Sunday, March 11, 2007

"Jambo" from Kenya

Hi everyone.

I’m sitting on the back porch of my room, looking through the palm trees and brilliant yellow African rose bushes down to the banks of Lake Victoria - the largest in Africa .

I rolled a lucky seven here, given other places I’ve stayed. We are in a town in Suba District called Mbita, in far southwestern Kenya , near the border with Uganda . Our housing is at an educational facility that includes primary and secondary schools for local kids. It is truly idyllic – and we’ve got running water, which is a real luxury in Suba. But I’ll get to that in a bit.

In Suba, HIV and AIDS are having a catastrophic impact on every single person in the region; someone either has the disease, is helping care for someone with it, or a child whose parents died of it.

Here’s a staggering set of statistics for you: while the rate of HIV among the adult population of Kenya is around six percent, it is 38 percent in Suba. What’s worse, many of those with HIV also contract tuberculosis because of their compromised immune systems. Throw in the heightened incidence of malaria and you’ve got a population that’s literally being decimated.

In gathering places and markets everywhere, you see posters, signs, people wearing t-shirts with messages advocating AIDS and TB awareness, prevention, testing, and counseling. The word is slowly getting out. Four years ago, when IMC began working here with funding from PEPFAR (President’s Emergency Plan for AIDS Relief) and the CDC, rates of HIV were even higher – 44 percent.

But there are deep pockets where generations of behavior are damn difficult to reverse and where people are living in such remote areas that information doesn’t easily get to them. These are the areas most often ignored by the rest of the world, so they are where IMC is focusing its activities.

That means hours by boat across the lake, or in a Landcruiser, traveling along dusty, rocky, unpaved roads to reach people who have close to nothing except the mud huts where they live, their family members, and a disease that is destroying all of them.

Our first day here, we set out with a handful of IMC community mobilizers from Suba to a remote “cul de sac” of mud huts where a large extended family lived. Our guide was a phenomenal woman with IMC named Grace Muthumbi, a nurse who is our HIV/AIDS Program Coordinator based in Nairobi . Grace’s face was badly burned in a fire in 1991; she has had to confront issue of stigma ever since. She came to work for IMC in 2000, hoping to help others stigmatized by society because of diseases like AIDS.

When Grace and the rest of our small group walked into the mud hut we found waiting for us the patriarch of the family, his brother (both in their 60’s), his daughter and his two wives. Polygamy is practiced by about a quarter of the population of 165,000 in Suba, making the spread of HIV and people’s (especially women’s) ability to protect themselves from it that much more difficult.

This family was receptive to our visit and gave their consent for me to videotape. They knew the basics about the disease and that it can be spread through sex. The community mobilizers had a relaxed conversation with them, dispelled some of their misconceptions, stressed the need for taking personal responsibility and using condoms, and talked about the importance of taking medications properly in the event any of them tested positive.

The family then agreed to give blood and receive their test results immediately, right there, right in front of us and my camera.

I wasn’t fully prepared for this.

After taking their blood, the counselor examined all five test stick-results. I watched him and again pondered the statistics for Suba: 38 percent. There are five people in this room. I was suddenly very troubled by the odds.

One by one, the counselor showed the two older men and the wives their results, holding the test stick before them, and the chart displaying two columns of results: positive and negative. Each of their results was negative.

Then he took the 26-year-old daughter to the other side of the room, away from the others. He showed her the stick and how it compared it to the chart. He looked at her and whispered, “positive.” She stared at the stick, without expression. Her whole life was changing.

I shut off my camera and walked outside.

A different counselor took the young woman to another hut to talk with her about the results and the drug regimen she now should follow. She agreed to take medications.

I know that without IMC this woman (who has no children) likely wouldn’t have found out she had HIV ‘til much later - perhaps when HIV turned into full-blown AIDS; wouldn’t have started taking drugs that could save her life; wouldn’t have informed her husband, from whom she was already separated, that he was at risk. I know it is good that we’re here. This is what it’s all about. People get AIDS and we have to do our best to strangle its impact.

But it was crushing to watch this unfold for her.

The next day Grace and I traveled two hours in the opposite direction to some remote villages and to a clinic that IMC built primarily for the treatment and prevention of HIV/AIDS, TB and malaria.

With us was IMC’s Country Director, Peter McOdida, who is a native of Suba. Peter is fantastic – big, toothy smile and a great laugh. He’s loved by his staff and has a warm, fatherly way with the beneficiaries as he offers guidance and encouragement.

At the clinic I was introduced to Risper and her husband, Sebastian, a vibrant, gregarious couple in their 30’s. In 2004, Risper met with an IMC mobilizer who urged her to get an HIV test. She tested positive. At the time, she was pregnant with her third child. She tells me that when she first learned of her status, she was afraid for her life and that of her unborn child – and afraid to confront her husband with the news. But an IMC counselor convinced her how important it was to have Sebastian tested as well. He did, and he was positive.

IMC worked with Risper and Sebastian to counsel them, get them treatment, and try to prevent transmission of the virus to their child with the help of prophylactic anti-retroviral drugs and more effective feeding practices once the child was born.

Today, that child is a gorgeous three-year-old named Salome, who regularly tests negative for HIV. She very likely would not have been so lucky had her parents given in to the widespread fear and denial of the disease.

Risper and Sebastian are currently healthy and are now employed by IMC as community mobilizers, raising awareness about HIV. Risper says she feels strong and loves knowing that despite the adversity she faces, she is helping to save the lives of the people in her community.

The next morning, I was up at 5:30 to meet the boat that would take us across Lake Victoria to a series of islands where the primary engines of economy are fishing and prostitution. HIV is rampant here; it’s difficult to mobilize and educate villagers because of the transient nature of the population, the intractable stigma surrounding the disease, and the fact that the commerce of sex is essentially sanctioned by beach community leaders.

There is a massive need for robust HIV/AIDS programs – not to mention water and sanitation systems.

As we approach our first destination, Mfangano Island , I see a shoreline crowded with hundreds of long, colorful fishing boats. But once we dock, the conditions we find are appalling. Garbage is strewn everywhere - mounds of it. And packed in tightly across the island are tiny corrugated tin dwellings. This is for all intents and purposes a slum.

There are about 6,000 people on each island, and only one or maybe two latrines for all of them. When it rains, the refuse washes down to shore, where people bathe, clean their clothes and dishes, and collect water for drinking. It’s completely unacceptable but it’s all they have.

On these islands, nearly all the men fish for a living, then travel from beach to beach, selling their catch. You find that many of the women have children but no husband or partner (many have died of AIDS and other diseases), so they must find ways to buy food for themselves and their kids. But the only financial opportunity available to them is selling fish. To do that, a woman is required to first go to the chairman of the beach community. He then assigns her to a man, who will give her fish to sell. The understanding of course is that the man will demand sex from her in exchange for the fish.

The women tell Grace and me they desperately want other options, perhaps building more latrines for pay, or opening a cafe. IMC is working to persuade the various beach committee chairmen to work with the women in devising different income-generating opportunities, but ritual is difficult to undo. And let’s be honest, the men like getting sex.

IMC has enlisted hundreds of women and men with HIV living on these islands to form groups and become community mobilizers. On this day, we’ve brought a big box of t-shirts branded with IMC and Kenyan Ministry of Health logos, promoting HIV awareness and the prevention of mother-to-child transmission – what we call PMTCT. After discussing strategies with these groups for fighting HIV and creating new economic livelihood opportunities, we hand out the t-shirts. They proudly slip these on and then beam for my camera.

I think about the small steps you have to take. I think about the man on Remba Island who walked away dismissively when we tried to talk to him about HIV, but who later was engaged in that very discussion with one of the community mobilizers wearing his new IMC t-shirt. It’s tough to chip away at taboos, and getting buy-in from men is generally so much harder than from women.

But in just this three-day period I witnessed dozens and dozens of people being reached for the first time. Maybe in another four years the HIV rate will be down another six percent. How many lives is that? By my calculation, just over 10,000.

Next week I'm headed to the north, where Starbucks just gave IMC a $1 million grant to build a water and sanitation system serving about 180,000 people.

I love you all...


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