Bringing the issue home

So even though AFCA only works in African countries and I’ve blogged a lot about developing nations, I want to bring the issue home a little. The United States is huge and industrialized and “modernized” but that hasn’t exempted us from this crisis. America has the highest rate of HIV infections of all the industrialized countries at 0.6%. Sure, 0.6% looks really small compared to the countries AFCA works in but think about what that means: about 1.2 million people are living with HIV in this country. Bringing it even closer to home, a total of approximately 31,220 Pennsylvania residents are living with HIV (according to a 2008 estimate). A lot of people see the HIV/AIDS issue as a problem for developing and third world nations. But recently there has been a significant amount of reports on the problem here in America and especially in urban areas. For instance, some cities have the same prevalence rate as a developing nation in Africa. Just a few years ago Washington, D.C. reported a 3% HIV prevalence rate which is on par with or even more than some developing countries (such as Ghana). D.C. has been making improvements since then but it just goes to show that HIV/AIDS is not a foreign issue.

            Here are some great sources if you want to learn more about HIV in the United States: http://aidsvu.org/states/PA (you can also view other state profiles), http://www.avert.org/usa-states-cities.htm (HIV incidences by state), http://www.aidsaction.org/communications/publications/statefactsheets/pdfs/2004/pennsylvania_2004.pdf (specific to PA), http://www.statehealthfacts.org/profileglance.jsp?rgn=40# (you can view other states and compare them to one another on a range of health issues!).

More from Tanya's trip

A road of red dirt, dotted by deep holes, as wide as the road, as long as a car, and deep – filled with water. Are these little lakes deep enough for fish?  I don’t ask this silly question, but it does cross my mind as the truck crosses yet another puddle, with the driver declaring in broken English ”that was a piece of cake”.  As laughter escapes my mouth, I wonder if I’ve heard correctly.  Before the question is spoken, Rachel tells me that Edison, our fearless driver, learned this phrase from other visitors.  I smile. My smile meets the fish question and it settles while my body continues to bounce.

I listen to the Lingala flowing around me, picking out now-familiar works and making up the rest of the conversation in my head. Lingala is a trade language and is not a rich language, at that.  It would not be hard to learn this language, I decide silently, and I try to memorize words as I hear them.  Two hours pass quickly and I look up to see that we’ve arrived in Bwamongo.  Here, we are visiting the pharmacy where we get the medicine we donate to the clinics of the Tandala Health Zone (16 of them) and the Tandala Hospital.   I have been brought here by Rachel, Tony, Dr. Bienvenneu, and Edison. 

Since French is easier for me to understand, we conduct our business in that language, visiting the warehouse and making some small purchases for some doctors and the dentist at the hospital, who made requests when they knew we were coming here.  Soon, our business is over and we climb back into the back of the truck.  We settle our sore bums for another couple of hours of riding as we make it back to the hospital and I settle my brain to do some more listening and thinking.  My friends sing in the truck – lilting voices combining to make a gorgeous sound.  At least four parts in each song and is it simply amazing.

I let the sound wash over me and I look out the window and look at the women balancing heavy burdens on their heads.  Before we ever reach them, they move silently into the tall grasses that edge the road.  I quickly turn my head to see them through the back door window.  I am always surprised when one or two more people come out after our car moves on than the number I saw go into the grasses. I think how grateful I am that their disappearances are short-lived and that they are due to a peaceful car passing by.  Not long ago, women and children disappeared into tall grasses because they were running for their lives.  With soldiers ransacking, raping and killing, the grasses meant life.  Babies were hushed with soft singing and hands pressed over their mouths.  Mothers prayed and dragged children while looking out for water and edible leaves.  Soldiers walked by on the road and the lucky ones in the grass fled and counted the days until the soldiers went home.

More from Tanya and pictures!

The bathroom sink is black and it is moving.  Wait.  It is not moving, although movement is definitely present, as ants have taken over.  The bathroom is quite dark, so I can’t see clearly, but I can see enough to know that we have a problem – hundreds of ants.  I try not to keep the ants off me as I lean into the water barrel to get some water to dump over the ants, washing them down the drain and back to the earth.  I wonder if anyone cries for them?  Is there a mama ant out there, crying for her children?  At that moment, I don’t really care – all I want is to get those ants out of the sink which used to be white and is now black.

As the day progresses, I feel ants on me, in me and around me.  Sometimes, they are on me, but sometimes, they are just a thought, a feeling. 

As I walk from ward to ward at Tandala Hospital, talking to doctors and seeing first-hand what their needs are, my head swims with possibilities.  Everything needed is possible.  For a price.

Beds, birthing beds, mattresses, mattress covers, new floors, repaired windows, headlamps – all doable.  All available.  All out of reach without money.  God, give me wisdom.  Bless our work.  Help us help. Help us not do harm while helping.  The truth is that no child should have to spend the night in a dark hospital ward, all by themselves, scared and hurting.  No mother should lay on a metal bed without a mattress while waiting for the birth of her twins.

Twins. I hold a pair of day-old baby boys today and I felt full.  It was an especially sweet moment because both babies and their mama are doing well and they are healthy.  So soft and so new, these babies, yet uncounted.  Why count your babies, when they will likely die?  They’ll be counted once they turn five.  Until then, every day is a prayer. 

More from Tanya!

Here's some more from Tanya in the Congo!

Sunday June 19, 2011

I feel old time missionaries here.  Even though I can’t see them, I smell them as they walk by, fingers brushing their dusty books in the old bookshelves.  The books are well-loved and they are the books of my childhood, so I drink in their sight and sigh, knowing that those who lived here in the past are much like those who lived with me in Colombia as a child. The small fan in the corner, the one that needs non-existent electricity to function, sits by a cracked mirror, which, doubtless, saw many faces pass through this room.

The bottom bunk, wrapped under a mosquito net, is the perfect place to think and plan my day.  It is 5:00am.  How many others did that in this exact spot before me? After my quiet time is done and I have stretched out the kinks in my body and imagination, I search for my flashlight and sandals on to make my way to the kitchen.  It is still dark there, but I put a pot of water on the stove (thank God for gas!) to take the chill out of the morning bucket bath.  Nothing feels as good as that lukewarm water as I dump it over my head and it washes over my crouched body and my feet, which are protected by a pair of shared flip-flops.  After several house in a bouncing car to reach Tandala Hospital yesterday, this bath is glorious and I fell alive again.  I strive to only use ½ a bucket of water, knowing it is a precious commodity.  I am so grateful to have short hair.

Now, with the 6am light of morning, I am ravenous.  Peanuts and a cup of tea will assuage my appetite, as soon, we’ll head for morning devotions at the hospital before starting a day of meetings, photos, handshakes, and smiles. The song is sweet and doesn’t over power or overtake the prayer.  It enshrouds us.  It covers us.  It makes us feel like one, thanking God for His goodness.

Updates from Tanya!

For those of you who don't know, Tanya is currently visiting the AFCA programs and children in the DRC and Zimbabwe. She managed to get access to the internet and sent me some entries to post on the blog:

Dem. Republic of Congo

June 15 - 18, 2011

Ken and I arrived in Kinshasa on June 16 and stayed at a semi-nasty hotel with no running water in Ken’s room, some running water in my room and cockroaches.  My room had water, but it came in spurts and water was not to be found coming out of the sink.  Instead, it came out through the water tubes running on the side of the wall, flooding the tile bathroom.  This was a bit of a pain, especially when the electricity ran out and I thought I’d fall and break my neck on the slippery floor.  I managed to bathe using a bucket of water while diligently keeping my eyes focused away from the spider on the wall.  I figured if I gave him a wide berth, he’d leave me alone in gratitude for his life.  It worked well and we both slept in different rooms, that spider and I.

While in Kishasa, we spent time with Pastor Alenge, who is a great driver in a sea of mad drivers and casual walkers with a death wish. We ate tasty dinners at his home, cooked and served by his wife Betty and spend the day in his car, driving from place to place.  We went to the airlines office to deposit our suitcases which would forwarded to Gemena, to the bank to exchange money, to the church where the pastor lives and works, and to the grocery store.  All of these tips should have been doable in a couple of hours, but the traffic was so dense that it took us all day to complete these four tasks.

On Saturday, we flew to Gemena, where the air was thick with humidity and where sweat started pouring down my shirt and into my pants, finally finding its way to my ankles.  We arrived at the mission station where we were greeted by children who receive medicine from AFCA and who were holding a banner thanking AFCA for the hope they have received.  The children had t-shirts on which said “AFCA, thanks for giving us hope” and which almost made me cry.  Had I not been the only woman in the whole bunch of people, I would have cried, I am sure.  But, I held it together and really enjoyed the short but touching ceremony carried out by the various leaders of CECU and PEASIT.  Rachel arrived in time to translate the ceremony for Ken and me and it was a beautiful service.  The music was my favorite part, with different voices joining in to form a hymn that I recognized in my own language.  The music had a distinct African sound to it, with harmonies and clapping forming sounds and feelings that make me swell up inside – it is a sound that makes me smile and that makes me sorrowful, at all once.  It leaves my soul feel full and I know I am in Africa once again.

Now, on the 18^th of June, we sit in a small guesthouse  while Rachel cooks up some Ramen Noodles for dinner and we wait for the internet to work so we can write our loved ones back home.  The generator is working, so we are able to charge our cameras, phones and laptops, but we can’t get hooked up to the V-Sat quite yet. 

I am trying not to drink too much liquid at this time of night because I don’t want to have to use the outhouse unless my kidneys just can’t take it anymore.  I don’t like it when my flashlight catches shadows made by giant spiders or cockroaches.  I don’t like having to set my flashlight down in order to fetch water to pour into the toilet that doesn’t flush.  So – little water and soup for me tonight.

Outside, the dark is dark.  It is gorgeous and smells fresh due to the storm that passed this way, washing away the humidity and leaving behind the clean, earthy smell and cool temperatures that promises good sleep tonight.  I am told that this is not normal and that tomorrow, we might swelter as we sleep.  But, for now, I am looking forward to a great night of sleep, as last night was lost to a cacophony of noise outside our hotel windows.  Tonight, all I hear is the croaking of frogs, the chirping of insects, and the sound of chickens sleeping. I feel peaceful, which is such a welcome feeling after the oppressive, dirty, and sad feel from Kinshasa.  I’d be happy not to pass through that city again, but I know I must.  Next time, I will come through Bangui in Central African Republic.

Democratic Republic of Congo

The final country that AFCA works in that I’ll briefly introduce is the Democratic Republic of Congo. The DRC has been riddled with violence ever since its independence in 1960 (originally Congo, the country was renamed Zaire in the 1970’s and then became the DRC in 1997). Refugees from the Rwandan genocide flooded into the country and eventually the DRC found itself in the midst of a five year war that has been referred to as ‘Africa’s World War’. The violence is still present and rape has been a major issue. Last year a UN official actually called the DRC the ‘rape capital of the world.’ The adult HIV prevalence rate is around 1.3% and many studies suggest that this number is on the rise. The effects of the conflict in the region are mostly apparent in the poverty and lack of access to proper resources. USAID says that approximately 70% of the population does not have adequate access to health care. Women have been disproportionately affected due to the sexual violence that has occurred. Additionally there is a big orphan population in the country (around 8.2 million) who could be at risk for contracting the virus and according to a study done in 2009 in the DRC around one million of these children have been orphaned due to AIDS (see the USAID document for more on this). 

I’d recommend the BBC website for basic information on the conflict in the region (http://www.bbc.co.uk/news/world-africa-11108589) and USAID and UNAIDS for information on the HIV/AIDS problem in the region (http://www.usaid.gov/our_work/global_health/aids/Countries/africa/congo_profile.pdf) (http://www.unaids.org/en/regionscountries/countries/democraticrepublicofthecongo/).

Improvement in Ghana

As I was sifting through the news today I saw an article that immediately caught my eye. It read “How Ghana Has More Than Halved Its HIV/AIDS Rate.” The prevalence rate has apparently gone down from four percent to one and a half percent thanks to a national strategy plan and AIDS commission. This is clearly something to be excited about. But as I kept reading I noticed that there was no mention of homosexuality in the country. I’ve been doing quite a bit of research on Ghanaian culture in preparation for my trip and I’ve found that homosexuality is actually illegal and very much seen in a negative light. So I found it a little strange that the article mentioned reducing the stigma attached to HIV but nothing about homosexuality. In fact I sort of started questioning whether that 1.5% prevalence rate was really accurate. I looked up a little more on homosexuals living in Ghana and most of them are afraid to come out and instead make up this sort of secret society in the country. I think this article just about sums up the perception of homosexuality in Ghana: http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=211415. I’m certainly not denying the great achievement of the Ghanaian government in reducing the HIV/AIDS prevalence rate nor am I saying that these statistics are deliberately misleading or anything of the sort. But I do wonder how many people in that 1.5% that have HIV are gay and how many others are living HIV positive but are not reported. It’s just a thought. What do you think? Feel free to comment!

 Here’s the article on the Ghanaian governments success: http://www.npr.org/2011/06/20/137298597/ghana-vp-explains-how-country-has-more-than-halved-hiv-aids-rate. This should no doubt be used as a great role model for other countries on how to successfully curb HIV transmission.

Zimbabwe

There are currently about 1.2 million people living with HIV in Zimbabwe which is nearly one tenth of the population. 150,000 of those are under the age of 14 and half of all child deaths (ages 5 and under) are due to HIV/AIDS. Similar to Kenya, the government of Zimbabwe was slow to respond at first. However, the response has still been slow mostly in part to a series of devastating social and political issues. The government of Zimbabwe, run by President Mugabe, has been subjected to scrutiny from the international world for years which has hindered many HIV/AIDS efforts. Some foreign donors have been reluctant to get involved in the country due to its political turmoil. Other socioeconomic issues such as inflation, land resettlement, unemployment and food shortages have exacerbated the HIV problem. Despite this grim picture, the prevalence rate of HIV in the country has been on the decline. However, the political, social and economic issues of Zimbabwe stunted its ability to make substantial progress regarding HIV/AIDS and the country still has a long way to go.

            Zimbabwe’s history and issues are very interesting and a simple search of “Mugabe” produces an incredible amount of biographies and memoirs of people living under his rule in Zimbabwe. As usual I recommend UNAIDS website (http://www.unaids.org/en/regionscountries/countries/zimbabwe/), the CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/geos/zi.html) and this article which addresses the connection between the political and social issues in the country and the HIV epidemic (http://www.prb.org/Articles/2004/ZimbabwesPoliticalandEconomicProblemsHinderEffectiveResponsetoAIDS.aspx).

UN Meeting on AIDS Sets High Goals for 2015

The UN General Assembly High Level Meeting on AIDS finished up on the 10^th. Some of the goals set by world leaders included halving the infection rate among IV drug users, eliminating new HIV infections among children and reducing sexual transmission by 2015 and also achieving the Millennium Development Goal 6 which aspires to halt and reverse the spread of HIV by 2015. As mentioned in my last blog, pediatric AIDS was given a significant amount of attention as well at the meeting with particular focus on gender inequalities and its impact on HIV transmission and treatment. A panel discussion centered on females and HIV brought up the issue of the unequal access to HIV treatment for women in many countries which has a significant effect on the pediatric AIDS issue. The meeting chose to focus on equal access to treatment for women as a means of combating mother-to-child transmission. The meeting did not set up any concrete plans or programs and only served to set goals for the UN member states to aspire to regarding HIV/AIDS. The goals are incredibly ambitious in my opinion and it will be very interesting to see the results in 2015 and which member states really commit to achieving the goals.

            If you would like to read more about the goals set forth and the discussions you can go to www.unaids.org. There is also an official website for the meeting at: http://www.un.org/en/ga/aidsmeeting2011/ where you can read the final declaration that was adopted titled “Political Declaration on HIV/AIDS: Intensifying Our Efforts to Eliminate HIV/AIDS”.

Kenya

            HIV in Kenya first began to spread through its sex workers (mainly in Nairobi). Presently, women are disproportionately affected with prevalence rates nearly twice that of males. Kenya was accused of not initially responding as aggressively to the HIV problem as its neighbor country, Uganda. However, since 2000 Kenya has made significant strides in prevention and care. Prevalence has decreased from its peak rate of 13.4% in 2000 to 6.9% as of 2006. Around 20,000 children are reported as HIV+ each year in Kenya which is decreased from the rate in 2000 at around 40,000. However, according to the Kenyan newspaper Business Daily, these figures are not accurate and many more children are infected but not reported (http://www.businessdailyafrica.com/-/539444/1176552/-/122i2bbz/-/). This lack of information has hindered the ability to implement effective pediatric programs according to the article. Additionally, Kenya has a very low number of pediatricians that are mostly concentrated in urban areas which poses major problems for children living in rural areas to get treatment.

On a related note: the UN is currently holding a High Level Meeting on AIDS and First Ladies from around the world have put forth pediatric AIDS and gender inequality as top priorities. I will be following the UN meeting and writing more on the issues that are presented and focused on. If you would like to read more on it as well you can go to www.unaids.org.   

Prepping for Africa

In preparation for my study abroad this upcoming fall to Ghana I, unfortunately, had to get six shots and order anti-malarial pills on Wednesday. But the shots didn’t phase me nor did the daunting task of taking those malaria pills every single day the whole time I’m in Africa. What truly affected me during the nearly-two-hour session was the way in which Ghana was perceived by the nurse. I know she certainly didn’t mean any harm by it but I also got the feeling that she had never been to Africa. As she was giving me precautionary advice she kept referring to the Ghanaians as “them” and was telling me not to trust their police or hospitals or water or anything for that matter. I was informed that I absolutely should not get tap water in my mouth nor should I eat anything that has not been cooked. I should not use their hospitals unless absolutely necessary since their doctors are not up to par with American standards. I should remember that their police are not to be trusted and have no interest in helping foreigners. And as she kept listing what I should and should not do all I could think was “Do you expect me to stay holed up in my dorm room the entire time?” There’s no need to fear going to a country in Africa (or any country for that matter). Yet, this is what she seemed to want—she wanted me to fear all the diseases and parasites and dirty food and unsanitary water that I would be exposed to. She had this strange perception of Africa as this dangerous and dirty place and it really bothered me. I’d love to hear from people who have been to Africa—have you experienced this perception from others?

A Cure?

This week marks the 30 year anniversary of the discovery of AIDS. There still has been no cure but an article on Reuters does provide some hope.  A man in Berlin was, in fact, “cured” of AIDS. There is a genetic mutation that is well-known to be resistant to the virus. The CCR5 delta 32 mutation has been found in a (very) small proportion of people. Timothy Ray Brown was both HIV positive and sick with leukemia. He needed a bone marrow transplant and his doctor suggested a transplant from someone with the genetic mutation. Miraculously it worked and Brown survived and has since not had any signs of the virus replicating and his doctor does not believe he will have any problems with HIV ever again. Obviously a very risky procedure such as this could not be implemented on all HIV+ patients and, in fact, this could be the only success story of its kind.

This story does brings hope that a cure could be found in the near future but it has also sparked a debate, or, rather, reignited the debate over whether money and attention should be focused on prevention or finding a cure. Some believe that research for a cure would detract from the immediate need for stemming the transmission of HIV. It’s an interesting debate and I still don’t know where I truly stand on it. What is your view? Feel free to share your thoughts on this subject or on anything else!

Here’s the link for the article: http://www.reuters.com/article/2011/06/01/us-aids-idUSTRE75030I20110601