HIV Gets Personal

Botswana is a country plagued by HIV. It is estimated that nearly a third of the country is infected, although those of us working at the village level believe this is likely a very conservative estimate. And that doesn't even begin to take into account the devastation the disease has brought on the rest of the populous, most notably the children who are often orphaned and those loved ones who are left to assume the burden. The country has set lofty goals to eradicate the disease but, unfortunately, seems to be falling short. This is why Peace Corps is here. We are here to work in the health sector - improving organization's capacity to help - and to inspire and motivate children and youth to live healthier lives. As such, we meet and befriend many people who are living with HIV.

The work I am doing in Botswana puts me in direct contact with numerous people who are HIV positive. Whether it be through assisting my NGO and the Clinic with improving home-based care services, collaborating with the Support Group on projects, or playing with children affected and infected, I have gotten to know so many individuals whose lives are forever impacted by the disease. It has opened my eyes and my heart in ways I could never have expected. 

That being said, there has always been some semblance of distance. Although they are people that I work with all the time and who I care about, I have been able to look at them as colleagues or smiling children first and let the disease take a backseat. I don't often have to see the deterioration nor experience first-hand its impact. Their HIV status is only one aspect of who these people are and, honestly, it isn't all that important. As long as they are taking care of themselves - adhering to their ARV regimen, eating nutritiously, and being supported by family/friends/caregivers/my NGO - then we can all carry on with our lives as normal. That is, until two weeks ago...

Two weeks ago a very dear friend of mine sent me a text message that said "Kamogelo, I am having a very serious problem. I am not sure when I will be coming back but I need you so I will find you when I return." I frantically tried calling her but she did not answer. I waited (im)patiently for nearly a week before I heard from her. When I did, she assured me that she was okay but that she wanted to talk in person.

With nervous hugs and hand-holding, she carefully told me that her husband of nearly twenty years, who had been very sick lately, underwent a series of tests at a nearby hospital. After ruling out prostate cancer and a slue of other things, he finally succumbed to an HIV test and learned that he is HIV+. In shock, he refused to get his CD4 count read to find out if he should start ARV treatment, despite urging by the doctor and my friend. My friend said that what happened next was an almost psychotic episode by her husband, who left the hospital before he received HIV counseling and demanded they go directly to their lands in the Kalagadi. He then refused to say anything more on the matter, would not discuss his newfound status, and began making ridiculous requests and talking gibberish. This lasted for four days. 

After returning to the village, my friend's husband holed himself away inside the house. He got even more sickly. He continued to refuse counseling or to get his CD4 count tested. My friend begged him to talk about his status with her or with a counselor from the Clinic or with a trusted friend. She hasn't been able to process her own feelings about his new status because she has been so overwhelmed with helping him grapple with it. She is constantly worried about him.

This is the first time I have witnessed this side of HIV - the emotion, the turmoil, and the tragedy before the recognition and acceptance. To listen to my friend talk about the struggles she is going through and how hard it is for her and her husband to come to terms with things has been heart-wrenching. This is someone who I deeply and profoundly love and she is going through something I cannot even fathom and I don't even have any point of reference. Everyone I know who is HIV+ have already come to terms with their illness to the point where it's practically a nonissue. And every time I ask her how she is doing and how she is coping, she (of course) brings the concern back around to her husband. It is devastating to feel so helpless. I can only imagine how they must feel.

I am humbled that she chose me to talk to and believes in our friendship enough to share this burden with her in some way. Right now, all I can offer her is hugs, which she says is enough. 

The Words of my Fellow PCVs

Sometimes other PCVs express events and sentiments and experiences in such a way that no other words could describe them as accurately. (And sometimes it's just a perfect anecdotal story to show what life is like here!) I often read other Volunteers' blogs and feel like this. I wanted to share some particularly pertinent blog posts, with the hope that it will paint a more clear picture of what I am feeling and what life is like here in Botswana. Please take some time to read these noteworthy and amazing posts by my friends:

On Culture:

"African Time" 
Cultural Norms and Personal Acceptance
Clothing in Botswana 
Traditional Healers 
Superstitions in Botswana 
Hitchhiking
Charity in Botswana 
Hair 

On Language:

Learning Setswana 

On Food:

What We Eat 
Sugar Cane
Eat With Your Hands 

On Work:

Safe Male Circumcision
HIV/AIDS: Remembering The Individual
HIV Solutions
In The Schools
Children 

On Growth:

Becoming "Able" 
Year One Reflections
Lessons
Integration
United States and Identity
Americans and Donkeys 

On Experiences:

Death  and Funerals 
Botswana Metal Festival
Life Without Running Water
For The Record...

On Emotions:

Falling in Love 
Mind Games
Dealing and Support
How We View Africa

And there are many many others that I think will help shed light onto this experience and give you all a more holistic view of life here. I learn so much from my fellow volunteers. I hope you do too.

GWB Visits Botswana

Former President George W. Bush and his wife, Former First Lady Laura Bush, visited Botswana on July 5th. They were here to promote an expanded cancer treatment program to specifically address cervical cancer prevention. Included in his trips were visits to Princess Marina Hospital, a number of clinics, the UPenn Partnership, the US Ambassador's house, and MY NGO. What was the only thing that "made the cut" for the official video of his visit? That's right, MY EVENT at MY NGO! I kid you not! Watch the video below and you will see! My event starts at the traditional dancers (Nare tsa Pina dance group who graciously donated their time) and continues on to a discussion with members of Peace Corps, and finishes with the precious children from my OVC Preschool. Yes, that means there's six minutes of my event broadcasted online as the main attraction of President and Mrs. Bush's visit!

Perspective (In the form of a "Case Study")

On a few occasions, I have discussed a family that I work with in my NGO's home-based care program. The family recently lost a daughter to AIDS because she waited too long to test. She left behind her mother (who remains one of the sickest people I have ever seen in real life), her daughter, her sister and newborn baby, and four small siblings. Her sister, while in the hospital giving birth to her baby, discovered she is also HIV+. She has gotten very sick since delivery and now is inflicted with TB as well. Her baby remains in the hospital but mom has returned to the house to live out her days with her family.

This family, all seven of them, live in a one-room shanty house. There is no water on the property and no toilet/latrine. They defecate into a bucket and bring it to a neighbor's house to dispose of in their latrine. The daughter, who is both HIV+ and suffering from TB, is too sick to do even this much. Pampers (diapers we hand out to those in need) are almost impossible to come by these days, as there has been a shortage around the country. My NGO is trying to make a plan to help this struggling family if, for no other reason, than to keep the four small children and the newborns safe from infection. (Besides HIV, we are worried about them sleeping on cold concrete floors this winter and also being piled into the one-room house with someone who has TB. We are also trying to make plans for the future, as these children may be orphaned soon, losing their grandmother and both of their mothers.)

In the past, my NGO has managed to build homes for families like this one. The cost to build suitable living place? About $5,000 (with donations of labor by the community). It is amazing how much can be done for so little money here. This would be our ultimate goal to help this family (and we have found an abandoned structure that we could build from). We have started making contacts with people to try and come up with a solution and a way to make this a reality. But this situation is dire and we need to do something sooner, so we are starting with building a pit latrine on the property.

Imagine for a minute that this was your family or someone you know. Picture these children huddling together this winter and caring for their sick family. It is heartbreaking. This is a reality here for a number of the patients we work with. And yet they keep smiling, welcoming every little thing we do for them - be it come to sweep their house or bring them a hot meal - so graciously. It puts things into perspective, doesn't it? I know that it reminds me every day that I am fortunate.

Losing Another Patient: Prayer Service and Mourning

About a month ago I blogged about losing a young girl to AIDS. She had waited too long to be tested for HIV and died within a few weeks of finding out her status. It was a tragic loss but also one that has motivated me to make significant efforts in getting people tested early and often. Hopefully her death won't be in vain.

Recently, we lost another patient from our home-based care program. She was an older woman, a grandmother, who was both HIV+ and diabetic. We had been transporting her to medical appointments for a long time and helping the family with her other medical needs. Sadly, her condition had deteriorated to the point where she slept on a mattress on the floor because her family could not get her onto the bed and she could no longer do anything for herself. She died with her large family by her side.

As is tradition here, the week preceding the Saturday burial was filled with prayer services. These are gatherings where friends and villagers come together each night to pay their respect to the family and the deceased. There is often wailing tears by those closest, prayers made by the guests, and some of the most beautiful singing you will hear anywhere. The prayer services for this sweet grandmother was no different. I sat among the women, helping to knead the dough for the diphaphatha that would be served, and listened to their voices fill the air. There has hardly been a moment in my life where I have been filled with more emotion. The tears of so many over the loss were heartbreaking but the togetherness of the community was palpable. By the end of the first night, I had met countless new people, cried alongside a small child (a grandchild perhaps?), offered a blessing to the family, was in awe, and felt a range of emotions that seemed in perfect contrast to the last.

Sadly, after so many losses in this country, these services run like a well-oiled machine - every person has a role and they all gather to make sure it is fulfilled for the family. There are people leading the services, those making the bread and tea and the greetings being given and songs being sang. The loss aside, they are a beautiful testimony to the people of Botswana and their sense of community. I am grateful for being allowed to be a witness to it.

"There is no future, there is no past, I live this moment as my last"

Last week I spent my days observing home visits for HIV+ clients enrolled in our home-based care program. What this means is that I went around the village with the Head Nurse from the Clinic and a staff member from the NGO to meet with people to assess their health and what our organization can do to help. My role in these visits would be nominal at this point - mostly to meet more community members, gain a better understanding of the issues in Gabane, see how the visits are conducted, and offer suggestions for how to help the people and how to better coordinate and carry out visits. I was both anxious and excited to be a part of this side of the organization.

I have to admit, most of the visits were quite unsettling and it's taken me a week to adequately process. Throughout training, Peace Corps threw statistics at us and discussed the many issues in Botswana but it is not the same until you have seen it with your own eyes. In a sense, I was sheltered from the reality having only seen one side before now - the gleeful children at play in the OVC centers. While it was heartbreaking to know their stories, I had not been invited into the homes to see what HIV/AIDS looks like in the raw. In actually going into the homes, I was able to clearly see the difference between simply having knowledge of something and then actually experiencing it. This reality brought my consciousness to a whole other level. As we went from home to home, greeting and meeting with clients and their families, I was struck by the magnitude of devastation that HIV/AIDS has brought to this village and the sheer poverty that exists. One household in particular paints a clear picture. Let me tell you that story:

We took an off-road path that bumped and thrashed the combi around and then turned into a small compound. There was one dilapidated stone building and then overgrown weeds waist high. I thought we were turning around to go back the way we came, seeing as how there was no room to do so on the path we had taken. But then the driver turned the combi's engine off and the Head Nurse said to me "lets go" as she opened the sliding door to get out. I was a little startled but got myself together as we approached the front door, which appeared to be nothing but a piece of tin roofing leaning up against the opening. We knocked ("ko ko") and entered the one-room building. There was a young girl sitting on the floor on a blanket and a mostly naked woman laying on the bed that took up the majority of the space in the house. We were there to see the woman that was now mostly bed-ridden. She was skin and bones and more feeble than any person I have ever seen. Even still, she kept a smile on her face (as much as she could muster anyway) and spoke to us in a joyous tone. She told us that she had been having trouble getting to her doctor's appointments and requested transport as it was available. We committed to help her. She then informed us that her daughter, who was sitting on the floor next to us, had just tested positive for HIV. (Transactional sex is common here, which made me wonder: With this family so poverty stricken, could this girls' status be a result of this? What kind of person would take advantage of a young girl that needs help? These are some of the issues we face every day.) The Head Nurse talked with the teenager for some time and they agreed she would come to the Clinic for counseling and then to enroll in our program. I could have cried in that moment. Looking at this family that was so poor, meeting this mother who was so sick but who was keeping as positive an attitude as possible, and then learning that her daughter was infected too - it was so devastating. What lessons were being missed in this home? in this community? Why do Batswana still refer to HIV/AIDS as someone "being sick" instead of calling it what it is? How can I help start the discussion? Will the suffering ever stop if people don't face the truth and learn from it?

The home visits have left me with a lot of questions and some frustrations that I need to work through. I wonder about how much of an impact we, as Peace Corps Volunteers, can truly make. Real change comes from the community and from within. But I needed to be educated and shown the reality here if I am going to have any chance of helping. I need this knowledge if I am going to be effective, however difficult it may be to see. And, in the end, it has made me even more compassionate because I have seen what it does to people and to their families. This compassion is what will rededicate me when the work gets tough. These are good people and they deserve more.

World AIDS Day 2011

Today is World AIDS Day. This is an important day around the world and one that is especially important to Peace Corps Volunteers in Botswana. Botswana has the second highest HIV/AIDS infection rate in the world, with an estimated one-third of the population being infected. As such, each of us has been brought to this country to work on HIV/AIDS issues at a grassroots level in an effort to get to "zero new infections" by 2016. It is an issue that we have become passionate about and one that plagues our thoughts and motivates our actions. For me, that means working most directly with orphans and vulnerable children (OVC) and in helping design programs to work with this demographic.

To learn more about HIV/AIDS in Botswana or the work that PCVs are doing, please click on the following links:

World AIDS Day in Botswana

HIV/AIDS in Botswana

A Message from the Botswana Network on Ethics, Law, and HIV/AIDS (BONELA) on Why Botswana Will NOT Achieve its Vision 2016 Mission

Save the Children: World AIDS Day

Botswana PCV Ross Szabo: What the Struggle Against Obesity and HIV/AIDS Have In Common

Peace Corps, Volunteering, and World AIDS Day

What is World AIDS Day?