“Your view of other cultures and that they are poor says more about you than the place you’re trying to help.”  -Lemn Sissay

 

Been missing me?  Sorry it’s been so long since I have written.  I’ve been so busy settling in, adjusting, and absorbing my surroundings.  Things are pretty good here.  While the difficult days are frequent at this stage, I really am happy to be where I am.  The clinic staff are all great, and while of course at the moment I have the discomfort of being the awkward white person who doesn’t know nine-tenths of what people are saying, I am confident about my role, both at the clinic and in the village, and am so thankful and humbled about my surroundings.

 

Maitengwe is indeed an intense place.  Once a month ‘new’ mothers (new meaning given birth in the last two years) come in and have their babies weighed, to make sure they are gaining weight.  We also keep bio’s on the moms.  I was perusing the list today and noticed the ages of the mothers:  16… 19…. 14…. 21… 48….51…. 57….  Um, what?  “Where are all the mothers aged 25-45?” my inquiring mind naturally asked (though already sort of knowing the answer):  The nurse kind of chuckles as if it should be 100% obvious:  “They’re late.” [i.e. they’re dead].  So what you find now is a bunch of young mothers (often victims of rape, or being married off – i.e. being sold – to old men) and grandmothers who are taking care of their dead daughter’s orphans.  We had a 12 year old give birth the other day, and let me just say it’s highly unlikely that she wanted the pregnancy.  The oldest people (which in Africa is like 50+... hell the life expectancy here is well under 40, so don’t be offended when I speak of ‘old people’… it’s all relative!) have largely avoided HIV, save the occasionally grandpa having an affair and bringing HIV home to granny.  However, the elderly are the ones faced with an increasing burden as their sons and daughters are passing, leaving them to care for many children – not to mention themselves!  Being old is hard enough, especially here.  This is a very cursory explanation; it’s far more complex than I make it sound or understand.

 

Our lay counselor was ‘arguing’ with me the other day how HIV was not a problem in Maitengwe.  And I said, “You do realize that most people in this village have HIV, right?”  Her response:  “Not most… maybe just 50%.”  When I told her the prevalence rate of the US, and how this region in Bots is among the highest in the world, she refused to believe and has asked me to print statistics to prove it.  This is from the person who does our testing!  She thinks, with support from other staff, that TB and cancer are bigger problems - despite that TB is the number one cause of death for people with HIV (in other words, they’d probably be able to survive it if it weren’t for the HIV.  Thus, they are really dying of HIV and not TB).  I asked how many people in Maitengwe have cancer, and she said maybe three dozen, compared to the 4,000 or so with HIV.  But cancer is a bigger problem, she claims, because at least with HIV you can take drugs and live for 15+ years, but with cancer you’re doomed to die.  She clearly does not believe in utilitarianism haha.  But I see a lot of resignation here with regards to HIV and I guess I can understand it.  There are signs everywhere, and radio messages, and posters, and, and, and… so I guess if my country had been trying, at least publicly, SO HARD for over a decade to combat HIV but we were still struggling at reducing prevalence OR we could just take drugs and live with it, then I guess I’d probably be resigned and just take the drugs and do the best I can do being HIV positive ya know?  So I guess in their minds it isn’t a big problem because they can live with HIV.  The problem is that I don’t think they have fully grasped the magnitude of transmission.  Plus, a lot of men don’t get tested and therefore don’t take the drugs… so…

 

Meanwhile, I was flipping through our books for the last yr (our clinic does an exceptional job of recording, for the resources that we have) and June was a ‘good month’ because only 4/15 new pregnant mothers were positive.  The good news is most positive pregnant women are signing up for PMTCT services, and in the last year we only had a handful of babies being born HIV-positive.  Now we can only hope they are able to stay HIV-negative until they become coherent enough to make their own sexual choices.  The hope is in the youth; really, they are the only shot left – my heart races when I think of what this place may be like in 20 yrs.

 

It’s come to my attention that I never really fully explained what I am doing here in Botswana, so let me take this opportunity to explain what I am doing, at least in theory.  I will be assisting with the implementation of Botswana’s PMTCT (prevention of mother-to-child-transmission) program.  Started in 2004, it was the first program of its kind in Africa.  Technically, Botswana had been providing free PMTCT services since 1999 but not on the scale nor with the vigor that the 2004 program offered.  A very cursory explanation of the routine is that women begin taking ART around 6 months into their pregnancy (it is not commonly known that HIV is most commonly passed from mother to child during the actual labor and/or post-labor process, not through gestation, so it is safe to wait until the 6 month point.  It’s amazing how much of the body is separated from blood).  Then during labor they are given some other ARVs and the babies are put on them as well for usually 12 weeks or so.  The mothers are encouraged to exclusively breastfeed (meaning absolutely no bottles) or to exclusively use bottles.  This may sound odd, as breast milk is a method of HIV transmission; however, assuming that there are no open sores, the mouth is not a vector of transmission, hence why oral sex does not transmit HIV.  So a baby swallowing HIV-positive breast milk will not give the baby HIV unless the baby has open sores.  Bottle-feeding a baby typically causes sores in a baby’s mouth, as the nipples are not quite as suitable for the mouth as the mother’s.  God makes things better than we do, eh?  Thus, if the mother is not exclusively breastfeeding she is likely to pass on the virus by way of the open sores caused by the bottles.  ‘Why not just do exclusive bottle feeding with formula,’ you might ask?  Well we do for HIV-positive women in America (mostly).  The problem in Africa is that formula is very expensive, and therefore unattainable for the general population – not to mention that it’s best if refrigerated.  Moreover, our clinic has been out of formula for several months – so the women who initially chose to bottle-feed their children are now forced to breastfeed their kids, due to the absence of formula.  This is hugely problematic.   Therefore, exclusive breastfeeding is the most culturally-appropriate method and is what’s promoted here in Botswana.  My ‘job’ if you want to call it that is to help assist with the uptake and adherence to this program.  More generally, I am here to build capacity in the community.  Maitengwe already has a PMTCT counselor (most clinics here do) and I am not here to take the job of a Batswana – that isn’t sustainable.  The development perspective of the Peace Corps, with which I agree, is to build the capacity of the community – not to come in, do this and that, and then leave; that isn’t helping the community in the long run.  We need to be doing things that can be continued when we exit.  Thus, my role is to examine the situation as-is, tweak it as necessary, and enable/empower the clinic staff as well as other community members to move things to the next step.  Development doesn’t work if there isn’t a sense of ownership for the community.  “You cannot develop people; people must develop themselves” is a paraphrase of the famous quote by former Tanzanian President Julius Nyerere.  I agree with him.

 

Secondarily, I will be working with the orphan community in Maitengwe.  As previously mentioned, there is a whole generation of people missing in this country and so there are a lot of orphaned children.  Unfortunately the older people in this country are slow to accept change, but the youth are still quite moldable and so my job is to help empower the youth to make good decisions as they grow up (Sometimes I think development is just a new form of colonization… but that’s neither here nor there).  You can’t exactly tell a 7 year old girl that she needs to use a condom, but you can teach a 7 year old girl how to stand up for herself, how to say no to boys, how to respect herself as a person, how to value education over being offered gifts by older men, and hope that those lessons will translate into her sexual life when the time comes (which unfortunately for girls it comes all-too young here).

 

However a lot of my work with the children is indirect.  I am helping the umbrella organization, Maitengwe Home Based Care, secure funding for their development by drafting proposals, submitting requests for funding, inviting donors to come visit, etc.  THE GLOBAL FUND, one of the world’s top organizations combating HIV/AIDS recently pulled out of Botswana (for political reasons) and since then MHBC has been suffering financially. (And if any you at any time feel compelled to contribute, we can have a discussion about that, as it’s a complex issue.)  I have to say, so far I am pretty impressed with MHBC.  The money seems to be going where it needs to be going, the staff are incredibly dedicated (most are volunteer), and the organization is genuinely willing to do all it can to be self-sufficient, and I am assisting with that process – seeking to help them establish income-generating activities so as not to rely on external donors.  But it’s difficult, as their burden is greater than their capacity.  I am in communication with the American Embassy, trying to get them to build a kitchen so we can more efficiently cook for the orphans.  Those of you who come to visit will no doubt be incredibly moved by the Project Manager and her commitment to the organization and the children it supports.  She is seriously the Mother Teresa of this village LOL.  And she calls me ‘son’ & gives me free oranges :)

 

Speaking of orphans, I have a confession to make.  *Big breath* For the first time in my adult life, I am having paternal feelings.  Did you fall out of your chair?  I know, sometimes I do too.  I was working out one day when I randomly heard a soft tap on my window.  I looked down to see this small boy, maybe 3 years old, dirty and wearing nothing but shorts.  He was as cute as can be, as they often are, and we had played for some time and he went on about his way.  I didn’t think too much of it, as it happens all the time here.  Then the other week, a girl - about 10 or so - came in to have her baby brother weighed (she is essentially the mother as they are an orphaned family of 5) and brought with her the boy that had tapped on my window.  I see so many kids that, although I recognized him, at first I was wondering from where - but then when he smiled I remembered him as the one underneath my window.  I talked to the girl for some time, weighed the baby, etc.  The eldest girl is too thin, perhaps a victim of what likely killed her parents, but she is obviously strong - too strong for someone her age, and too young to be as ‘old’ as she has to be. 

 

Anyway, while she and the nurses communicated about the baby’s health, I played with the 3 yr-old-window-tapping boy.  This one, among all the other kids I have met, has something about him.  Most of the kids here under 5 are scared of me (for many of them I am the first white person they have ever seen).  Not this one, man, he is a pistol.  But I think what is most captivating about him is that he is sad.  For having such energy, and the best smile in Maitengwe, behind his big eyes you can see that he is suffering – and the worst part is that I think he knows it.  So I walked them to my house, gave them sweets, got their names, and sent them on their way.  I walked back to the clinic and the nurses said, “Kagiso, we have never seen you so in to a child!”  I sighed and said, “That’s my son.”  They laughed at me, as they do a lot, but I reiterated: “I am serious, that one is my son.  I feel it in my bones!”  We all laughed it off, but I wondered why this one got inside of me.  I am supposed to be the Tinman, free of all that mushy emotional stuff! Throughout my times in Africa, I have of course come across hundreds of charming and endearing kids – they’ve made me laugh and cry (privately, of course…) but at the end of the day that’s all it was.

 

Days went by and I did not see the children, until the other day I had one of the nurses take me to where they stay.  They have a ‘guardian’ and those are big quotation marks.  I wont comment any further at the moment.  His brothers and sisters are all wonderful too, and I feel so much for this family, but there’s something about this one in particular.  I stayed for a short time and met the other siblings and began to leave as he ran after me and said, ndo shaka yenda (I want to go) and he wrapped his arms around my leg, and I found my steps being accompanied by the weight of the 3 yr-old-window-tapping boy.  The nurse said, “Kagiso, I think he knows he is your son too.”  LOL.

 

Then today (sorry LAST story!) we had a morning meeting as usual and then were awaiting the mass arrival of the patients when a nurse said “Kagiso, turn around” and sure enough there was the 3-yr-old-window-tapping boy – sad as can be – a few feet behind me.  Rather than walking to the orphan center, he walked to the clinic.  He wrapped his arms around my legs and sighed.  Bless him lol.  I asked him if he was sad (In Kalanga, by the way – I am proud) and he said yes… I asked why but I didn’t understand the answer.  I picked him up and took him to my house for hot tea (mornings are still BITTER here) then took him to the school.  I went to the orphan center to have lunch with the kids and played with them afterwards.  I was seated Indian style, kids going crazy all around me of course, and you-know-who pushed his way through the crowd, sat on my lap, took my right arm and wrapped it around him, did the same with the left arm, and began hitting any kid who tried to get my attention, haha.  The teacher said, “He doesn’t want to share his father.”  That’s when the coldness kicked in and I said, “Ok byeeeeee!”  LOL.  I went back to work for the afternoon, but sure enough, at the end of the day – he showed up again.  So I took him back to my house and we snacked and danced (pictures at http://www.facebook.com/album.php?aid=2262019&l=ba27b&id=6213504) and off he ran back home (barefoot as always) and with a bag of potatoes for the rest of family.

 

I guess while I can write proposals, raise funds, and give talks, at the end of the day it’s in the small ways that I may make a difference – right?  Eesh, was that romantic optimism?  What’s happening to me...

 

Meanwhile, I can die a happy man!  An older woman said she wants to have a baby with me so that it will have my nose.  FINALLY – my nose isn’t the source of laughter and criticism!  Haha.

 

If you made it this far, thanks for reading.  Hope all is well at home.