of vertigo, and how a woman's child was once bed-ridden but is now running around. At one point, Wasswa looks particularly pleased as a mother tells of how her young son - who she had taken to three separate public healthcare facilities before he was cured of cerebral malaria by TIENS - now wants to change his name to 'Doctor Wasswa'.

 

"You see, these products work," Wasswa announces after one of the testimonies. "At hospitals, they will ask you how you feel, but here, we tell you how you feel. At hospitals, they treat signs and symptoms. Here, we treat causes. At hospitals, they give you medicines made from chemicals which are harmful and can give you ulcers. Here, we use herbal medicines which have no side-effects."

 

"This is real," he continues. "This is Chinese herbal medicine based on 5,000 years of traditional medicine and it works."

 

In Kampala, I test this out for myself. I visit a couple of the company's stores, nestled in the city centre's endless bustling plazas, and in one of them, managed by an intense man named Frank, I get tested.

 

Frank, the self-declared "best in the business" at doing diagnostic tests, seems thrilled at my presence and bundles me across to the end of the room. He sits me down and pulls across a thin curtain to give us a modicum of privacy from the handful of waiting patients. He takes out a battered looking hand-held device, pushes a 9-volt battery into its back and plugs a wire into it that branches into two metal tips. He gives me one of the electrified points to hold in my right hand and says he will use the other to press points on my left palm. With a grave look on his face, Frank instructs me to tell him when I feel a tingling. This seems to be a more basic version of the first test I'd seen in Iganga.

 

To begin with, I report whenever I feel something, which is every single time the tip touches my hand, completing the basic electric circuit. Frank nods excitedly when I do so and explains that I have a serious problem in whichever part of my body he is testing. After a while, however, I decide to stop reporting every time I feel a tingling. Frank lets me get away with one, but after that he frowns when I stay silent and simply keeps the metal point on my hand until I give in, sometimes rubbing my hand and even licking the metal tip if I am being particularly resistant.

 

In the end, Frank writes out a list of around 25 health conditions including "liver disorder," "STROKE," and "enteric fever [aka severe typhoid]," and prescribes a roster of products that comes to over USH 1 million ($400).

 

Before committing to his costly regimen, I decide to get a second opinion.

 

In the bright, clean reception of Beijing Clinic, a private health facility in Kampala, I relate my experience to a young Ugandan doctor, who trained and qualified in China, specialising in traditional Chinese medicine. The doctor, who prefers not to be named, laughs as I explain the machines I saw in Iganga and the test I underwent in Kampala. "No machine can test all those things like they claim," he says.

 

Next, I show him the TIENS Information Guide, a booklet from which it seems Julius and Wasswa get most of their information. On page 3 of the booklet, a short disclaimer warns: "Tianshi Company does not make any medical claims whatsoever." However, the next 60 pages are filled with bold declarations about the powers of its products and instructions on how to treat different diseases.

 

"Whatever this is, it is not Chinese medicine," says the Chinese-trained doctor with a combination of amusement and incredulity. He chuckles as he reads how TIENS medicines are supposed to treat about a dozen different conditions each, from preventing cancer to reversing impotence to promoting "the growth of children's reproductive organs."

 

However, the doctor's amusement soon turns to horror as he reaches the section of the booklet advising distributors on what steps to take when patients are suffering from different diseases. TIENS customers are typically encouraged to undergo diagnostic tests in store, but most who go to TIENS have previously been to hospital and know some of the conditions from which they are suffering. The company guide offers clear and easy instructions on what they should be prescribed.

 

Of the few hundred conditions listed - which span from AIDS to Yellow Fever - a handful include the recommendation to 'see a doctor'. But the rest just list a few products to be taken.

 

"This is a death sentence," mutters the doctor, falling silent.

 

One of the most repeated claims by TIENS distributors is that because the products are 'herbal', they have no side-effects. This assertion is used to elevate them above Western medicines, which they say are made from chemicals and so can be harmful, but the claim is also used to suggest that there are no dangers involved in taking them.

 

"Even if I tell you to swallow one and you swallow four, there will be no problems," Wasswa had insisted. But when put to the Chinese-trained doctor in Beijing Clinic, he just shakes his head. "That is a flat out lie," he says.

 

He recalls that last year, he was consulted by police after a man suffering from kidney problems died suddenly from liver failure. A toxicology report found that he had had a toxic overdose and it was suggested that the TIENS supplements the patient had been taking without his doctor's knowledge had either caused additional problems or reacted badly with other medicines. The man's family could not afford to get a more detailed medical report, however, and declined to take the matter further.

 

At another private clinic in Kampala, Dr Wen, a highly-regarded practitioner with three decades experience, is similarly concerned. "This is not medicine," he says, "but it is still dangerous. Everything has side-effects. Even herbal medicines and herbal supplements used wrongly can kill."

 

I contacted Uganda's Health Minister, Ruhakana Rugunda, repeatedly for comment, but received no reply...

 

Continue To Part 2