What You Pretend You Don’t Know Won’t Hurt You!?

Today I met an 11 year old boy who is HIV+. He was born positive, had no say in the matter and now lives his life knowing that one day his cd4 count will drop and he will either have to start taking Anti Retro Viral drugs (ARVs) or fall prey to opportunistic infections that will lead to his death. It is possible to reduce the chances of transmission of HIV from mother to child if it is known that the expectant mother is positive. However, convincing mothers to get tested and start the necessary medication if they turn out to be positive is a hard task because most women remain stubbornly in denial about the possibility that they could have contracted this virus. Denial is an act that has great destructive strength and is not confined to mothers in Zambia but exists in all sections of society all over the world.

While I have seen many in denial, I could not say to you that people in Zambia lack awareness about HIV/AIDS. I have found that the lay person’s knowledge about the disease, its transmission, methods of prevention and even treatment is far greater than that of people in the UK or India (having lived in both countries I speak of just these 2, though I am sure one could list many more). In fact, the level of ignorance and denial about HIV and other sexually transmitted diseases in the UK and India is frighteningly high. The consequences of this can be significant in both countries though the potential impact might be greater in India as AIDS is silently and surely creeping up on India’s youth.

With the decline of traditional values in Indian cities, young men and women have become increasingly promiscuous. I make no moral judgment on the issue but merely wish to point out the different implications that promiscuity has in the west and in India. While it is quite standard, across the globe, that young adults exercise their freedom to have premarital sex, many sexual partners (consecutively or at the same time) unprotected sex with multiple partners (again, this could be consecutively or at the same time), the difference that I have noticed between the youth in the west and that in India is this – empowerment! It is quite normal for youth in the west to be open about their sexual activity. This gives the advantage of being able to openly seek medical help and keep track of their sexual health. The situation is just not the same in India. The average sexually active Indian youth has never been tested for HIV or sexually transmitted infections. Even though they are aware of the possibility of having contracted something they will be hesitant to seek medical attention. This is a result of stigma or perceived stigma against sexual activity/promiscuity. Though it is still not OK for the Indian youth to engage in sexual intercourse outside of wedlock, it happens, and stigma persists. The issue that arises out of this partial rejection and partial preservation of traditional values is that the Indian youth remain in denial about their sexual health which should be a cause of great concern.

It will take ages for attitudes to change. I cannot even say with a great deal of confidence what these attitudes should be. Working so closely with people living with and affected by HIV/AIDS I feel there is strong case to be made for abstinence. But I do not think it very realistic to hope that young people will stay away from sex. Hoping that this will be the case and in fact assuming that it is might be the easy Indian way but it is extremely dangerous. The repercussions of such an attitude in the age of HIV can and possibly will be disastrous. We live in the 21^st century, everything we hear about it is not ‘out there’ but ‘right here’! So while we wait for things to change, my message is really quite simple – be strong, shake yourself out of denial, get tested and use a condom.

Hakuna Matata

“It’s a problem free philosophy”

- A warthog named Pumba

I recently had the loveliest holiday on Lake Malawi. Snorkeling, boating, hiking and eating lots of seafood, it really doesn’t get much better than that. Malawi is a beautiful country and the lake just has the most diverse array of fish species I have ever seen. Apart from the exotic and colourful fish that one sees when snorkeling in the lovely rock pools, there is a variety of fish available for eating, the most delicious of which is the ‘Chombe’.

The lake is central to the lives of those Malawians that are lucky enough to live around it. It supports the local fisherman (though due to over-fishing this is becoming more and more unsustainable), it attracts tourists and therefore benefits the local tour guides, boatmen, artisans and lodge owners (though the latter lot is mainly white, not local). The lake also provides a steady water supply to the surrounding villages. As you walk along the lake shore in the morning, you can see people bathing (the soap, shampoo, loofah type of bathing), washing their dishes, washing their clothes and/or generally having a swim in the lake. So when we decided to have a New Year’s Eve barbeque and were looking for a spot to gut and scale the Chombe we had just bought from a local fisherman, well, no problem, we were just directed to the lake. Post feast dishwashing was also done in the lake, using the gritty sand in lieu of dishwashing liquid and scrubber. Hakuna matata!

The only issue with all this usage of Lake Malawi (or Lake Nyasa which is why Malawi under the British was known as Nyasaland) is that this fresh water lake in southern Africa is perhaps the worlds most Bilharzia ridden spot. Bilharzia or Schistosomiasis is found in fresh water lakes where a certain type of snail is present. The larvae of the schistosome penetrate the skin and travel to the blood vessels in the urinary bladder and intestine where they reproduce. However, there is no need to worry about deadly diseases contracted by swimming in lakes, for, hakuna matata, you’ve got praziquantel! Just pop a few pills and you’ll probably be fine.

So after lots of swimming, eating, drinking and being merry despite snail infested lakes our sojourn at Cape Maclear came to an end. On the first day of 2009, at 5.30am, my fellow travelers and I set off for Lilongwe (the capital city of Malawi) for one night en route to Zambia. There are two options for traveling between Cape Maclear and Lilongwe. One is short and sweet, the other, well, you’ll soon know more about that. On our way out, we decided to take a bus from Lilongwe to Salima and then a short (45minute) speed boat ride to Cape Maclear. This was just lovely. However, at the end of our holiday when the time came to return, we were too broke to pay for the speed boat so decided to hit the road! Now the route was as follows – jump onto back of pickup truck that takes you out of Cape Maclear to main road, jump onto the back of another pick up truck after that that takes you to the nearest bus station, then take mini bus from this bus station to Salima, on reaching Salima jump onto yet another minibus going to Lilongwe. Sounds slightly annoying yet fairly easy? It wasn’t!

It would be all the more dramatic for me to be able to tell you the time frame for all this but to be completely honest I have no recollection of how many hours we must have spent on this journey. Time was no longer a concept that mattered. In fact, it was the last thing on our or anyone else’s mind. The only thing that mattered was survival between point A and B. Managing to stay on the truck, not getting flung off, squashed, trampled or suffocated, gathering enough strength to bear the icy rain and wind, hoping that when the tyre went *BANG* and the truck began swerving that we would be able to avoid the tree, the ditch and the oncoming traffic. These things became much more relevant than time.

Needless to say, it was a journey from hell. The strangest way I have ever begun a new year. But that’s not why I decided to write about it. Not because of what it meant to me, and how it affected me, but because this is how it is in Africa. The Malawian people deal with this on a daily basis. There is no reliable, timely, safe public transport system. There is not enough money for people to have their own cars. What you have to do to get from one place to the next, be it from the lake to the market where you can sell your fish, or from your home to your school, or from the nearest shop to your home, you get there on the back of a run down pick up truck, driven by a drunken stranger, packed in the back like sardines (and yes, along with sardines). The resilience that these people have built to the stresses of their everyday existence is just tremendous. I have the greatest respect for people who can face such circumstance with a sense of humour. For I never could. So while I sat there fretting and fuming, all my fellow sardines could say to me was Hakuna Matata!

Whats in a Name?

When it comes to naming their newborn child couples around the world go to great lengths to find the right name. Much thought and research, quarreling and consulting goes into the naming process. Some like names pregnant with meaning, others choose them for their sound or the number of alphabets they have if they are bothered about numerology.

Here in Zambia though a name is a name and sometimes it’s all about practicality. If a child is born on a Friday or a Sunday or a Monday well, that will be his name. Similarly a first born could very well be named First. Other interesting names I’ve come across are Charity, Innocent, Loveness, Ringness, Stone, Opper and my personal favourite -Exnobert!

The Inswa

Every year at the start of the rainy season the flying termites appear. I don't know where they suddenly come from but once they arrive you can't miss them. The inswa, as they are called are rather large and move in swarms of what must be hundreds.

The other night, while my house-mate and I were settling down to watch an episode of 'Grey's Anatomy', we heard a loud flapping sound coming from near the dining room light. I have no clue how, but one of those giant insects had managed to enter the house despite our taking every precaution against just that. So we decided that the creature must die. We must have spent about ten minutes comically swatting the air with dusters trying to get the evasive insect down . Eventually with one random blow it was on the floor.

After our little victory, we toyed with the idea of soaking the termite in water and then frying it up as a snack, something we had heard was commonly done as Inswa are quite the delicacy here. We decided this was a good idea but one was not going to be enough so we would wait till we had collected some more. We sat back down to continue watching 'Grey's Anatomy', a new un-winding ritual in our house. And then again we heard the flapping.

Our night was spent killing insects, shrieking, giggling and taking photographs of what had turned out to be an insect safari in our living room. Our killings were mainly inswa and beetles though a cluster of flying ants, a stick insect, a beautiful moth, a locust and a happy looking lizard were also spotted.

Since the insect killing was not enough to work up an appetite, we decided to refrigerate our inswa for frying the next day. Of course, the next day we chickened out. But I am determined to try this delicacy soon. I believe they taste like nutty scrambled eggs. Will have to find out for myself.

Meeting the Team

Friday 7th November 2008

Today was a great day! We were picked up from the hospital and driven to the Buntolo drop in centre. ‘Buntolo’ means oasis and it is the hospital’s HIV/AIDS centre. It was to be a day of introductions. We, the new VSO volunteers were being taken there to meet the ‘Home Based Care’ team. As our car pulled in to the compound, a group of about 40 Care Givers stood up and welcomed us in song. I was completely overwhelmed as I had not expected anything of the sort. A meeting was what I was prepared for and this was unlike any I had ever attended. Zambians can really sing! They have rhythm in their veins and sing their hearts out at any opportunity they get. They can also really dance! I will not be ready to leave this country till I have learned to shake my waist like these women can.

So in between much singing and dancing, a meeting was conducted in which we were all introduced to each other and briefed on our roles and yada yada. I’ll skip the boring stuff (though there was very little). All in all, I am very happy to have a chance to work with such a wonderful group of people and look forward to going out into the villages and seeing them in action.

The Mother That Wasn't

Monday 3rd November 2008

On Monday, I spent the day at the maternity ward of the hospital where I work. I was mainly there to learn about the ‘Prevention of Mother to Child Transmission’ (PMTCT) work that they do there. PMTCT programmes aim at reducing the probability of transmission of HIV from positive mothers to their children. This can be done by encouraging mothers to get voluntarily tested and learn what their HIV status is (though now this is more or less compulsory in Zambia). If mothers are tested as positive they are advised to start taking Anti Retro Viral (ARV) drugs in order to reduce the likelihood of their child being born positive and of course improve their health and delay the onset of AIDS. Other measures to reduce transmission to the child involve a post exposure course of drugs given to the infant and reduction if not complete substitution of breast feeding as the virus can be transmitted from the mother’s milk into the infant’s bloodstream through cuts and soars in the mouth.

After spending the morning learning about the HIV/AIDS work done at the maternity ward, I was invited to observe activities in the labour ward. The first procedure that I was able to observe was an ‘evacuation’. This was a procedure carried out on a young woman of 23 years. I was not quite sure what it was that I was observing but I saw the doctor remove something from the woman’s uterus – a 2 inch long piece of what looked like flesh – it was the fetus. I later learned that an evacuation is basically carried out after a woman has had an abortion in order to clean out the uterus. I’m not quite sure what my views on abortion are, I do value the right to choose but still find myself uncomfortable with the idea of terminating pregnancy. However after having watched the procedure which can only be described as a brutal invasion of the female body, I would never ever want myself or any of my friends to end up in that situation (girls…seriously!). There is no way in which to exorcize the painful moans of that young woman from my mind but though she was in great despair, hers was not the only pain I witnessed that day. A few beds away, an expectant mother had gone into labour, she was now fully dilated and as the ‘evacuation’ patient began to recover from her trauma, this soon to be mother was just at the beginning of hers.

Her water broke, giving off a foul stench and many of the nurses suspected the baby had died. They were indeed right. At 3.16 pm I watched a mother deliver a still born child, with just the same amount of hope and with the same pains as any other mother. She had carried this child in her womb for 9 months, gone through all the tribulations of pregnancy but was not to be rewarded at the end. It was truly one of the saddest things I have ever seen. Post delivery, the mother experienced heavy bleeding and complications that I could no longer stand to watch. I waited outside for hours during which an expert surgeon was called in and the patient’s cries of anguish diminished to soft periodic moans. My day was done. I thought perhaps I should stick around to witness another delivery with the hope that it would be successful and therefore reassuring. I wanted for the most selfish reasons to be reminded of the joys of child birth, to see the sheer delight in a mother’s eyes when she catches the first glimpse of her baby. But I could not get my mind of the agony of that mother that wasn’t, so I called it a day.

‘The place is nice’

Monze is a small town in the southern province of Zambia located 180kms south of Lusaka on the Lusaka-Livingstone road. The town has a population of approximately 10,000 and is part of Monze district which has a population of 200,000. The district is made up of a number of small villages that are quite spread out unlike the villages in the eastern province which have been consolidated into clusters. A village in Monze may have just 2-3 families living in a few mud huts rearing farm animals and cultivating just enough for subsistence. I visited one such village along with a group of peer educators from Monze Mission Hospital that was on a community outreach trip to raise awareness about HIV/AIDS.

The truck picked us up from the hospital grounds and took us out to the heart of Monze. The journey along the dirt roads was bumpy and long but the peer educators kept us entertained as they sang and played their bongo drums. The reason behind the song and dance was not just amusement but to draw the attention of villagers from neighbouring villages.

Our truck dropped half of us off at a handicap village where we were to spend the afternoon till pick up at 1500. On our arrival, the village members promptly gathered under a tree and the children ran out of the school building to greet us. The peer educators soon began their performance and the villagers were enthralled. The programme consisted of songs on HIV/AIDS, Sexually Transmitted Infections, the need for getting tested for HIV and adherence to Anti Retro Viral treatment. In addition to the singing and dancing, they performed a few sketches that touched upon issues such as widow cleansing (a custom involving sexual intercourse with the deceased husband’s brother), transmission of HIV, re-infection and the need to disclose one’s status to the partner. Zambians are generally fun loving people and enjoy music and dance which is the perfect medium to use when trying to raise awareness in the community. During these performances, a number of villagers volunteered to get tested by the accompanying nurse and will soon know their HIV status.

While waiting to be picked up by the truck, the group sat under a tree and asked me to join them for lunch which consisted of bread, nshima and a cooling drink made with maize, sugar and water. It was during our lunch that we got a call saying that the truck had a punctured tyre and would not be able to pick us up for a while so we decided walk to the main road in the mean time. This was a long walk, through the country alongside Monze dam. The surrounding bush was just beautiful and I really enjoyed the walk despite almost being attacked by herds of cows and goats along the way. Unfortunately I did not carry my camera with me so the only pictures I have were taken on my mobile phone which just hasn’t done the place justice. But after driving out into the country that day, I felt for the first time since I came to Monze that the ‘place is nice’ – indawo nimbotu loko!