Mozamblog

In spite of ourselves

2006-03-18T15:14:00.000+02:00

There are few more wrenching film scenes than the one in Rabbit Proof Fence when three “half-caste” children are ripped from the arms of their mothers and sent thousands of miles away to a work camp/orphanage as part of a notorious cultural genocide campaign. Kenneth Branagh brilliantly plays the coolly obsessive “Chief Protector of Aborigines” whose goal is to scrub all the black out of Australians via state-controlled selective breeding—better known as slavery and rape. He sees himself in the center of a strange evolutionary struggle between darkness and chaos versus order and light—and casts himself as chief engineer, foreshadowing Hitler’s experiments with eugenics.

The protagonist of the film, one of the stolen children who escapes to return home, shares the same name with my best friend: Molly. Which must mean “clever and tenacious as hell” in some Gaelic or aboriginal tongue.

“We face an uphill battle against the bush natives, who must be protected from themselves. If only they would understand what we’re trying to do, we must help the native in spite of himself” says Chief Protector Neville.

Earlier today in the airport I was pointedly avoiding speaking English so I wouldn’t be associated with a small knot of my fellow countrymen, snorting and joking amongst themselves about "Mozambican time" and the typical lateness of the plane (only about 10 minutes—and not any more typical than late planes anywhere else in the world). I think they were missionaries. As I seethed at their conversation, I considered that maybe I was overreacting, in spite of myself. I don’t think so.

The arrogance betrayed by their comments irks me most, a characteristic shared by so many Americans—the blindness to the faults in our own society accompanied by a commensurate eagerness to pick on others’. Last year I was in Cape Town with a two friends who live in Boston and Kansas. We sat in an upscale restaurant surrounded by the other 95% white clientele and talked about how eerie it was that you could still feel and see the vestiges of Apartheid so strongly. I asked, how is this different from Boston or Kansas or the Westside of Cleveland?

We know all about South African Apartheid, but less about all the other Apartheids and ethnic cleansings and Stolen Generations, from our own particular US brands to England’s Rhodesia to Portugal’s Mozambique to Australia--even lily-white Canada has a few skeletons in the closet. It’s not much comfort to know that selective memory isn’t unique to Americans. A friend of mine was working on a film project about the politics of forgetting in Belgium--the erasure of King Leopold II’s bloody history from their collective consciousness. Leopold was arguably the last century's greatest architect of genocide—up to 15 million Congolese were killed and millions more were enslaved when he turned a huge swath of Africa into a forced labor camp at the dawn of the 20th century. He too hid behind the cover of a humanitarian mission to civilize the savages.

In the New York Times today there are two articles about corruption, one about Kenya and another about Louisiana post-Katrina. The Kenya article’s headline mentions “graft as part of Kenya’s social puzzle” and goes on to say that three cabinet ministers have quit because of the efforts of an anti-corruption czar. The Louisiana article focuses on small-town mayors and city councilmen and makes the problem sound like something confined to those crazy Cajuns. The mainstream media just nibbles at the edges of high-level corruption in our own government (rarely even using the term). On this side of the world, I never hear Europeans or Americans or Africans lamenting the graft of Western governments, while the plague of crooked Africans is such a staple of cocktail party conversation and writing on Africa that the phrase “corrupt African leaders” has become cliché. One question: if Africans are accepting graft and bribes, who is doing the offering? Seems we’re still trying to help the native in spite of himself--and in spite of ourselves as well.

Camisihnas

2006-01-20T10:15:00.000+02:00

My friend Rachel, who worked here for four years in the mid 90s, is responsible for coining the name of the most popular condom here in Mozambique: jeito. It's one of those untranslatable words that means something akin to skill or talent or knack. They're widely available in urban areas, but still rarely used. I've seen a lot of kids fashioning balloons from them and they're often inflated and batted around the crowd at concerts, but statistics on national condom use show that it's still sporadic at best, even in the cities. Part of the problem is that the initial Jeito marketing campaign coincided with the dawn of awareness of the AIDS epidemic in the public consciousness and the descent of a proliferation of NGOs to address it. Tenacious rumors sprouted that, at worst, Jeito condoms acutally cause HIV or, at best, the Western NGOs are profiting so much from the sale of condoms that they don't really want the epidemic to end. Jeito's initial advertising seemed to strongly link condoms with promiscutiy and probably didn't help matters any, especially for women wanting to broach the subject to their partners. The marketers are a little more sophisticated these days, but there's still little discussion of the public uneasiness with condoms or the real reasons why people are so reluctant to use them.

Condom ad heard on the car radio driving through Maputo (Translated from the Portuguese):
This program is brought to you by Kama Sutra condoms, when you need a camisinha, (little shirt, Portuguese slang) think of Kama Sutra. Now in strawberry, mango, vanilla, cheese, mint, and chocolate flavors. And there’s Long Life Kama Sutra, yes, that’s right, believe it, go the distance on the very longest voyages. Kids, be safe, use Kama Sutra condoms. They’ll prevent pregnancy and some of the nastier illnesses that can ruin your life.

Condom slogan hanging in HAI offices:
Better to come a little later in this life than come early to the next.

Indian poster of all the positions of the Kama Sutra with slogan:
Many positions with one is better than one position with many.

Now a major motion picture

2006-01-15T16:28:00.000+02:00

The short 6 mintue film we made almost a year ago is now up on our new and improved HAI website (many kudos due to Clayton Farr, filmmaker and web designer par excellance.) It's worth a thousand blog words many times over. If you'd like to get a better idea of what we do here and what the stakes are, go here.

Happy New Year

2006-01-15T15:32:00.000+02:00

The afternoon thunder is booming outside, I’m just back from an hour of power yoga at the house of co-worker temporarily turned yoga studio led by DVD Rodney Yee, Bach’s Cello Suites are on the ipod and I finally have a minute to update the blog. There’s a lot here and I have to again chastise myself for being such a bad, bad Blogger. The backdated entries were written a couple of months ago, but with my whirlwind schedule and spotty internet access the past few months, I haven’t had time to get to the blog. After coming back to Mozambique in mid-November, I spent only two weeks here and for much of December was in Nigeria and Ethiopia at conferences and meetings. I took a break over Christmas and New Years, first traveling in South Africa with a Maputo friend, then hosting my friends Noelle and Josephine (Noelle’s 7 year old daughter), trying to show them a cross-section of life in southern Africa in just 10 days or so. I think they were travel-sated when they left for Cape Town last Tuesday after seeing four of the big-five (we saw a leopard prance across a beach, but no lions); traveling in 4 countries; and staying in a Christian missionary flop-house on the Indian Ocean, a traditional Swazi style thatch hut, an upscale house in a rich Maputo neighborhood, an Afrikaans-owned B and B, a Rhodie-owned B and B, and my own humble rat-infested abode (more on the rats later.)

The big news is that I’m moving back to Cleveland by the end of April (interesting timing you might note, just as winter ends there and starts here.) I look forward to a lot of visiting and catching up this summer. See you soon!

Giving Thanks, Backdated Blog #2

2005-11-30T16:03:00.000+02:00

It’s thanksgiving. People are always giving me thanks here. Going out of their way to tell you what a big heart they think you have. What astonishing feats of altruism warrant this outpouring? Lending $10 when a mother living in a distant village is sick and the money to finance a visit home is short; contributing to the cost of automatic basic human rights like an education or a decent house; letting neighbors and friends take water from my full tank during the last dry difficult weeks before the rainy season starts. All this presumed generosity on my part never really threatening my access to excess. My relationship to most of the people I know here is at least partly tinged by my role as boss or benefactor. Sometimes I feel like I represent nothing so much as a big bobbing life preserver in a sea of need.

We had an amazingly abundant Thanksgiving dinner on Sunday. Nearly all expats, we gathered to celebrate the lives we were born into. Turkey, stuffing, homemade fresh mango chutney in place of the cranberry sauce, gravy, green beans, mashed potatoes. Even pumpkin pie and peach cobbler. As I drove home, sated beyond reason, I passed the lines of Mozambicans filing out of their small adobe, thatch-covered churches; walking home to their small adobe, dirt-floored homes.

It finally rained today. We can only hope it marks the beginning of the now two-month late rainly season. I would be most thankful for that.

Back home? Backdated Blog # 1

2005-11-15T15:44:00.000+02:00

So I’m back home. If that’s what this is. I’m not sure I have a home these days, certainly nothing that has that gemütlich feel too it. My eyes had to readjust and I noticed funny things. In a sea of abject need, oodles of broken things, what is chosen for spiffing up?

There are shiny new reflectors along the curve of highway leading into town, right before you come to the supermarket. It’s just where the population density starts to warrant some sort of protection for the folks living in the huts nearest the road, where the demographics shift from “rural” to “semi-urban.” It’s a dangerous spot to live if a fast-moving truck takes a few extra seconds to gauge the trajectory of the turn and careens off into the neighborhood, but not sure I would be comforted by some flimsy reflecting metal posts in the few feet separating me from the steady stream of rickety semis barreling into town.

In the middle of nowhere, on a barren stretch of pock-marked asphalt connecting two small towns, some men were carefully painting the railings bright blue on a 20 foot bridge over a seasonal creek. The gates guarding the two railroad crossings in town now have festive red and white stripes.

The average skin-color of Shoprite (the only supermarket in town) clientele continues to get paler. It’s dramatically lighter than when I first arrived and I was often the only Mzungu in the store. The white Zimbabweans have really started to put down roots here, or more accurately, to put up walls. The number of compounds going up around town continues to multiply, cement houses with the beginnings of imposing brick walls surrounding the acre or two or three adjacent. They have no country of their own anymore, so I suppose that makes them overreact in their defense of whatever spot of land they are currently calling home.

There are moments, days, when I feel I shouldn’t be here. The Sub-Saharan African environment is clearly not meant for northern-European skin if the Rhodesian complexion is any indication. Their blotchy-red, sun-scarred faces would make good before photos on Extreme Makeover.

My eyes are full

2005-09-07T12:14:00.000+02:00

My eyes are full. Weary of images of suffering and selfishness. I don’t recognize my country in the images on TV. Maybe I’ve been away too long, but I don’t remember the callousness, the intense and relentless pursuit of self-interest, the distrust, the hair-trigger resort to violence. From the images on CNN, it doesn’t look like a country I’d choose to move back too--it looks like a disorganized, segregated, badly run police state. I am reminded of my white privilege here much more frequently than back home, maybe because a fish generally doesn’t think too often about the water it breathes. Cleveland, with its segregation and divisions, is like an aquarium. You can swim around for awhile some days before coming to the glass wall. Africa is more like a goldfish bowl. But some goldfish get so acclimated they even forget the bowl. I’ve seen it with expats here and now I recognize it in my own shock over the images from New Orleans. What else could possibly be the fruit of all the seeds we’ve sown? How could we not have expected this? I can only hope the images of New Orleans make more people aware of the fishbowl, but in my experience, those that deny its existence it can almost never be convinced.

Here, life goes on as always, or not. At a friend’s 30th birthday party last week, her brother began his toast to her by noting what an accomplishment it is, in this day and age in Mozambique, to even make it to 30.

Josina's Birthday

I visited an outlying rural health center about 5 hours by car from my house. Twenty-one women in the last days of their pregnancies are packed into a bare cement block building, “the house of expecting women,” sleeping on woven mats and cooking on open fires outside. No electricity, no running water. They come from hours or days away and patiently wait alone for the contractions to come so they can make it to the adjacent hospital in time for the birth.

"Casa de maes espera" =

House of expecting/waiting/hoping women

It’s getting to be the rough part of the dry season. Water is scarce but the rains are still two months away, so it’s far too early to start hoping yet. The goal is simply to get through to the next day. Expectations are low and no one even imagines being rescued.

When words fail

2005-08-03T21:07:00.000+02:00

I'll just let these images speak for themselves. They are all works of art we encountered this weekend in Zimbabwe. The border is only an hour or so away and so every couple of months we take off to enjoy the Vumba mountains (one of the best birdwatching places in the world just in case you're reading this, Steve and Beth.) It's kind of like Vermont. Seriously.

We have a routine. Leave Saturday morning, fill up with gas since there hasn't been any available in Zim for the last 3 months, get across the border and into Mutare just in time for lunch at the Green Coucal--a pretty good substitute for the Fulton Bar and Grill. Sit under the Frangipani tree eating roasted pumpkin and kale lasagna and sipping cappucino. Stop at the street corner where Moses, Zebron and Givemore, our Shona sculptor friends, are selling their works of art under some mango trees. Talk to them awhile about how bad things have gotten in Zimbabwe (all the while being assiduous to not mention any reasons why this might be true or any dictators that may be responsible), how their art would fetch 10 times more if we could just get it to the US, buy a piece or two and pay them more than their asking price. Then off to our favorite cozy lodge with an amazing view and a fireplace tucked into the corner of each room. After a late afternoon hike, we're ready for dinner in front of a roaring fire and a game or two of cards before drifting off to sleep. Only problem is, it's become impossible to enjoy the Vermont-like facade when thousands of people have been thrown out of their homes and put out into the streets during the coldest part of the Zim winter. The first work is by Moses, it's one of the victims of Mugabe's recent "clean-up" campaign. If you want to learn more, click here for a recent article about how the razing of slums is also denying people access to the fledgling HIV treatment program.

The other two photos are pieces from the Zimbabwe National Gallery of Art branch in Mutare.

"HIV Carrier"

"The HIV Burden African Women Have To Carry"

I'm back. . .

2005-06-30T16:28:00.000+02:00

Today, like most weekend mornings, I woke up to choral harmonies coming from a parade of overloaded flat-bed trucks passing my house carrying a steady stream of mourners from the morgue to the cemetery. The altered pitch rises and lowers as they go by, and most of the songs are now familiar to me. The past few months have been a deluge of events that, back home, we understand as rare ordeals requiring weeks or months for recovery. Here the velocity of death and birth are such that the grief and joy are tangled up together in ways that are hard for me to comprehend.

One story of far too many: There is an activist at the Beira Day Hospital who learned she was HIV positive after her first husband died and her soon-to-be second husband asked her to go with him to get tested for HIV. She was positive and he was negative. “Never mind,” he said, “no one else who I’ve asked to do this has had the courage—you were the only one. I still want to get married.” Nine months later, she fell ill with tuberculosis and was bed-ridden. Somehow, he wasn’t bargaining on that--the burden of a sick and possibly dying wife was something he hadn’t considered. As is common here, decided he couldn’t be bothered to care for her and delivered her back to her parents’ home, a gesture that essentially means: “Here, I don’t need this any more, you can have it back.” Just then, the Beira Day Hospital HIV treatment center was opening, and although she had to be carried to her appointment, she managed to be one of the first patients enrolled. Her TB was treated, she rapidly improved, and she has gone on to be one of the star health activists now working there—supporting her friends, family and other patients as they are tested and go through the difficult early stages of understanding and accepting the diagnosis that she knows so well.

She met her third husband when she was recovering from her TB and just getting her strength back. She always insisted on using a condom and when he confronted her about it, she told him that she had HIV. He too accepted it – but now she knows that ultimately, she’s on her own. She has no ill will towards the second husband who abandoned her. “If it weren’t for him, I never would have been tested at all,” she plainly observes. She didn’t want to have another child (she has a 9 year old from her first marriage) but here in Mozambique, marriage is inconceivable without children and the social stigma against childless couples is too much to bear. So after careful consideration and control of her HIV, she got pregnant and now has a chubby 3 month old with an easy laugh and insatiable bright eyes that drink in everything. She spent nearly the entire week before he was born in the hospital, not for herself, but instead caring for her brother who was dying of Malaria. Her first labor pains came during his funeral. Everyone here has a story like this one.

So I have been negligent in the care and feeding of the blog because sometimes, it’s too much to put into words, and it feels wrong to write about the more mundane things when you’re stuggling to come to terms with the traumas that are part of daily life.

On the brighter side, I also had a deluge of visitors over the past few months. My film guru friends and mentors came out and we took hundreds of photos and hours of film which we are editing down to about 6 minutes to put on the HAI website soon. You can see a small sample of the photos we took here, and I’ll let you know how to download the film as soon as we get it up in finished form.

In case you think my life is all tragedy, I went on a great birthday canoe safari with my friend Ed. We got laughed at by hundreds of hippos and scared a few elephants (apparently, they don’t like the way people smell.)

We got some US press on our efforts in Slate.com after a short visit from a journalism fellow. I am quoted in one article dissing the US government and in another dissing the Vatican. Not bad for a day’s work. You can read his view of the scale-up here. Click on different days of the week if you want to read Adam's other articles about Mozambique.

Finally, I'll put you all on notice that I'll be back in the US (after spending a couple of days in London) on about September 22nd. I'll be in Cleveland for a few weeks, then New Mexico and possibly Seattle, with a last stop at the American Public Health Association Conference in New Orleans and then back here. Hope to see you all during that whirlwind visit.

Abracos,
Wendy

2005-03-04T14:46:00.000+02:00

Good morning

Free time

2005-03-04T14:30:00.000+02:00

It’s starting to feel like late August here now. On my usual running route, the broad yellowing tobacco leaves are beginning to obstruct the view that, up until a couple of weeks ago, the farm workers enjoyed of my jog past in the evenings. So my run’s gotten a bit quieter, but I still get the occasional shouts of “Good morning” (at 6 pm), “thank you” and “how are you” from the locals practicing their English. I took to running out here in the tobacco fields, about 5 kilometers from my house, because running in town became too much of a virtual obstacle course--an exercise in practiced nonchalance in the face of quizzical open-mouthed grins and stares, good-natured taunts of “muzungu” (the African equivalent of “gringa”), and the occasional uninvited running partner hoping for a date. I get the same reaction out here in the matu, but the population density is much lower, so I pass only a few weary souls returning to the village after a day’s work in the machamba. Most are groups of women and children, sometimes with husbands in tow. Mom and older children carry the younger children swaddled in capulanas tied tight around their around their shoulders and backs, everything else is balanced on the women’s heads—cords of firewood, baskets and burlap bags of harvested food, huge bunches of bananas, thatch for the roof, farming tools, basketball-sized squash, everything goes up.

So I understand the puzzled, bemused looks directed at me. To stay fit, I have to consciously seek out exercise and turn down food. I have to think about burning at least as many calories as I take in each day. Not worries shared by my trail-mates. So they see me run past and shake their heads—crazy muzungu that I am. Meanwhile, I marvel at them. I pass two women, both carrying at least 80 pounds of firewood on their heads and perfect, serene babies on their backs, smiling and chatting as they stroll by, their bare feet striking the ground for maybe the ten thousandth time that day.

Good News and Bad News

2005-01-30T16:05:00.000+02:00

A couple of weeks ago, at the same moment when the Minister of Health was giving a press conference here about the laudable progress the government is making in expanding HIV treatment and providing free anti-retrovirals across the country, a few blocks away a young man in his mid 20s was jumping off a 10 story building to his death. Friends and relatives attributed the suicide to his recent discovery that he was HIV positive.

Surreal juxtapositions like this are common here. We are supposedly awash in donations from PEPFAR, from the Global Fund, from the World Bank, but complicated funding mechanisms and reporting requirements mean that it takes months or even years for the money to be turned into drugs or infrastructure improvements. So even as we read that the Global Fund money has arrived, the local health departments here are asking us if we can help procure medications to prevent mother-to-child transmission of HIV and malaria for a few more months. Meanwhile, Mozambique’s yearly debt service (about $150 million dollars) is enough to buy drugs to treat over 200,000 men, women and children with HIV. Right now, only 8,000 are being treated, but the rapid scale up plan calls for access to drugs for those 200,000 within 5 years.

Often the surreal moments reach into my daily life. Last week I was flagged down while driving past what looked like a broken down machibombo (small bus). The bus had been emptied and the passengers gathered around it, spilling into the road. The only white man in the crowd approached us and explained that there’d been an accident, the bus had hit a young boy, he was unconscious but still alive. I got out and before I could walk 10 feet, a couple of guys were half carrying-half dragging the limp child to my car. We opened the back, I tried to make a flat surface big enough for him to lie down, and we raced off to the nearest hospital, about an hour’s drive away. Once I had time to assess him, my heart sank. He had a pulse and was breathing, but he was completely unresponsive and his pupils were fixed and constricted. There was no flicker of life left in his motionless eyes, only his hands twitched occasionally with involuntary posturing. Outwardly, he had a small laceration on the right side of his scalp, but otherwise looked completely unscathed. We are fragile creatures.

He may not have survived even in the best of circumstances, but here, his chances were nil. At minimum he needed a neurosurgeon and the nearest one is 600 miles away. Still, his chest rose and fell at regular intervals and his heart continued to beat, not quite catching on to the futility of its continued service, still on the powerful automatic pilot of the deep brainstem.

Most disturbing to me about the whole experience was the reception we got when we rolled up to the emergency ward. I went in first and asked for a stretcher, and after a couple of minutes was able to get an orderly’s attention. It was late afternoon and only a few people were milling around. One man was lying on a bench behind a screen with labored breathing and desperate, hypoxic eyes, a couple of others sat patiently on another bench across the hall. A receptionist was giving all his attention to the mound of paperwork in front of him and was not going to be distracted. Finally a nurse noticed me and said “put him in room two.” As I was wheeling the bed into the room, I noticed a man in a white coat and stethoscope strolling by. Repeated “excuse me sir”s got no response. Finally, I walked in front of him, said “good afternoon,” introduced myself, and explained the situation. He walked into the room where the nurse was starting an IV, and said simply, “put him in the surgical ward” and walked out. I stayed with the boy about an hour longer, as he was transferred to a regular hospital bed, hoping his parents would show up and I would have a chance to explain the hopeless situation. Someone had gone to tell them that we were taking their gravely wounded son to the Chimoio hospital, but from their home about 80 kilometers away, it might take them hours to arrive on public transport.

The next morning, I went to work in the Chimoio HIV treatment center “day hospital,” about 100 yards away from the emergency ward in the hospital complex. It was also a tough day, we saw the malnourished child of a mother with HIV. The five month old weighed only 7 pounds and wasn’t breastfeeding. We saw a skinny 15 year old with big frightened doe eyes who was just diagnosed with HIV and was sick with malaria. But we also saw 10 or 11 people who were healthy, gaining weight, getting the treatment they need from attentive docs, caring social workers and kind peer-activists. I wrote an email to some friends commenting on the amazing difference that basic infrastructure and a few thousand dollars makes. The reply from a doctor who worked here for two years was more accurate: “a little remuneration gives one's selfless side the ability to come out and play.” In absence of doctors, nurses, basic supplies and medicines, beds and equipment, the hospital staff is continually beaten down and has come to know that there’s not much they can offer— everyone’s overworked and disappointment is constant. Those are the perfect conditions to foster the inhumanities that I witnessed. But it’s also surprisingly easy to turn the equation around. Every month now, we’re putting about 150 new people on anti-retrovirals at the two day hospitals we support. For those patients and their families, it may be the first time they’ve gotten attentive, comprehensive medical care from the down-trodden health care system.

Homecoming

2004-11-22T15:12:00.000+02:00

City Club World Aids Day Speech

I've learned a lot in the last three months, some lessons I expected and some more surprising, and I'm thrilled to have the chance to share my experiences with the Cleveland Community during the week of World AIDS Day. I have to thank the Sisters of Charity Foundation/
Saint Ann Foundation for their support of the project and for funding my trip home to accept their generous donation of a light truck . The vehicle will be vital for our work following up on HIV patients and helping people get to their appointments and pick up their medications. Mayor Campbell, Matt Carroll, The Cleveland Department of Public Health and The AIDS Task Force of Greater Cleveland have also been key in their support of Health Alliance International's work here. It's a critical time right now, and the global struggle for HIV treatment equity is being threatened on several fronts.

High on his extra dose of post-election chutzpah, George Bush recently tried to thwart the Global Fund's efforts to finance a fifth round of projects in the develping world.

Meanwhile, in typical go-it-alone fashion, USAID is getting ready to give 7 billion dollars to a defense contractor to be the sole distributor of expensive brand name anti-retroviral drugs to developing countries accepting USAID money for treatment. In the face of all this, Mozambique's government continues to demand fair prices and equity in access to treatment.

I'm looking forward to a yummy traditional Thanksgiving Dinner (pretty hard to find cranberry sauce here) which will help fuel my efforts the following week to share Mozambique's story as widely as possible. In addition to the city club gig, I'll be at Pilgrim Church on December 1st (World AIDS Day), and on WCPN's 9:00 show on December 2nd. Hope to see many of you during this very short whirlwind visit. I've been reading the comments to the blog (apologies for not posting more often--I have already made a New Year's resolution to post more regularly) and your emails and comments help keep me going. Thanks again. Ate logo. Abracos -- Wendy.

2004-10-18T00:03:00.000+02:00

Backyard mines

Life as a Minefield

2004-10-17T23:40:00.000+02:00

Finally had some time to explore the environs. My friend and now colleague, James Pfieffer, is visiting and we decided to head out to a nearby dam and the lake that was created behind it. Passing over the dam, we came over a ridge and the expanse of calm blue waters stretched out in front of us, beaconing. We arrived in the heat of mid-day and had to remind ourselves that a swim might not be worth the consequences. It wasn't nearly hot enough to risk the twin dangers of crocodiles and schistosomiasis. Schisto is a tiny parasite that infests most of the lakes and rivers around here. It enters through the skin, then migrates through the lungs before finally settling in the host's veins, the microscopic worm then lays eggs which migrate into the bladder and pass eventually back into another river or lake to start the cycle again. The disease is endemic here, and can cause heart failure and liver disease, but mostly manifests as hematuria--more commonly known as "peeing blood." In some communities here, up to 25% of the population has schisto in their urine.

So no swim. Instead we opted for a hike along the edge of the lake with Pablo and Ana Judith, a Colombian couple working with us. We started off on the dusty red-earth road but soon found a well traveled path veering off towards the lake shore. We trekked on, passing clusters of huts with women baking bread, men fishing out of canoes, families doing their washing in the lake. James was teaching us a little Shona along the way, and everyone we passed seemed amused and pleased to see this troop of "brancos" practicing our Shona greetings.

As we walked, we noticed brilliant scarlet-tipped stakes marking some paths veering off to the left, with the same stakes randomly scattered through the fields on either side. Occasionally a whole stump or tree trunk was splashed with the fresh, blood-red paint. We considered walking down one of these well-demarcated trails, but something about the crimson shade seemed ominous. Then it dawned on us - a minefield. We didn't quite believe it could be possible, after all, the paths and the fields were woven through hamlets where families lived and cooked and fished and farmed. The next villager we met confirmed our fears. During the Mozambican civil war, mines were laid in three sweeping swaths across the road and neighboring lands in order to protect the dam. An international organization had recently gotten around to marking and clearing the minefields. He seemed to take this all in stride, explaining that the locals stayed on the well traveled paths and roads and that no one had been injured by a mine in several years. In the context of crocodiles, schistosomiasis, malaria, HIV, poverty, floods and droughts, a minefield may be one of the more managable perils. We took the widest path we could find, farthest from the threatening cairns, and safely made our way back to the main road.

Nuturing Hope

2004-09-17T01:47:00.000+02:00

MOZAMBIQUE:
“AIDS Sharply Cuts Life Expectancy in Mozambique”
Reuters (09.03.04)::Mateus Chale
Life expectancy in Mozambique has dropped sharply due to HIV/AIDS, threatening the government's ongoing reconstruction following the 1992 end of its 16-year civil war, Health Ministry officials said Friday. This year, life expectancy at birth is estimated at 38.1 years, compared to 46.4 years without the presence of HIV/AIDS, a Health Ministry report said. By 2010, life expectancy could drop to just 35.9 years. “We need to act to reduce the speed of the growth of HIV/AIDS, which is a huge development challenge,” said Health Minister Francisco Songane. “These are figures… that remind us of how serious we should face this fight.”
The report called for “immediate and effective” action to control the AIDS epidemic
in Mozambique, where 1.4 million of the country's 18 million people are
HIV-positive. HIV prevalence in the key 15- to 49-year-old group jumped to 14.9
percent from 13.6 percent in 2002, the report said. It projected that figure
will reach 16.8 percent in five years and would likely stabilize around those
levels.
Health Ministry officials noted that HIV prevalence was much higher
in urban centers than in remote areas of Mozambique. In the port city of Beira,
HIV prevalence is around 35 percent, compared with 8.0 percent in northern
districts on the Tanzanian border.
Songane said that about 8,000 of the 218,000 patients in need of AIDS medicines could benefit from the government's program to distribute free antiretroviral drugs. The number receiving drug therapy will rise to 58,000 patients in 2006 and 132,000 by 2008, he said.

Most of the images and stories we receive of Africa in the US can be divided into two categories: the exotic and the dismal. Between the depictions of tribal ceremonies and distended bellies, it’s nearly impossible to get a good idea of what African life is really like from the US media. I could write hundreds of pages on what I’ve already seen and learned, but I’ll try to give you a taste that fills the void between the hopelessness and the sensationalism that characterize the media coverage.

Over the past three weeks I’ve been to 6 of the country’s 16 day hospitals for HIV treatment. Invariably, they are overflowing with expectant patients hoping to finally get life-saving treatment. The Mozambican Ministry of Health began making drugs available at no cost only a few months ago. Widespread HIV Testing has been available for just over a year. Estimates are that only about 1% of the population has been tested so far, but now that treatment is available, numbers are slowing increasing. The whole health system is being retooled from offering only solace to providing hope. At 8 am at the Beira Day Hospital, there is barely room to move through the narrow waiting room. Every available seat is occupied and some sit cross-legged on the floor. On one of the wooden benches, a man lies curled under a capulana, the brightly colored fabrics that are used as skirts, shawls, baby-carriers and blankets. He is too weak to lift his fragile, wasted frame. But most of those quietly waiting in the concrete-walled room are not obviously ill. Almost half of the 50 or so people here this morning are women with babies, some breastfeeding as they wait for their CD4 results.

Treatment is based on a protocol which depends heavily on CD4 counts (CD4s are the type of white blood cell attacked by HIV). Those with counts under 200 get triple drug anti-retroviral therapy, those with higher counts are given prophylactic medications and told to follow up in a few months, or if they develop symptoms. Higher counts are a good thing, it means the virus hasn’t yet ravaged the immune system and the drugs aren’t needed, but it’s proving hard to explain. People are often disappointed to leave the day hospital empty-handed.

I’ve also spent a good bit of the past few weeks making the rounds with all the institutions and agencies that are here to help. So far the list includes the CDC, USAID, The World Bank, UNICEF, WHO, MSF, and various and sundry other NGOs and US academic centers. Each one has its own modus operandi and its own concept of what’s needed. In the middle of it all, the Mozambican Ministry of Health has to balance the competing political interests and keep the donors happy without getting bowled over--all while working to build a complex health care and drug distribution system with scarce resources. So far, they’re proving an example for many other African countries. Health Minister Songane was featured in a recent New York Times article for standing up to USAID and refusing to buy expensive brand-name drugs in place of the generics that cost thousands of dollars less. The cost difference can be easily measured in lives saved. One year of the generic, twice-a-day triple therapy pill is only $140. Brand name regimens can cost 10 times as much or more.

This weekend, back in Cleveland, many of you will be at the AIDS walk in Edgewater Park. Keep the Mozambicans in mind. I’ll be having my first weekend off since I arrived, probably sitting on a beach watching fishermen paddle their dugout sailboats (called dhows) out to sea in the morning and sail back in the late afternoon. Maybe I’ll even convince one of them to give me a dhow sailing lesson.

Goodbye Cleveland

2004-08-20T17:56:00.000+02:00

Four months ago, I decided to leave a great job and great co-workers at the Cleveland Department of Public Health to work with Health Alliance International, scaling up HIV treatment and prevention programs in Mozambique, Africa. I knew it would be difficult to leave Cleveland, but I didn’t anticipate how difficult. I have an incredible network of friends, neighbors and colleagues that I rely on here to feed my mind, my soul, and often my stomach as well. By September 1st, I’ll be in Chimoio Mozambique, settling into a new community and a new job, but a big part of my heart will remain here.

Although it’s difficult to leave friends and family, I felt compelled take on the challenge in Mozambique and put myself at the center of an effort to address one of the world’s most pressing public health and humanitarian catastrophes: the AIDS epidemic in Sub-Sarahan Africa. When Jim Kim, one of the founders (with Paul Farmer) of Partners in Health and now the Director of the HIV/AIDS Depatment of the World Health Organization, spoke at the Cleveland City Club on World AIDS Day two years ago, he explained his involvement in the fight against AIDS in terms of how we would explain ourselves to the next generation. He compared the epidemic to the worst plagues in human history and said he wanted to have a good answer for his son when he asked, “Where were you in the fight against AIDS?” As a physician committed to health and human rights, the words resonated with me.

Mozambique is ranked as one of the 10 poorest countries in the world and also among the 10 countries with the highest rates of HIV. In the region of the country where I’ll be working, as many as 25% of working age adults are infected. A whole generation is being erased. There are 400,000 AIDS orphans in the country, one in 5 children doesn’t live to see her 5th birthday, and there are only 600 doctors in a country of over 17 million. Meanwhile, insanely profitable drug companies and the WTO have conspired to make it almost impossible, until very recently, for anyone in the developing world to afford life-saving anti-retroviral treatment. While the drug companies guarded their profit-margin, 25 million people died world-wide. The problems are staggering, the need is overwhelming, and I expect to feel like a tiny drop of water in a giant desert most of the time. During the most trying times, the support I feel from my Cleveland community will be vital.

I have been overwhelmed by the well wishes and offers of support from so many Clevelanders. When I told Mayor Campbell of my decision, she immediately understood why I needed to go and wanted to be supportive, so she hosted a farewell fundraiser, which was co-sponsored by the AIDS Task Force of Greater Cleveland. We raised nearly $4,000 to contribute to the cost of a desperately needed truck to transport patients to clinics and to help pay for bed nets to protect against Malaria.

As I embark on this new challenge, I promise to keep in touch via frequent updates to this “blog” about my experiences. Meanwhile, you can keep in touch with me at wendyj@igc.org so I still feel like I’m a part of this great community. I would also encourage you to continue to support the fight against AIDS in our own backyard. This fall, the Clevleand AIDS Walk will honor mothers affected by HIV/AIDS. Please join 3,000 of your fellow Clevelanders at Edgewater Park on September 19th. I will be there with you in spirit and I will carry your spirit with me in Mozambique.