U.S. rolls back AIDS drug prevention trial in Botswana
By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor Thu Dec 17, 3:48 pm ET
WASHINGTON (Reuters) – U.S. officials said on Thursday they will give up on a trial in Botswana that was trying to show whether it is possible to prevent HIV infections by taking a daily pill because too few people are being infected.
There are also problems keeping track of people enrolled in the trial, so it will be adjusted to show instead how well people can stick to the routine, the team at the U.S. Centers for Disease Control and Prevention said.
The trial of 1,200 people was trying to see if people could prevent infection with the AIDS virus if they took a daily pill that combined two HIV drugs. It was using Gilead Sciences Inc's Truvada, a combination of two drugs called tenofovir and emtricitabine.
They did not release the data on how many people in the trial became infected. The researchers also said that there appeared to be no safety concerns with the treatment so far.
The study, called TDF2, is one of several globally looking at the new approach, called pre-exposure prophylaxis, or PrEP. The idea is that a daily low dose of the drugs, which interfere with the ability of the virus to replicate, could also lower the risk of infection.
It has worked in monkeys and researchers are keen to see if it could provide an easy and cheap way to protect people from the virus, which infects 33 million globally and has killed 25 million people.
"The TDF2 study will be adapted due to unanticipated challenges that make it very unlikely that the trial will be able to determine if tenofovir-emtricitabine is effective in reducing the risk of HIV infection," the CDC said in a statement.
"The trial protocol and timeline will be revised to focus instead on the other remaining study questions -- primarily behavioral and clinical safety and adherence."
The problem is that new HIV infections are becoming less common in Botswana, where nearly a quarter of adults are infected.
"While the trial met its original enrollment goals, this study will not be able to determine efficacy given much lower than anticipated HIV incidence in the study population (likely due to declining HIV rates in Botswana generally, and to extensive HIV prevention services provided to all participants), and challenges in retaining participants in this highly mobile population of young adults," the CDC said.
"The trial, however, will provide critical information on safety and adherence to help guide potential implementation planning should PrEP prove effective in other trials. "
Other, similar trials are under way in the United States, South Africa, Thailand, Brazil, Peru, Kenya, Uganda and elsewhere.
Researchers are also looking for other ways to prevent infection, including by circumcising men.
There is no vaccine against the AIDS virus yet although work continues to make one, and researchers are also working on testing microbicides -- gels or creams that could be used to help prevent sexual transmission of the virus.
(Editing by Jackie Frank)
Sunday, December 20, 2009
Monday, December 14, 2009
This week in Seronga.....
Seronga Men’s Sector Event:
Traditional Healer/Midwives, Faith Based Leaders & Medical Professionals-
Working Together for Community Health.
On 8 December 2009 the Seronga Men’s Sector was the sponsor of a unique event bringing together traditional healers and midwives, faith based leaders and members of the medical community to address the spread of HIV in the greater Seronga area. The event was funded by the Okavango District Multi-Sectoral AIDS Committee (DMSAC).
The workshop was held at the Seronga Police compound and was facilitated by Ms. Celia Kauthemwa, health education technician from Gumare district health team and Mr. Emmanuel Segotso, a lay counselor and moruti from Gumare Counselling Centre. Dr. Mpata Lumbu and Nurse in Charge Florence Nkaelang from the Seronga clinic presented specific information regarding the issues they are encountering as medical professionals in the health facilities in the targeted area.
Also present were the dikgosi from Seronga and Gunotsoga, the councilor from Seronga, the Chair of the Seronga Men’s Sector Mr. Douglas Khumalo, the vice Chair of the Men’s Sector and master of ceremony of the day Mr. M Ramphisi, and the Peace Corps Volunteers from Seronga and Gumare, Ms. Jennifer “Lorato” Katchmark and Catherine “Duduetsong” Lecesse. Participants hailed from various villages, cattle posts and settlements from Mogotho to Gudigwa in Okavango delta area. They ranged in age from late twenties to 85 years old and were evenly divided in their capacities as traditional healers/ midwives and church representatives with 16 healer/midwives and 13 church leaders from various denominations.
Seronga Kgosi Maeze B Maeze welcomed the participants to the workshop, which was officially opened by local councilor Mr. Kotongwa. The format of the workshop was both lecture style and interactive, with participants playing an active role in sharing their experiences and having the opportunity to have many of their questions and concerns addressed by the facilitators. This equality based approach proved to be a very effective forum for all sectors to work together to trouble shoot and problem-solve various issues that were raised in a respectful and effective manner.
The goal of the workshop was to educate the targeted groups about HIV and AIDS and to discuss their practices to identify ways in which they can avoid the spread of HIV and to protect themselves and their patients and congregants from contracting HIV. Participants were informed of the differences between HIV and AIDS as well as practices such as using razor blades (or any other method of blood to blood contact) with multiple patients. They were also urged of the necessity of using latex gloves with their patients and were provided with a box of gloves in order to begin this new practice immediately. The healers/midwives were informed of various resources that they could reach out to in order to continue to acquire gloves for their practices. Traditional healers were encouraged to register their practices to legitimize their businesses and protect themselves in instances of accusation of malpractice or other controversy.
Traditional Healer/Midwives, Faith Based Leaders & Medical Professionals-
Working Together for Community Health.
On 8 December 2009 the Seronga Men’s Sector was the sponsor of a unique event bringing together traditional healers and midwives, faith based leaders and members of the medical community to address the spread of HIV in the greater Seronga area. The event was funded by the Okavango District Multi-Sectoral AIDS Committee (DMSAC).
The workshop was held at the Seronga Police compound and was facilitated by Ms. Celia Kauthemwa, health education technician from Gumare district health team and Mr. Emmanuel Segotso, a lay counselor and moruti from Gumare Counselling Centre. Dr. Mpata Lumbu and Nurse in Charge Florence Nkaelang from the Seronga clinic presented specific information regarding the issues they are encountering as medical professionals in the health facilities in the targeted area.
Also present were the dikgosi from Seronga and Gunotsoga, the councilor from Seronga, the Chair of the Seronga Men’s Sector Mr. Douglas Khumalo, the vice Chair of the Men’s Sector and master of ceremony of the day Mr. M Ramphisi, and the Peace Corps Volunteers from Seronga and Gumare, Ms. Jennifer “Lorato” Katchmark and Catherine “Duduetsong” Lecesse. Participants hailed from various villages, cattle posts and settlements from Mogotho to Gudigwa in Okavango delta area. They ranged in age from late twenties to 85 years old and were evenly divided in their capacities as traditional healers/ midwives and church representatives with 16 healer/midwives and 13 church leaders from various denominations.
Seronga Kgosi Maeze B Maeze welcomed the participants to the workshop, which was officially opened by local councilor Mr. Kotongwa. The format of the workshop was both lecture style and interactive, with participants playing an active role in sharing their experiences and having the opportunity to have many of their questions and concerns addressed by the facilitators. This equality based approach proved to be a very effective forum for all sectors to work together to trouble shoot and problem-solve various issues that were raised in a respectful and effective manner.
The goal of the workshop was to educate the targeted groups about HIV and AIDS and to discuss their practices to identify ways in which they can avoid the spread of HIV and to protect themselves and their patients and congregants from contracting HIV. Participants were informed of the differences between HIV and AIDS as well as practices such as using razor blades (or any other method of blood to blood contact) with multiple patients. They were also urged of the necessity of using latex gloves with their patients and were provided with a box of gloves in order to begin this new practice immediately. The healers/midwives were informed of various resources that they could reach out to in order to continue to acquire gloves for their practices. Traditional healers were encouraged to register their practices to legitimize their businesses and protect themselves in instances of accusation of malpractice or other controversy.
The views and customs of the traditional healers/midwives were quite openly shared with the medical professionals, giving them much greater insight into potential areas of conflict in various treatment regimens and traditional practices. There was an emphasis on how all involved sectors can work together and refer patients and clients to each other for complimentary treatments and services. Medical professionals urged the traditional healers to encourage their clients to bring their clinic health cards to their appointments for better coordination of services. The importance of bringing patients into the clinic in a timely manner, especially pregnant women who are in labor was emphasized as well as those showing symptoms of HIV or AIDS. Faith based leaders were implored to continue to support those in their congregations suffering from HIV and to encourage them to continue to adhere to ARV’s and the use of condoms.
Throughout the day participants repeatedly and enthusiastically expressed their understanding that they know they themselves cannot cure HIV and AIDS, and also showed a great deal of support and respect for the services provided at the local health facilities. Many reiterated their appreciation for the information they were given during the day and were pleased with the respect they felt they were shown by being targeted as important stakeholders in the prevention of spreading HIV. They expressed their intent to go back to their communities to continue to share the information they had been given.
Organizers of the event judged it to be a success, and feel it is an important type of event to replicate widely as these stakeholders have the potential to impact many members of their communities. Traditional healers, midwives and faith based leaders, while having a tremendous impact within communities have often been shunned or ignored by those attempting to address the spread of HIV. This workshop proved that when approached with respect and humility these important stakeholders can be eager to gain new knowledge and are even open to changing their traditional practices and beliefs and culture to better protect themselves and their clients from contracting HIV. Increasing their understanding of HIV/AIDS, prevention strategies and proper adherence to ARV’s may prove to be an effective way to reach populations who have been historically difficult to address and inform. Members of these important sectors of the community are very interested in improving the lives of those they serve by spreading messages of prevention in their unique capacities and should be utilized to the fullest.
Throughout the day participants repeatedly and enthusiastically expressed their understanding that they know they themselves cannot cure HIV and AIDS, and also showed a great deal of support and respect for the services provided at the local health facilities. Many reiterated their appreciation for the information they were given during the day and were pleased with the respect they felt they were shown by being targeted as important stakeholders in the prevention of spreading HIV. They expressed their intent to go back to their communities to continue to share the information they had been given.
Organizers of the event judged it to be a success, and feel it is an important type of event to replicate widely as these stakeholders have the potential to impact many members of their communities. Traditional healers, midwives and faith based leaders, while having a tremendous impact within communities have often been shunned or ignored by those attempting to address the spread of HIV. This workshop proved that when approached with respect and humility these important stakeholders can be eager to gain new knowledge and are even open to changing their traditional practices and beliefs and culture to better protect themselves and their clients from contracting HIV. Increasing their understanding of HIV/AIDS, prevention strategies and proper adherence to ARV’s may prove to be an effective way to reach populations who have been historically difficult to address and inform. Members of these important sectors of the community are very interested in improving the lives of those they serve by spreading messages of prevention in their unique capacities and should be utilized to the fullest.
*** this is the report that Mr. Khumalo, the policeman from the Seronga Police and Chair of the Men's Sector Committee, and I put together. The original report is much cooler with the pictures artfully added in, but it appears blogger is a little past my area of expertise in terms of putting them where I want them ;-0
Friday, December 4, 2009
Month End Madness!!!!
In Seronga, the village that-like Sleeping Beauty, nearly always seems to be sleeping (and is of course, not to be confused with New York, which from my startlingly foggy recollection of American geography-seems to have lapsed in the 20 months I’ve been away from it- is “the city that never sleeps”, or perhaps that’s Vegas? Either way-Seronga-completely different.) a certain time of month brings around the handsome prince known as Pula (money). With one brief brush of his lips the money is deposited, the cash is acquired (in Seronga all government employees-which is pretty much everyone- gets two days off each month strictly for banking. For many of us, the nearest branch of our bank is between 6 and god knows how many hours by car.) and a general state of Chaos ensues.
Now why, you ask, would an influx of cash be anything less than stupendous and gladly welcomed, Lorato, you evil Scrooge? In a village that clearly has so little? These people have surely worked hard for and earned each Thebe they are being granted. Surely when people have money they must feed their children and their animals sufficiently, and incorporate more vegetables into their diets. Everything must be better/easier/simpler with money! These good hearted villagers probably indulge is some harmless, (and especially in light of a first world expectation) extremely simple pleasures. And likely well deserved! These people have so little Lorato, why must you begrudge them their small pleasures that come with having some cash? Who let you into the Peace Corps anyways? Aren’t you supposed to be some sort of kind hearted humanitarian?
Yes gentle Readers. I too used to believe in this wonderful Botswana fairy tale, that this was a place where just a little cash could make such a big difference, and I believed in the power of the almighty dollar (Pula?) to really change lives, and solve things. Hell one reads about the wonders of microfinance (and increasingly sexy concept if it works as it’s purported to in other African nations, and believe me, I want in on some of those projects..) and how simple it is to make a small amount really felt in Africa, and you’d think that payday in Botswana would appear to be much like a Christmas every month end.
That’s exactly the problem. It’s the reason my mother spent most of my childhood proclaiming “Christmas comes but ONCE a year.” Through some stroke of genius, some infrastructurally cognizant wizard decided that all government employees in Botswana would be paid at the same time, which was then christened MONTH END. The few private enterprises appear to have followed, and thus THE ENTIRE COUNTRY GETS PAID AT THE SAME TIME. 12 times per year.
Yes, dear reader, I can see from your blank stare that you’re still not getting the picture I paint for you. I too remember what it’s like to spit and hit a Target store, and to have not one but four huge grocery stores and two Walmarts in any given strip mall complex. But alas the Target Empire has not yet crossed the ocean to Africa (although I stand eagerly on the shore of Botswana awaiting its arrival, oh wait, landlocked country, right….) And this means that there is a limited number of stores that carry foodstuffs and other items. And these limited numbers of stores are invaded as though by Vikings each month at month end. As such nearly entire employed population of most of Ngamiland district descends on Maun at once. In Maun, the ATM’s routinely run out of cash on any given day, but at month end, the line is not only long but usually hopeless. The buses are overfull, and the traffic on the road is more than dangerous, it’s deadly. Because an influx of cash means not only more drunks at any given hour of the day and night on the street grabbing you, but more frighteningly, drunk drivers. Sub Saharan Africa is not known as the deadliest place in the world for road accidents as some white elephant gift from the other regions of the world, it’s for real. I unfortunately know too many people who have died in road accidents here, including a Peace Corps volunteer who was killed the night before we received our site placements.
So aside from ransacked grocery stores, empty ATM’s, and deadly roads, what’s the problem, Lorato? The problem, dear friends, is the noise.
Now why would it be any noisier because of this mythical Month End you are wenching about? You’ve clearly got no grocery stores or ATM’s in Seronga, and there’s only one (dirt) road there that you should have no problem avoiding. What’s the problem, Princess?
MY BEAUTY SLEEP!!!!!!
As I write this it’s much much much past dark (quarter past 12 for those of you into the specifics) and I should be long asleep. And I was. The village was the sort of quiet you only get with a crescent moon, as it seems all the animals are resting their vocal chords (and their loins) in anticipation of the upcoming the extravaganza that is a full African moon.
And then the music begins pumping. In the middle of the night. And it’s not even a good song.
One thing that has never ceased to amaze me in a culture that is so incredibly communal is the lack of consideration that people seem to have for others. I have been woken up at each hour of the night by some guy listening to his music as loud as his car battery will allow (month end means he’s got money to put petrol in his car in order to run the battery or generator. If it’s the latter, the music must be that much louder to be heard over the whirring of the machine) and I have WALLS. Most of the village huts are constructed of reeds or mud. Not soundproof.
I have tried to be patient about this noise disturbance and chalk it up to cultural integration, but sometimes it’s ridiculous. Once a few months back I was awoken at about half eleven, by a horrible sexual American song from the mid 90’s (damn us and our crap cultural imperialism!!!) with a shit ton of expletives and gratuitous swearing. Now those of you who know me know that I consider swearing one of my absolute favorite filthy habits, but this song goes above and beyond.
In this half asleep daze, I forgot my flashlight but managed to remember to put on something “decent”. I stormed off into the overcast night with no moon to guide me towards the sound of the offenders. I clothes-lined myself half a dozen times with various wire fences and vines and trees that appeared to be running around, as I didn’t remember having this much navigational trouble in the daylight.
The sound was coming from an area deeper in the village than I usually wander even in daytime, and I could sort of tell I was headed in the direction of the floodplain, which as luck would have it, was flooded. As I heard the now familiar grunt of a hippo I tried not to think of the Kgosi’s story about the hippo he found resting at the kgotla in the early hours of morning. The kgotla is much further into the village from the water than I was at this immediate moment. As big as they are those guys are quick, and I wasn’t in the mood to try to negotiate with one of those guys as well as the music dudes.
After ten minutes and 6 thorns in my feet, I found the source of the noise. Two drunk guys whom I didn’t recognize (but then I was half asleep) smiled drunkenly and began the rigmarole of greeting me.
I cut them off, not even bothering to attempt to search my brain for some form of language these guys might understand. My wild hair, eyes, and gesticulations must have made my message clear, because once the shock of an angry white woman crashing their party and making demands in the middle of the night wore off, they began to laugh and walked in the direction of the volume button. I stomped away (as much as one can stomp on sand) and then called the police, thinking that if I had any more problems that they would be the next to deal with these guys (and probably in Setswana).
Now three of my village husbands, (true to the culture of the country there seems to be no problem among them that in one office there are three of them offering to negotiate cows for my hand in marriage, they all know about each other, and I just shake my head and wonder if anything I’ve been preaching about multiple concurrent partners and their negative impact on HIV has sunk in AT ALL. Although I’ve blunted and repeatedly rejected any of their attempted advances, I haven’t been able to shake them of the title, so when in Rome if you can’t beat them cause they are police officers, join them in what you desperately hope is a joke) are policemen, and I have to admit I may have been a bit overzealous in my initial training regimen with this poor police force.
When I first came to Seronga, in the Zen state I like to think on as “Scared Shitless” I did my best to communicate to the police office the duty of the police to protect me or Seronga would lose its Peace Corps. Perhaps I did a bit too well. When you call the police land line number, they are unable to call me back at night time because in the interest of controlling corruption all the outgoing lines are locked behind doors. So on the few occasions I’ve called in the evening or night they have to call me back on my cell phone from their cell phone. And what do they do with that prized number of the Lekgowa (white person) white person in Seronga? They push save.
In the beginning more than a few times I would then get drunken dials from various members of Seronga’s finest. Over time I’ve gotten all their numbers and thus know when to push ignore. We’ve come to a happy understanding.
But the point of the story is that in the process of calling the police and re-clotheslining myself back through the village to my hut, I managed to get lost. Not horribly, mind you, but lost enough. It’s amazing how much more difficult navigation becomes with no light. All huts begin to look alike, and you can’t follow your own footprints. So I trudged on in the direction that felt right and hoped that the cold weather meant that all those deadly poisonous snakes (puff adders, black mambas) that like to lie in the middle of sandy paths were in some sort of hibernation rather than plotting to kill me.
I’d like to say that to solve this conundrum I looked up at the sky and navigated by the stars (which would be so badass, but as I mentioned it was an overcast sky… and I couldn’t do it anyways) but in reality it was dumb luck (and the headlights of the police cruiser that was rapidly approaching my gate). I have to admit that this is the fastest I’ve ever seen any Batswana move in response to a request, but I quickly realized why this was when in response to my description of the problem each of the two officers in turn offered to inspect the inside of my hut for intruders, including my bed. I’d like to say I politely refused, but polite had nothing to do with my response.
So now it appears the distant pounding has ceased for a moment at least, and I must now rush to sleep before it pounds again. Time continues on, and there are fewer month ends ahead of me than behind me, and so I sink back into my pillow in gratitude for where I am right now, in my funny little village.
Happy Thanksgiving!
Lorato
Now why, you ask, would an influx of cash be anything less than stupendous and gladly welcomed, Lorato, you evil Scrooge? In a village that clearly has so little? These people have surely worked hard for and earned each Thebe they are being granted. Surely when people have money they must feed their children and their animals sufficiently, and incorporate more vegetables into their diets. Everything must be better/easier/simpler with money! These good hearted villagers probably indulge is some harmless, (and especially in light of a first world expectation) extremely simple pleasures. And likely well deserved! These people have so little Lorato, why must you begrudge them their small pleasures that come with having some cash? Who let you into the Peace Corps anyways? Aren’t you supposed to be some sort of kind hearted humanitarian?
Yes gentle Readers. I too used to believe in this wonderful Botswana fairy tale, that this was a place where just a little cash could make such a big difference, and I believed in the power of the almighty dollar (Pula?) to really change lives, and solve things. Hell one reads about the wonders of microfinance (and increasingly sexy concept if it works as it’s purported to in other African nations, and believe me, I want in on some of those projects..) and how simple it is to make a small amount really felt in Africa, and you’d think that payday in Botswana would appear to be much like a Christmas every month end.
That’s exactly the problem. It’s the reason my mother spent most of my childhood proclaiming “Christmas comes but ONCE a year.” Through some stroke of genius, some infrastructurally cognizant wizard decided that all government employees in Botswana would be paid at the same time, which was then christened MONTH END. The few private enterprises appear to have followed, and thus THE ENTIRE COUNTRY GETS PAID AT THE SAME TIME. 12 times per year.
Yes, dear reader, I can see from your blank stare that you’re still not getting the picture I paint for you. I too remember what it’s like to spit and hit a Target store, and to have not one but four huge grocery stores and two Walmarts in any given strip mall complex. But alas the Target Empire has not yet crossed the ocean to Africa (although I stand eagerly on the shore of Botswana awaiting its arrival, oh wait, landlocked country, right….) And this means that there is a limited number of stores that carry foodstuffs and other items. And these limited numbers of stores are invaded as though by Vikings each month at month end. As such nearly entire employed population of most of Ngamiland district descends on Maun at once. In Maun, the ATM’s routinely run out of cash on any given day, but at month end, the line is not only long but usually hopeless. The buses are overfull, and the traffic on the road is more than dangerous, it’s deadly. Because an influx of cash means not only more drunks at any given hour of the day and night on the street grabbing you, but more frighteningly, drunk drivers. Sub Saharan Africa is not known as the deadliest place in the world for road accidents as some white elephant gift from the other regions of the world, it’s for real. I unfortunately know too many people who have died in road accidents here, including a Peace Corps volunteer who was killed the night before we received our site placements.
So aside from ransacked grocery stores, empty ATM’s, and deadly roads, what’s the problem, Lorato? The problem, dear friends, is the noise.
Now why would it be any noisier because of this mythical Month End you are wenching about? You’ve clearly got no grocery stores or ATM’s in Seronga, and there’s only one (dirt) road there that you should have no problem avoiding. What’s the problem, Princess?
MY BEAUTY SLEEP!!!!!!
As I write this it’s much much much past dark (quarter past 12 for those of you into the specifics) and I should be long asleep. And I was. The village was the sort of quiet you only get with a crescent moon, as it seems all the animals are resting their vocal chords (and their loins) in anticipation of the upcoming the extravaganza that is a full African moon.
And then the music begins pumping. In the middle of the night. And it’s not even a good song.
One thing that has never ceased to amaze me in a culture that is so incredibly communal is the lack of consideration that people seem to have for others. I have been woken up at each hour of the night by some guy listening to his music as loud as his car battery will allow (month end means he’s got money to put petrol in his car in order to run the battery or generator. If it’s the latter, the music must be that much louder to be heard over the whirring of the machine) and I have WALLS. Most of the village huts are constructed of reeds or mud. Not soundproof.
I have tried to be patient about this noise disturbance and chalk it up to cultural integration, but sometimes it’s ridiculous. Once a few months back I was awoken at about half eleven, by a horrible sexual American song from the mid 90’s (damn us and our crap cultural imperialism!!!) with a shit ton of expletives and gratuitous swearing. Now those of you who know me know that I consider swearing one of my absolute favorite filthy habits, but this song goes above and beyond.
In this half asleep daze, I forgot my flashlight but managed to remember to put on something “decent”. I stormed off into the overcast night with no moon to guide me towards the sound of the offenders. I clothes-lined myself half a dozen times with various wire fences and vines and trees that appeared to be running around, as I didn’t remember having this much navigational trouble in the daylight.
The sound was coming from an area deeper in the village than I usually wander even in daytime, and I could sort of tell I was headed in the direction of the floodplain, which as luck would have it, was flooded. As I heard the now familiar grunt of a hippo I tried not to think of the Kgosi’s story about the hippo he found resting at the kgotla in the early hours of morning. The kgotla is much further into the village from the water than I was at this immediate moment. As big as they are those guys are quick, and I wasn’t in the mood to try to negotiate with one of those guys as well as the music dudes.
After ten minutes and 6 thorns in my feet, I found the source of the noise. Two drunk guys whom I didn’t recognize (but then I was half asleep) smiled drunkenly and began the rigmarole of greeting me.
I cut them off, not even bothering to attempt to search my brain for some form of language these guys might understand. My wild hair, eyes, and gesticulations must have made my message clear, because once the shock of an angry white woman crashing their party and making demands in the middle of the night wore off, they began to laugh and walked in the direction of the volume button. I stomped away (as much as one can stomp on sand) and then called the police, thinking that if I had any more problems that they would be the next to deal with these guys (and probably in Setswana).
Now three of my village husbands, (true to the culture of the country there seems to be no problem among them that in one office there are three of them offering to negotiate cows for my hand in marriage, they all know about each other, and I just shake my head and wonder if anything I’ve been preaching about multiple concurrent partners and their negative impact on HIV has sunk in AT ALL. Although I’ve blunted and repeatedly rejected any of their attempted advances, I haven’t been able to shake them of the title, so when in Rome if you can’t beat them cause they are police officers, join them in what you desperately hope is a joke) are policemen, and I have to admit I may have been a bit overzealous in my initial training regimen with this poor police force.
When I first came to Seronga, in the Zen state I like to think on as “Scared Shitless” I did my best to communicate to the police office the duty of the police to protect me or Seronga would lose its Peace Corps. Perhaps I did a bit too well. When you call the police land line number, they are unable to call me back at night time because in the interest of controlling corruption all the outgoing lines are locked behind doors. So on the few occasions I’ve called in the evening or night they have to call me back on my cell phone from their cell phone. And what do they do with that prized number of the Lekgowa (white person) white person in Seronga? They push save.
In the beginning more than a few times I would then get drunken dials from various members of Seronga’s finest. Over time I’ve gotten all their numbers and thus know when to push ignore. We’ve come to a happy understanding.
But the point of the story is that in the process of calling the police and re-clotheslining myself back through the village to my hut, I managed to get lost. Not horribly, mind you, but lost enough. It’s amazing how much more difficult navigation becomes with no light. All huts begin to look alike, and you can’t follow your own footprints. So I trudged on in the direction that felt right and hoped that the cold weather meant that all those deadly poisonous snakes (puff adders, black mambas) that like to lie in the middle of sandy paths were in some sort of hibernation rather than plotting to kill me.
I’d like to say that to solve this conundrum I looked up at the sky and navigated by the stars (which would be so badass, but as I mentioned it was an overcast sky… and I couldn’t do it anyways) but in reality it was dumb luck (and the headlights of the police cruiser that was rapidly approaching my gate). I have to admit that this is the fastest I’ve ever seen any Batswana move in response to a request, but I quickly realized why this was when in response to my description of the problem each of the two officers in turn offered to inspect the inside of my hut for intruders, including my bed. I’d like to say I politely refused, but polite had nothing to do with my response.
So now it appears the distant pounding has ceased for a moment at least, and I must now rush to sleep before it pounds again. Time continues on, and there are fewer month ends ahead of me than behind me, and so I sink back into my pillow in gratitude for where I am right now, in my funny little village.
Happy Thanksgiving!
Lorato
Life/Death
Death is here. No matter how I may try to avoid it, to run or hide from it, death is in this village. It’s amongst the children, which for some reason feels like the biggest injustice of all. You can smell it, the sickness, and in contrast the health amongst them. One of the children moans in a decibel that reminds me of a kitten. When I heard him in the infirmary the other day I thought the woman in maternity had given birth, but when I glanced in and saw her still full belly I checked the other room.
His mother had been cradling him, and my mind struggled to slowly register the contradiction between what I was hearing and seeing. While I heard the shallow cries of a newborn, I saw that the limbs of this child were too long to be a newborn. When I got closer and saw his skeletal mouth full of teeth and head full of the fuzz of a newborn I knew something was incredibly wrong.
I checked his chart and sure enough he was nearly a year and a half old. I glanced at his growth chart, which had progressed for a short period and then plummeted towards the bottom of the chart. Prior to this I’d never thought of that line as what it is, an indicator of growth in relation to averages, of expectations, something that measures health in relation to the space that one takes on the planet, one’s height and weight, a record of growth, of progress. What this line appeared to me as that day was an indication of the decreasing space this child required on the planet, likely soon to be no space.
The nurse standing next to me noticed the change in my demeanor as I reviewed the chart. Failure to thrive was written nowhere but rather implied. The multiple HIV blood tests taken from the baby’s foot had not been returned from the lab in Gaborone, but there was no doubt that HIV was the culprit. Tears welled in my eyes and I looked away. I quietly asked the nurse in English if the baby would live through the night.
“You feel for the kid, huh?” he said sympathetically. “He’ll be fine, he’s a fighter, look how many times he’s been to the clinic and he’s still fighting!” his enthusiasm rang with the hollowness of we both knew was the reality of the situation. I went to find the child a rattle that was left over from the breast feeding promotion we had. I was trying to distract him from the agony of the nurses probing every tiny vein in his emaciated body in a valiant attempt to revive and rehydrate him. I grimaced when he went to put his left thumb in his mouth, he had used this particular method to comfort himself so frequently that he had sucked off much of the skin, and refused to use his right thumb. He also refused the offer of the rattle, the pain in his watery eyes accusatory; it was as though he was insulted by my feeble attempt to comfort him with a bloody rattle.
I walked out of the infirmary, helpless, hopeless.
The next morning I arrived at the clinic to find the child had indeed survived the night, and sent up some gratitude to the universe. The patients and I made our way down to the boat to travel across the river to the hospital in Gumare.
On that journey, somewhere between Seronga and Sepopa another child, a brand new baby, has died. The last breath has escaped her lips and there’s nothing any of us can do about it, least not me. On the shore at Sepopa the women call me over in English, which is how I am first alerted to the problem. The people in my village and all the surrounding villages have decided that I will learn Setswana by immersion if nothing else, or perhaps they’re just more comfortable speaking in their native tongue and hoping I understand through some magic Rosetta stone of the universe. But when I hear them speaking to me in careful English I can sense the urgency in the situation. I know that obviously there are sick people on the boat, it is the water ambulance after all, and so most people are being transported to hospital, but I hadn’t taken the time to consider the ratio of women to sick children until now. So I approach them, and they open the circle from which they were originally huddling around the silent bundle in one woman’s arms.
“Is this baby alive, Lorato?” I hesitate to look but know I must. I see the baby’s purple face, lips still wet with her first tastes of life and although I know the inevitable answer, I search her motionless, still warm body for signs of life. I lift her arm, still covered in the waxy coating of birth, and search for a pulse, my thumb big and awkward and nearly the size of her tiny wrist. I fumble around before realizing that one’s thumb has a pulse of its own, and thus I must use one of my fingers, but I find they’ve also developed a pulse of their own.
I feel my own heart begin to race as I search for life in this child, it’s a cross between taunting me with the strength of its pounding and my own desperation to give this mother another answer than what is now the truth. I begin to feel frantic and panicky, as though there is some cosmic move I can make to bring this child back from the other side, if I only knew it, if only. The women somberly look over me, patiently waiting to see if my white skin does indeed have the special powers of which they’ve only heard.
It’s like not knowing the answers on exam day, or every bad dream I’ve ever had where I cannot control the course of events in any way, like the other night when I woke up crying. I look around in a state of anxiety and insecurity, I want someone else to take this burden, I don’t know what to do, and I’m not the doctor. I want to scream it; I want to run away, I want to know how to handle this situation.
There is no way. I’m the only one who hasn’t accepted the inevitability of the situation. Life and death come every day to Seronga, and everyone seems to know the score but me.
Just when I think that my heart is finished, that it has shriveled and hardened into a little palm nut, covered in a hard, protective shell, it is broken again. A tender piece of flesh exposed, to the wind, to the world, to the hurt and it bleeds anew. A little river of pain flows through and I know I can still feel, and this feeling is sadness. And it is sprinkled with despair, and laced with hopelessness, and I can taste the pain, it springs bitter onto the tip of my tongue and it mixes with the bile of the rage which has risen in my throat, the indignation and confusion that although this matters, it doesn’t seem to matter.
I want to scream primally, I want to howl, I want to shake my fist at the heavens and demand that this child’s spirit and her life be returned to its rightful place here on Earth. But how can I do any of these things when the child’s own mother sits stoically next to the woman who holds her now lifeless child, the body of which sprung from her own body less than 12 hours previous. The tears stream silently down my own face, defying the dehydration that is my normal state of being to protest this awful situation.
What do you do? There’s nothing. I don’t mean to sound like a “save the children” ad here, and to be honest it frustrates me to describe the problem in any depth as I know from living here that there is certainly not an easy, and possibly not even a difficult implimentable solution to this problem, which surely will not be solved any time soon.
Why should I even write about it, to make all of you reading this have an idea of the shittiness if there’s nothing to be done about it? I guess I do it to get rid of some of the rage and sadness that lives inside me as a result of this experience. Parts of me are becoming hardened to this constant human suffering, but am I so different from people who work anywhere else doing this type of work? What about nurses and doctors in Emergency Rooms anywhere on Earth, or homicide detectives, or even teachers in some areas?
What obligation can I possibly have to each of these children? What can I do? I swear I would move mountains if I thought it would help…
I have no answers. This upsets me. I go on with life, not able to forget, but slightly becoming numb to the pain.
This day comes, as all do, to an end. Later, in the darkness of night I hear the rain begin to fall on the corrugated iron roof. I run outside, desperate to feel the rain on my skin, to cleanse me of this day. I look to the sky for answers and find my hot tears mixing with the cold rain. I yearn to have the lightning illuminate the world, and make it clear again, if only for a moment.
His mother had been cradling him, and my mind struggled to slowly register the contradiction between what I was hearing and seeing. While I heard the shallow cries of a newborn, I saw that the limbs of this child were too long to be a newborn. When I got closer and saw his skeletal mouth full of teeth and head full of the fuzz of a newborn I knew something was incredibly wrong.
I checked his chart and sure enough he was nearly a year and a half old. I glanced at his growth chart, which had progressed for a short period and then plummeted towards the bottom of the chart. Prior to this I’d never thought of that line as what it is, an indicator of growth in relation to averages, of expectations, something that measures health in relation to the space that one takes on the planet, one’s height and weight, a record of growth, of progress. What this line appeared to me as that day was an indication of the decreasing space this child required on the planet, likely soon to be no space.
The nurse standing next to me noticed the change in my demeanor as I reviewed the chart. Failure to thrive was written nowhere but rather implied. The multiple HIV blood tests taken from the baby’s foot had not been returned from the lab in Gaborone, but there was no doubt that HIV was the culprit. Tears welled in my eyes and I looked away. I quietly asked the nurse in English if the baby would live through the night.
“You feel for the kid, huh?” he said sympathetically. “He’ll be fine, he’s a fighter, look how many times he’s been to the clinic and he’s still fighting!” his enthusiasm rang with the hollowness of we both knew was the reality of the situation. I went to find the child a rattle that was left over from the breast feeding promotion we had. I was trying to distract him from the agony of the nurses probing every tiny vein in his emaciated body in a valiant attempt to revive and rehydrate him. I grimaced when he went to put his left thumb in his mouth, he had used this particular method to comfort himself so frequently that he had sucked off much of the skin, and refused to use his right thumb. He also refused the offer of the rattle, the pain in his watery eyes accusatory; it was as though he was insulted by my feeble attempt to comfort him with a bloody rattle.
I walked out of the infirmary, helpless, hopeless.
The next morning I arrived at the clinic to find the child had indeed survived the night, and sent up some gratitude to the universe. The patients and I made our way down to the boat to travel across the river to the hospital in Gumare.
On that journey, somewhere between Seronga and Sepopa another child, a brand new baby, has died. The last breath has escaped her lips and there’s nothing any of us can do about it, least not me. On the shore at Sepopa the women call me over in English, which is how I am first alerted to the problem. The people in my village and all the surrounding villages have decided that I will learn Setswana by immersion if nothing else, or perhaps they’re just more comfortable speaking in their native tongue and hoping I understand through some magic Rosetta stone of the universe. But when I hear them speaking to me in careful English I can sense the urgency in the situation. I know that obviously there are sick people on the boat, it is the water ambulance after all, and so most people are being transported to hospital, but I hadn’t taken the time to consider the ratio of women to sick children until now. So I approach them, and they open the circle from which they were originally huddling around the silent bundle in one woman’s arms.
“Is this baby alive, Lorato?” I hesitate to look but know I must. I see the baby’s purple face, lips still wet with her first tastes of life and although I know the inevitable answer, I search her motionless, still warm body for signs of life. I lift her arm, still covered in the waxy coating of birth, and search for a pulse, my thumb big and awkward and nearly the size of her tiny wrist. I fumble around before realizing that one’s thumb has a pulse of its own, and thus I must use one of my fingers, but I find they’ve also developed a pulse of their own.
I feel my own heart begin to race as I search for life in this child, it’s a cross between taunting me with the strength of its pounding and my own desperation to give this mother another answer than what is now the truth. I begin to feel frantic and panicky, as though there is some cosmic move I can make to bring this child back from the other side, if I only knew it, if only. The women somberly look over me, patiently waiting to see if my white skin does indeed have the special powers of which they’ve only heard.
It’s like not knowing the answers on exam day, or every bad dream I’ve ever had where I cannot control the course of events in any way, like the other night when I woke up crying. I look around in a state of anxiety and insecurity, I want someone else to take this burden, I don’t know what to do, and I’m not the doctor. I want to scream it; I want to run away, I want to know how to handle this situation.
There is no way. I’m the only one who hasn’t accepted the inevitability of the situation. Life and death come every day to Seronga, and everyone seems to know the score but me.
Just when I think that my heart is finished, that it has shriveled and hardened into a little palm nut, covered in a hard, protective shell, it is broken again. A tender piece of flesh exposed, to the wind, to the world, to the hurt and it bleeds anew. A little river of pain flows through and I know I can still feel, and this feeling is sadness. And it is sprinkled with despair, and laced with hopelessness, and I can taste the pain, it springs bitter onto the tip of my tongue and it mixes with the bile of the rage which has risen in my throat, the indignation and confusion that although this matters, it doesn’t seem to matter.
I want to scream primally, I want to howl, I want to shake my fist at the heavens and demand that this child’s spirit and her life be returned to its rightful place here on Earth. But how can I do any of these things when the child’s own mother sits stoically next to the woman who holds her now lifeless child, the body of which sprung from her own body less than 12 hours previous. The tears stream silently down my own face, defying the dehydration that is my normal state of being to protest this awful situation.
What do you do? There’s nothing. I don’t mean to sound like a “save the children” ad here, and to be honest it frustrates me to describe the problem in any depth as I know from living here that there is certainly not an easy, and possibly not even a difficult implimentable solution to this problem, which surely will not be solved any time soon.
Why should I even write about it, to make all of you reading this have an idea of the shittiness if there’s nothing to be done about it? I guess I do it to get rid of some of the rage and sadness that lives inside me as a result of this experience. Parts of me are becoming hardened to this constant human suffering, but am I so different from people who work anywhere else doing this type of work? What about nurses and doctors in Emergency Rooms anywhere on Earth, or homicide detectives, or even teachers in some areas?
What obligation can I possibly have to each of these children? What can I do? I swear I would move mountains if I thought it would help…
I have no answers. This upsets me. I go on with life, not able to forget, but slightly becoming numb to the pain.
This day comes, as all do, to an end. Later, in the darkness of night I hear the rain begin to fall on the corrugated iron roof. I run outside, desperate to feel the rain on my skin, to cleanse me of this day. I look to the sky for answers and find my hot tears mixing with the cold rain. I yearn to have the lightning illuminate the world, and make it clear again, if only for a moment.
And I walk away.....
All Italicized lyrics from "One"-U2
It is a difficult thing for me to attempt to describe my experiences in Seronga. I tell stories that I hope give glimpses, of the sorrow, of the joy, of the essence of the place. I try to make aspects of most of it seem a little funny, or I try to find the poignant moment or the lesson learned. I’ve come to believe I’ve got a pretty good understanding of life here, and the motivations of the people, the reasons for their actions.
We’re one but we’re not the same,
We hurt each other and we’re doin’ it again.
The one area I can’t quite get around is the dying children. It’s an easy enough situation to overlook. In some ways I’m ashamed to say I try to stay out of that aspect of life here. I don’t attend all the funerals. I don’t even attend most of them. When I’m honest with myself, I have to admit I actively try to avoid them. What can one’s response possibly be when death is no longer a tragedy? I mean it is. It’s still a tragedy. But what is the proper word for it? How does one name the continuous state or condition of tragedy that has become a way of life?
I’ve noticed that African children aren’t really big criers. They don’t really cry because they’re tired, because if they’re tired, they are strapped to their mom’s back, which serves as their crib, and so they just go to sleep. They don’t really cry because they’re hungry, perhaps this is because they quickly get used to the feeling, or because their moms will just swing them around to nurse anywhere and everywhere. They don’t cry for many other reasons that I’ve seen children from my own culture cry, and a small part of me can’t help but speculate that it’s because they learn so early on that it really does no good. They’ll get what they get when it’s given to them, and in this culture it tends to be whatever is left over. There’s no use whining for something else.
(Worth noting: I might be wrong about this whole crying thing, as I was previously wrong on my “African children don’t crawl” theory, developed in part because I had never really seen it happen. It appeared to me that babies went from their moms back, being carried around- to walking. I mentioned this to a woman at the clinic one day and she laughed at me, told all her friends, who then also laughed at me, looked around the waiting room for a child of the correct age, picked it up, and put it on the floor in the crawling stance. She moved away and called the child and he crawled right to her. Touché. Perhaps these babies are just smart enough (or their mothers are) to not do too much cruising around in the loose sand full of broken glass and thorns.
But generally it’s got to be an injection, a serious injury or some pretty dire straights to get a child this side to cry.
A few weeks back I was at the clinic, trying to write or read or count pills or some other menial task that had been interrupted for what was likely a crap reason. I was about to leave the clinic, as it has increasingly become a difficult place for me to try to be for long periods of time, day in and day out, when I realized there were children crying. I have to admit I was surprised to find that I was in some ways deaf to the sound of children crying.
It’s often a haunting sound here. It’s a cross between a painful yelp and a prolonged moan. Sometimes I’ve noticed the children get so sick they don’t even sound like children any more, but rather some sort of injured animal, a sort of hoarse howling sob.
Just the other day I realized a child had followed me crying down the dirt road in Seronga for nearly ten minutes without me noticing until a car pulled up in front of me and asked, “Lorato, is that child crying for you?”
I looked back. The village is so full of children whom all know my name and scream it at me at any given opportunity that past indulging their fervent greetings I had no idea why the child was crying but walked back and picked her up.
As I’ve said before, I tend to get extremely mixed reactions from children here, from them running full speed from anywhere within eyesight to greet me in the village to shirking away in terror. I never know what reaction I’ll get, and have to admit I was a bit surprised when this child held up her arms in the universal “pick me up” way that makes even muddy or food covered children seem endearing.
I carried her along with my heavy bags, overloaded with at least two and a half litres of boiled, filtered and frozen water which I have to bring with me around the village daily in an attempt to stave off dehydration. I looked at the child and asked her what was the matter (I think) and told her to “quiet down” (didimala), which other than the Setswanafied English word of “sorddy” (sorry) is the only word of comfort I’ve really heard here.
The child eventually stopped crying and seemed satisfied to just follow me around for a while longer, to the co-op, the hardware store. At some point I looked back and had a gang of them following me like lemmings, rushing and nearly knocking each other over to help show me where the dish soap was.
One love,
One blood
One life you’ve got to do what you should
One life with each other, sisters, brothers
We’re one but we’re not the same
We’ve got to carry each other, carry each other…..
One
The other day I was walking home and heard the sound that my brain has recently begun to recognize again. Again it was a child crying. Not the I’m hungry, or thirsty, or that kid stole my toy, but the I’m in serious pain and I’m going to just cry myself into a state of passing out. I sighed and walked toward the sound. I found a child leaned up against a doorway, her torn and dirty dress hanging off her thin frame and a spot of sand in the front of her hair where she must have put her head onto the ground. She was half heartedly moaning, while someone on the other side of the piece of corrugated iron that was the door shouted at her periodically to stop. The other children played obliviously nearby, and the mother greeted me smiling when I entered the yard.
“What’s wrong with this child?” I asked her sharply, forgoing the usual series of polite greetings.
Realizing this wasn’t a social call, she thrust her chin in the child’s direction and indicated that “her hand was hurting.” I glanced at the child’s hand and saw that it was a swollen paw dangling at the end of a skinny wrist. The baby finger of her right hand was jutted out so far that it was perpendicular to her wrist, with a few small cuts between the last two fingers. “What happened?” I demanded from the mother.
“I don’t know,” she shrugged. I asked for the card from the clinic and saw that the child had first been seen on Saturday. It was Wednesday. I read through the card, and asked why the child hadn’t gone with the water ambulance to Gumare, as she had been referred to do for an x-ray.
“I wasn’t there.” said the mother. “It was her grandmother, and there was no money.”
“No money for what?” I asked. (The water ambulance is free.)
“For lunch,” She answered.
Is it getting better?
Or do you feel the same?
Will it make it easier on you, now,
That you’ve got someone to blame?
I wanted to scream. Instead I indicated that the child should follow me to my house. Two of her sisters followed. Against any and all Peace Corps policies, I busted out my often self raided medical kit for some antibacterial ointment, band-aids, and grabbed an ice pack from my freezer. This would be a temporary solution as it was 105 degrees Fahrenheit in the shade today, and this family would have no freezer. I attempted to clean the small punctures in the skin where the flesh was beginning to pop out that suggested it might have been a bug bite gone terribly wrong, but also thought it might have been a puncture from rusty piece of something.
I don’t know. I’m not a doctor. And unlike many people who join the Peace Corps, this experience has done absolutely nothing to push me in that direction, as a matter of fact I am quite certain that is absolutely not what I would like to be when I grow up. I have seen and heard about more strange injuries here, including one of my favorite village kids, who somehow managed to get a boiling water burn on her vulva (her mother was ready to yank off the dressings to explain to me exactly what was going on but I deferred) than I could care to see or hear about for the entirety of the rest of my life.
I walked the child back to her yard and spoke to the mother again. I called a few of my co-workers, none of whom could remember this child that had apparently been consulted today (“Is it the one with the abscess between the thumb and forefinger?” one of my coworkers asked helpfully.) and asked them if the child showed a referral on her card for the hospital if she should go with the water ambulance tomorrow. There was of course no certain answer for this so I indicated to the mother that this injury was quite serious and the child needed to go to see the doctor at the hospital the next day. I have no idea if she will actually be able to go there, as their might be adults with more serious injuries…
Did I ask too Much?
More than a lot?
You give me nothing-now it’s
All I’ve got……
(Sidebar: I traveled to Gumare the next day, and at the hospital I saw that the child was there waiting with her mother to go to the hospital via the water ambulance. When I arrived at the hospital and I heard a tiny voice calling “Lorato” –which isn’t completely out of the ordinary in this village far from my own-what can I say, people know me ;-0. I looked over and saw the girl’s sister smiling and waving at me and the little girl with the hand injury right behind her, staring at me slightly suspiciously- she might be remembering the painful application of the bandaid… It was afternoon and her hand still hadn’t been looked at by the doctor. I later heard that the trip was a waste and that the doctor never saw her, but back at Seronga clinic they had lanced the wound and drained it, and the next time I saw the child she had a bandage on it and the finger was closer to straight. Later when I got to the clinic and again mentioned the case, the nurses again said that the mother was supposed to bring the child back again for re-bandaging as they were worried about the infection spreading. The next time I passed the house I told the mother she must bring the child in again- as it said, in English-so helpful- on her card. The child’s sister later brought her back to the clinic, I found the nurse on call and sort of dragged him out of his house (it was a holiday) and had him attend to it. I think it’s gonna make it….. Update: I saw the little girl the other day, she called my name from the school yard and waved at me, with her fully healed hand. I guess I’ve done something here;-)
You say:
Love is a temple, Love the higher law
Love is a temple, Love the higher law
You ask me to enter, and then you make me crawl,
I can’t keep holding on to what you’ve got,
when all you’ve got is hurt.
A few steps farther down the path to my house I saw my neighbor and greeted her.
I asked her where her child was and she looked at me curiously. “He died this year.”
“What?” I asked. “He couldn’t have died this year, he was only born this year and I saw you with him only a month or so back.”
Through much discussion and producing several points of reference from events in the village, and who had been here or at the cattle post we managed to pin it down to when I was gone in Gabs for training last month.
“He was veddy sick,” she said matter of factly, continuing on to list off diarrhea and vomiting (universal signs of dehydration, one of the most common causes of death amongst babies and small children in Seronga) as legitimate and worthy causes of death. I muttered how sorry I was, and continued on my way.
I ask myself, How many times can you walk away from these situations before you are classified as a monster? What can you do, to stay, to help, to solve? What does it mean to when I stop caring, or feeling?
When I came here because I wanted to DO something, what exactly was it that I thought I might do? I mean truly?
“Have you come here for forgiveness,
Have you come to raise the dead?
Have you come here to play Jesus,
To the Lepers in your head?”
Did I think I would really run around actively saving lives? I’m not the Doctor.
As I entered my house, hot tired, dehydrated, sad, I turned and shut both my doors to the world, to this day. One of my prayer flags got caught on the door in protest, as though reminding me to try to keep my heart open. I ignored it and walked to the bathtub where I turned on the tap to fill the tub with the murky brown water in which I bathe or just sit in to get relief from the heat. Much like I was surprised by the cries of the children this day, I was startled to find myself suddenly sobbing. The tears began pouring down my face like the African rains that had been refusing to come. My heart melted and burned, and I sobbed, trying to release this sadness inside of me.
Did I disappoint you,
or leave a bad taste in your mouth
you act like you never had love,
so you won't need to go without...
It is a difficult thing for me to attempt to describe my experiences in Seronga. I tell stories that I hope give glimpses, of the sorrow, of the joy, of the essence of the place. I try to make aspects of most of it seem a little funny, or I try to find the poignant moment or the lesson learned. I’ve come to believe I’ve got a pretty good understanding of life here, and the motivations of the people, the reasons for their actions.
We’re one but we’re not the same,
We hurt each other and we’re doin’ it again.
The one area I can’t quite get around is the dying children. It’s an easy enough situation to overlook. In some ways I’m ashamed to say I try to stay out of that aspect of life here. I don’t attend all the funerals. I don’t even attend most of them. When I’m honest with myself, I have to admit I actively try to avoid them. What can one’s response possibly be when death is no longer a tragedy? I mean it is. It’s still a tragedy. But what is the proper word for it? How does one name the continuous state or condition of tragedy that has become a way of life?
I’ve noticed that African children aren’t really big criers. They don’t really cry because they’re tired, because if they’re tired, they are strapped to their mom’s back, which serves as their crib, and so they just go to sleep. They don’t really cry because they’re hungry, perhaps this is because they quickly get used to the feeling, or because their moms will just swing them around to nurse anywhere and everywhere. They don’t cry for many other reasons that I’ve seen children from my own culture cry, and a small part of me can’t help but speculate that it’s because they learn so early on that it really does no good. They’ll get what they get when it’s given to them, and in this culture it tends to be whatever is left over. There’s no use whining for something else.
(Worth noting: I might be wrong about this whole crying thing, as I was previously wrong on my “African children don’t crawl” theory, developed in part because I had never really seen it happen. It appeared to me that babies went from their moms back, being carried around- to walking. I mentioned this to a woman at the clinic one day and she laughed at me, told all her friends, who then also laughed at me, looked around the waiting room for a child of the correct age, picked it up, and put it on the floor in the crawling stance. She moved away and called the child and he crawled right to her. Touché. Perhaps these babies are just smart enough (or their mothers are) to not do too much cruising around in the loose sand full of broken glass and thorns.
But generally it’s got to be an injection, a serious injury or some pretty dire straights to get a child this side to cry.
A few weeks back I was at the clinic, trying to write or read or count pills or some other menial task that had been interrupted for what was likely a crap reason. I was about to leave the clinic, as it has increasingly become a difficult place for me to try to be for long periods of time, day in and day out, when I realized there were children crying. I have to admit I was surprised to find that I was in some ways deaf to the sound of children crying.
It’s often a haunting sound here. It’s a cross between a painful yelp and a prolonged moan. Sometimes I’ve noticed the children get so sick they don’t even sound like children any more, but rather some sort of injured animal, a sort of hoarse howling sob.
Just the other day I realized a child had followed me crying down the dirt road in Seronga for nearly ten minutes without me noticing until a car pulled up in front of me and asked, “Lorato, is that child crying for you?”
I looked back. The village is so full of children whom all know my name and scream it at me at any given opportunity that past indulging their fervent greetings I had no idea why the child was crying but walked back and picked her up.
As I’ve said before, I tend to get extremely mixed reactions from children here, from them running full speed from anywhere within eyesight to greet me in the village to shirking away in terror. I never know what reaction I’ll get, and have to admit I was a bit surprised when this child held up her arms in the universal “pick me up” way that makes even muddy or food covered children seem endearing.
I carried her along with my heavy bags, overloaded with at least two and a half litres of boiled, filtered and frozen water which I have to bring with me around the village daily in an attempt to stave off dehydration. I looked at the child and asked her what was the matter (I think) and told her to “quiet down” (didimala), which other than the Setswanafied English word of “sorddy” (sorry) is the only word of comfort I’ve really heard here.
The child eventually stopped crying and seemed satisfied to just follow me around for a while longer, to the co-op, the hardware store. At some point I looked back and had a gang of them following me like lemmings, rushing and nearly knocking each other over to help show me where the dish soap was.
One love,
One blood
One life you’ve got to do what you should
One life with each other, sisters, brothers
We’re one but we’re not the same
We’ve got to carry each other, carry each other…..
One
The other day I was walking home and heard the sound that my brain has recently begun to recognize again. Again it was a child crying. Not the I’m hungry, or thirsty, or that kid stole my toy, but the I’m in serious pain and I’m going to just cry myself into a state of passing out. I sighed and walked toward the sound. I found a child leaned up against a doorway, her torn and dirty dress hanging off her thin frame and a spot of sand in the front of her hair where she must have put her head onto the ground. She was half heartedly moaning, while someone on the other side of the piece of corrugated iron that was the door shouted at her periodically to stop. The other children played obliviously nearby, and the mother greeted me smiling when I entered the yard.
“What’s wrong with this child?” I asked her sharply, forgoing the usual series of polite greetings.
Realizing this wasn’t a social call, she thrust her chin in the child’s direction and indicated that “her hand was hurting.” I glanced at the child’s hand and saw that it was a swollen paw dangling at the end of a skinny wrist. The baby finger of her right hand was jutted out so far that it was perpendicular to her wrist, with a few small cuts between the last two fingers. “What happened?” I demanded from the mother.
“I don’t know,” she shrugged. I asked for the card from the clinic and saw that the child had first been seen on Saturday. It was Wednesday. I read through the card, and asked why the child hadn’t gone with the water ambulance to Gumare, as she had been referred to do for an x-ray.
“I wasn’t there.” said the mother. “It was her grandmother, and there was no money.”
“No money for what?” I asked. (The water ambulance is free.)
“For lunch,” She answered.
Is it getting better?
Or do you feel the same?
Will it make it easier on you, now,
That you’ve got someone to blame?
I wanted to scream. Instead I indicated that the child should follow me to my house. Two of her sisters followed. Against any and all Peace Corps policies, I busted out my often self raided medical kit for some antibacterial ointment, band-aids, and grabbed an ice pack from my freezer. This would be a temporary solution as it was 105 degrees Fahrenheit in the shade today, and this family would have no freezer. I attempted to clean the small punctures in the skin where the flesh was beginning to pop out that suggested it might have been a bug bite gone terribly wrong, but also thought it might have been a puncture from rusty piece of something.
I don’t know. I’m not a doctor. And unlike many people who join the Peace Corps, this experience has done absolutely nothing to push me in that direction, as a matter of fact I am quite certain that is absolutely not what I would like to be when I grow up. I have seen and heard about more strange injuries here, including one of my favorite village kids, who somehow managed to get a boiling water burn on her vulva (her mother was ready to yank off the dressings to explain to me exactly what was going on but I deferred) than I could care to see or hear about for the entirety of the rest of my life.
I walked the child back to her yard and spoke to the mother again. I called a few of my co-workers, none of whom could remember this child that had apparently been consulted today (“Is it the one with the abscess between the thumb and forefinger?” one of my coworkers asked helpfully.) and asked them if the child showed a referral on her card for the hospital if she should go with the water ambulance tomorrow. There was of course no certain answer for this so I indicated to the mother that this injury was quite serious and the child needed to go to see the doctor at the hospital the next day. I have no idea if she will actually be able to go there, as their might be adults with more serious injuries…
Did I ask too Much?
More than a lot?
You give me nothing-now it’s
All I’ve got……
(Sidebar: I traveled to Gumare the next day, and at the hospital I saw that the child was there waiting with her mother to go to the hospital via the water ambulance. When I arrived at the hospital and I heard a tiny voice calling “Lorato” –which isn’t completely out of the ordinary in this village far from my own-what can I say, people know me ;-0. I looked over and saw the girl’s sister smiling and waving at me and the little girl with the hand injury right behind her, staring at me slightly suspiciously- she might be remembering the painful application of the bandaid… It was afternoon and her hand still hadn’t been looked at by the doctor. I later heard that the trip was a waste and that the doctor never saw her, but back at Seronga clinic they had lanced the wound and drained it, and the next time I saw the child she had a bandage on it and the finger was closer to straight. Later when I got to the clinic and again mentioned the case, the nurses again said that the mother was supposed to bring the child back again for re-bandaging as they were worried about the infection spreading. The next time I passed the house I told the mother she must bring the child in again- as it said, in English-so helpful- on her card. The child’s sister later brought her back to the clinic, I found the nurse on call and sort of dragged him out of his house (it was a holiday) and had him attend to it. I think it’s gonna make it….. Update: I saw the little girl the other day, she called my name from the school yard and waved at me, with her fully healed hand. I guess I’ve done something here;-)
You say:
Love is a temple, Love the higher law
Love is a temple, Love the higher law
You ask me to enter, and then you make me crawl,
I can’t keep holding on to what you’ve got,
when all you’ve got is hurt.
A few steps farther down the path to my house I saw my neighbor and greeted her.
I asked her where her child was and she looked at me curiously. “He died this year.”
“What?” I asked. “He couldn’t have died this year, he was only born this year and I saw you with him only a month or so back.”
Through much discussion and producing several points of reference from events in the village, and who had been here or at the cattle post we managed to pin it down to when I was gone in Gabs for training last month.
“He was veddy sick,” she said matter of factly, continuing on to list off diarrhea and vomiting (universal signs of dehydration, one of the most common causes of death amongst babies and small children in Seronga) as legitimate and worthy causes of death. I muttered how sorry I was, and continued on my way.
I ask myself, How many times can you walk away from these situations before you are classified as a monster? What can you do, to stay, to help, to solve? What does it mean to when I stop caring, or feeling?
When I came here because I wanted to DO something, what exactly was it that I thought I might do? I mean truly?
“Have you come here for forgiveness,
Have you come to raise the dead?
Have you come here to play Jesus,
To the Lepers in your head?”
Did I think I would really run around actively saving lives? I’m not the Doctor.
As I entered my house, hot tired, dehydrated, sad, I turned and shut both my doors to the world, to this day. One of my prayer flags got caught on the door in protest, as though reminding me to try to keep my heart open. I ignored it and walked to the bathtub where I turned on the tap to fill the tub with the murky brown water in which I bathe or just sit in to get relief from the heat. Much like I was surprised by the cries of the children this day, I was startled to find myself suddenly sobbing. The tears began pouring down my face like the African rains that had been refusing to come. My heart melted and burned, and I sobbed, trying to release this sadness inside of me.
Did I disappoint you,
or leave a bad taste in your mouth
you act like you never had love,
so you won't need to go without...
A Measure of Success.....
When I arrived in Seronga, due partially to my inexperience in living alone, and also to my former shortcomings in the field of planning and preparation, there were quite a few items I didn’t have, many of which it didn’t occur to me I might need. Nowhere was this deficiency more evident than in the kitchen.
When I visited my hut in during the weekend in which we viewed and took inventory of our future new homes and villages, (an exercise in which many of my Bots classmates were able to wander around their comparatively spacious accommodations- and really how much is there to explore in a one and half room hut- for somewhere in the neighborhood of 5 days, I myself had about 1 due to the fact that I Seronga is just so damn FAR from…. everywhere. I t took me two days to get there from Moleps and two days to get back) I have to be honest and admit that I spent a majority of that time cowering in the corner (or really rather not—round room-no corners), or later, when I realized the creepy crawlies that resided in the corners, huddled in the middle of my bed (possibly in tears) eating my processed cheese slices and bread which seemed to be the only logical thing that might be properly kept through a journey of that many miles (or really, Kilometers).
In the midst of my quivering period of self doubt, I managed to observe that there were about four plates and a few half sets of cutlery which I assumed should be fine as it seemed unlikely that I would have any houseguests. The few sauce pans and glasses and two coffee mugs that rounded out the happy cupboard seemed to sufficiently cover what would be necessary for me to (learn to) cook.
A few weeks later in the altogether overwhelming experience of shopping in the mall in Gabs for the supplies that were to furnish our homes for the next two years, ( I blew a quarter of my moving in allowance on a down comforter and would do it again in a heartbeat… somewhere in my head was a line from what was undoubtedly an old Martha Stewart ”Living” magazine from my grandmother’s house extolling the virtues of nice bedding… or perhaps that was an advertisement… whichever) I did manage to remember to spend altogether too much money on a non-stick (yeah right) cake pan and cookie sheet. And with that I survived happily enough. I didn’t even have proper pot holders until this past July (which I got from someone who was moving away) but they’re those crazy silicon bird beak looking things, the technology of which must just be beyond me….
I give these examples of my culinary shortcomings as an overly detailed account of how inept I am when it comes to matters of the kitchen. You can see the direction this would be going when I resorted to taking up baking as a hobby.
Busy the hands to quiet the mind? Feed the stomach to empty the brain? I have no idea what pseudo fortune cookie theory I was operating under at that particular time.
But discovering I had no measuring cups was likely one of those charming little mishaps that defined those first few months at site (and likely sent me crying to that overly-expensive-down-comforter-covered-bed. I cried enough in those first few months to certainly last me the next two years…) Depressed, determined and most of all, hungry, the perseverance I’ve found in myself (and has jumped in to save me through much more trying and traumatizing shit than I can name) kicked in and I decided that measuring cups were going to have to be a luxury for the moment (incidentally I now have two sets;-).
So I baked. I eyeballed and felt the weight of the ingredients. I experimented and tried new things. It probably wasn’t always exactly right, but at least sometimes, it worked. Things tasted generally ok. I ate them. I didn’t poison myself or others (that I know of). I can’t even begin to tell you the amount of pride I experienced, and the amount of confidence in myself I developed, and the hope that was fostered that I could indeed do this Peace Corps thing.
Because what does it mean to measure? How can one determine exactly how much of something one has in different situations, under different conditions? How does one measure things, especially abstract things like success? Or behavior change?
I think about this often, even more so when it comes time to fill out our quarterly Peace Corps reports, those nightmarish visions in excel friendly format (allegedly) wherein we’re supposed to compile numbers and write a short synopses to describe what it is we do and how many people we’ve “saved” from the scourge that is HIV in Botswana.
So every three months I find myself in a tailspin of self doubt and feelings of inadequacy and failure when I face the difficult task of quantifying the work I do into an easy-to-read numerical format.
I often find myself envying people serving in other Peace Corps countries, where the goals appear (although I’ve learned nothing here if I haven’t learned that appearances can be deceiving…) to be attached to programs with tangible outcomes.
“What did you do in the Peace Corps?” a Question I anticipate enjoying almost as much as the one about “Why are you joining the Peace Corps?” or “What will you do in the Peace Corps?” To be able to simply answer, “I dug wells.” Or “I grew gardens”. Some of the members of a former cohort often said (only partially in jest) “I saved babies”.
What does it mean to have lived a year and a half of your life in a place and still not completely have a handle on it?
What have I done in the Peace Corps….?
Ummmm…
Crickets chirping….
(I mean really, I’ve been writing this lengthy, overly wordy blog which many people swear they’ve been reading for a year and a half and they still ask me what I do… and I don’t blame them a bit. Personally, I like to think there’s been some growth, and professionally, I’ve got ideas, and some energy still, I’ve got a helluva lot of goals, and things I’d love to see happen… but it’s also really tough to explain in a way that seems meaningful to the average onlooker. When I try to describe what have been some of the more meaningful moments and life changing experiences I've witnessed and had myself here, I'd be lying if I didn't admit that it can all start to sound a little kum-bah-ya and lame. I realize that. People say I'm doing good work over here, and I struggle sometimes to believe that is true, but it's the hope that I'm doing something that will incite change that gets me out of bed in the morning.)
As Americans (and especially as Americans with mostly American funders) we want results. We want numbers, we want hard facts, and we want success. We want gorgeous, Excel generated charts and graphs and spreadsheets that we can take back to show other Americans how successful we’ve been. These are our measuring cups. We want everyone to marvel at the cake we’ve baked, and we want to give them the recipe for success with exact and replicable ingredients.
But this is Africa. And more specifically, Botswana. And even more than that it’s Seronga, a tiny village in the heart of the Okavango delta and peoples whom even their own government often overlooks. We don’t eat cake here. And so I’m sorry. Success looks and tastes differently here. The measurements vary.
Because what can these numbers possibly mean? If it’s about numbers I can give you numbers all day, numbers that have been ascribed to me or to my accomplishments. I can give you my weight, my date of birth, my social security number, my high school and college GPAs, the score I got on any number of tests throughout my life, the number of stamps in my passport, any number at all that is supposed to have some meaning that in some way describes me. But do they? Can they tell you if I’m a success?
Ok then, lets talk experiences. If I gave you the name, presenters, brochure, location, duration, program from every class, speech, lecture, workshop, seminar, poetry slam, open mic night or reading I’ve ever attended that was supposed to in some way influence me or change my mind, could you from that calculate my risk behaviors?
Maybe. But probably not.
But it doesn’t exactly predict how I’ll act. And thus whether I’ll act in a way that might lead to me acquiring HIV.
So how can I report, honestly, that the guy over there that attended the workshop I’ve put on has been at all informed, has taken in the information presented to him in a meaningful way, that he relates to himself the benefits and risks of male circumcision and that his decision around this matter for himself might be changed. Can I report this quite honestly when I know for a fact he came for the free lunch?
And what about the woman over there, who just sat through the clinic health talk on multiple concurrent partnerships? Can she conceptualize what this means for her (sure she can repeat what has just been said, and she can tell me all day long what it is I want to hear.)? Does this mean that I can safely assume that she’ll have the sexual negotiation skills and confidence to confront her partner, and the independent financial resources to leave her partner should he refuse to give up his other wives, or even to go to the clinic to test for HIV with her? Is all this a success if it just ends up getting this woman a fresh beating?
You can see where the numbers and reporting are just the first wave of angst.
It’s hard to look at a report designed for the duel purpose of keeping track of what we’re doing (this is indeed the only evidence we submit that we are really doing anything-for those of us this far out it’s not like the Peace corps is just going to randomly wander through our villages-I’ll say it again, it’s a mission to get here) and reporting to funders (one might expect that it’s sort of in everyone’s best interest to produce high numbers of those reached- and thus effectiveness as it’s these funders who keep us in jobs-this has been a moral dilemma to me, as I had always envisioned the Peace Corps as a place in which the goal would be to “work myself out of a job…” And the HIV rate in this country has done nothing but go up since I’ve been here) and not feel a sense of confusion, and I daresay, failure?
Because really in the end, all the paperwork and reporting and questioning leads to one bigger, more personal end.
If the Peace Corps is my life (Which arguably it is, at least for these two years. It’s pretty difficult to separate the personal from the professional when you live in these circumstances, with these sorts of goals) and these are the predetermined measurements of my success, and I feel this much confusion and uncertainty over reporting my “accomplishments” and whether I’ve achieved success, then what am I doing? Am I doing the right thing? Must my goals and feelings of success as a person in an individual be intrinsically tied to the level of success present in this village-ie the increase or decrease in the number of HIV infections? Has this been worth it? Am I successful?
These are questions I ask myself everyday. And the answers have never come to me via the reports I agonize over and resignedly hand in every three months. I’ve had to redefine success. Again and again. And it rarely comes in a numerical form.
Because success has come to look and feel differently to me.
Do I know that making art projects around the village is going to have any impact whatsoever on the prevalence of HIV in my village, or in Botswana? Nope. But I do know that several children have taken a project through from design to completion and can see their efforts on the walls of their hometown. I can see in them a sense of pride in their accomplishment. Some of them have made a connection between the use of alcohol and HIV. Some have been inspired by the notion of recycling objects to make art.
Can I foresee if reading books in English and discussing the themes and watching the movies and journaling about their reactions is going to keep five precious girls from contracting HIV? I wish to God I could. But I can tell you that I have seen their comfort level of reading, comprehending and expressing themselves in English increase, for some of them, dramatically. And I am willing to bet that these skills will help them enormously when they’re in medical school, a plan that half of them have, with their primary goal to be to find a cure for HIV and to help their people.
So how do I measure success? I know it when I feel it.
I consider it a success when I see one of the nurses, after watching me practice reading aloud in English with some school children for 45 minutes while they waited for him to finish with patients so that he can help them complete a questionnaire they’ve been sent to complete, take real time to help them finish their assignment and make certain they understand. Last week a nurse shouted an answer at them from a doorway.
I consider it a success when the woman who sells me airtime texts me after I’ve given her some magazines because she’s expecting a child and wants to know more about healthy eating and how she should prepare health wise for the baby. Prior to my suggestion she had never before taken advantage of the library within 100 meters of the door of her shop.
The children with whom I practice writing their names and multiplication tables in the dirt have steadily decreased the time it takes them to answer my quiz like questions and increased their willingness to look me in the eye. Learning is becoming something that is fun for them. They’ve come to trust me and know I won’t beat them if they get the answer wrong.
And there’s no box on the form for that.
How much credit can I take for any of these things? Probably not much. But for me that’s the definition of Peace Corps. We don’t come here to achieve success in the typically American sense. We have to find it in other ways, to search and dig and redefine it for ourselves. For me that has meant that my feeling of success comes when others achieve something, when I see that they are becoming closer to their best selves, and that they are improving the way in which they interact with and manage their worlds and what they want from it, when they raise their own expectations of themselves and others.
Did I come here to solve HIV? Nope, that one is way bigger than me. Did I come here to personally have an impact on a massive reduction of HIV? Even at my vainest moments I’m not that delusional. Might I have helped someone who could potentially do these things for their own country? That’s the dream. Have I been successful? That’s the one I take to bed with me at night, and hope that in the end, the answer will come out to be a resounding “yes”.
When I visited my hut in during the weekend in which we viewed and took inventory of our future new homes and villages, (an exercise in which many of my Bots classmates were able to wander around their comparatively spacious accommodations- and really how much is there to explore in a one and half room hut- for somewhere in the neighborhood of 5 days, I myself had about 1 due to the fact that I Seronga is just so damn FAR from…. everywhere. I t took me two days to get there from Moleps and two days to get back) I have to be honest and admit that I spent a majority of that time cowering in the corner (or really rather not—round room-no corners), or later, when I realized the creepy crawlies that resided in the corners, huddled in the middle of my bed (possibly in tears) eating my processed cheese slices and bread which seemed to be the only logical thing that might be properly kept through a journey of that many miles (or really, Kilometers).
In the midst of my quivering period of self doubt, I managed to observe that there were about four plates and a few half sets of cutlery which I assumed should be fine as it seemed unlikely that I would have any houseguests. The few sauce pans and glasses and two coffee mugs that rounded out the happy cupboard seemed to sufficiently cover what would be necessary for me to (learn to) cook.
A few weeks later in the altogether overwhelming experience of shopping in the mall in Gabs for the supplies that were to furnish our homes for the next two years, ( I blew a quarter of my moving in allowance on a down comforter and would do it again in a heartbeat… somewhere in my head was a line from what was undoubtedly an old Martha Stewart ”Living” magazine from my grandmother’s house extolling the virtues of nice bedding… or perhaps that was an advertisement… whichever) I did manage to remember to spend altogether too much money on a non-stick (yeah right) cake pan and cookie sheet. And with that I survived happily enough. I didn’t even have proper pot holders until this past July (which I got from someone who was moving away) but they’re those crazy silicon bird beak looking things, the technology of which must just be beyond me….
I give these examples of my culinary shortcomings as an overly detailed account of how inept I am when it comes to matters of the kitchen. You can see the direction this would be going when I resorted to taking up baking as a hobby.
Busy the hands to quiet the mind? Feed the stomach to empty the brain? I have no idea what pseudo fortune cookie theory I was operating under at that particular time.
But discovering I had no measuring cups was likely one of those charming little mishaps that defined those first few months at site (and likely sent me crying to that overly-expensive-down-comforter-covered-bed. I cried enough in those first few months to certainly last me the next two years…) Depressed, determined and most of all, hungry, the perseverance I’ve found in myself (and has jumped in to save me through much more trying and traumatizing shit than I can name) kicked in and I decided that measuring cups were going to have to be a luxury for the moment (incidentally I now have two sets;-).
So I baked. I eyeballed and felt the weight of the ingredients. I experimented and tried new things. It probably wasn’t always exactly right, but at least sometimes, it worked. Things tasted generally ok. I ate them. I didn’t poison myself or others (that I know of). I can’t even begin to tell you the amount of pride I experienced, and the amount of confidence in myself I developed, and the hope that was fostered that I could indeed do this Peace Corps thing.
Because what does it mean to measure? How can one determine exactly how much of something one has in different situations, under different conditions? How does one measure things, especially abstract things like success? Or behavior change?
I think about this often, even more so when it comes time to fill out our quarterly Peace Corps reports, those nightmarish visions in excel friendly format (allegedly) wherein we’re supposed to compile numbers and write a short synopses to describe what it is we do and how many people we’ve “saved” from the scourge that is HIV in Botswana.
So every three months I find myself in a tailspin of self doubt and feelings of inadequacy and failure when I face the difficult task of quantifying the work I do into an easy-to-read numerical format.
I often find myself envying people serving in other Peace Corps countries, where the goals appear (although I’ve learned nothing here if I haven’t learned that appearances can be deceiving…) to be attached to programs with tangible outcomes.
“What did you do in the Peace Corps?” a Question I anticipate enjoying almost as much as the one about “Why are you joining the Peace Corps?” or “What will you do in the Peace Corps?” To be able to simply answer, “I dug wells.” Or “I grew gardens”. Some of the members of a former cohort often said (only partially in jest) “I saved babies”.
What does it mean to have lived a year and a half of your life in a place and still not completely have a handle on it?
What have I done in the Peace Corps….?
Ummmm…
Crickets chirping….
(I mean really, I’ve been writing this lengthy, overly wordy blog which many people swear they’ve been reading for a year and a half and they still ask me what I do… and I don’t blame them a bit. Personally, I like to think there’s been some growth, and professionally, I’ve got ideas, and some energy still, I’ve got a helluva lot of goals, and things I’d love to see happen… but it’s also really tough to explain in a way that seems meaningful to the average onlooker. When I try to describe what have been some of the more meaningful moments and life changing experiences I've witnessed and had myself here, I'd be lying if I didn't admit that it can all start to sound a little kum-bah-ya and lame. I realize that. People say I'm doing good work over here, and I struggle sometimes to believe that is true, but it's the hope that I'm doing something that will incite change that gets me out of bed in the morning.)
As Americans (and especially as Americans with mostly American funders) we want results. We want numbers, we want hard facts, and we want success. We want gorgeous, Excel generated charts and graphs and spreadsheets that we can take back to show other Americans how successful we’ve been. These are our measuring cups. We want everyone to marvel at the cake we’ve baked, and we want to give them the recipe for success with exact and replicable ingredients.
But this is Africa. And more specifically, Botswana. And even more than that it’s Seronga, a tiny village in the heart of the Okavango delta and peoples whom even their own government often overlooks. We don’t eat cake here. And so I’m sorry. Success looks and tastes differently here. The measurements vary.
Because what can these numbers possibly mean? If it’s about numbers I can give you numbers all day, numbers that have been ascribed to me or to my accomplishments. I can give you my weight, my date of birth, my social security number, my high school and college GPAs, the score I got on any number of tests throughout my life, the number of stamps in my passport, any number at all that is supposed to have some meaning that in some way describes me. But do they? Can they tell you if I’m a success?
Ok then, lets talk experiences. If I gave you the name, presenters, brochure, location, duration, program from every class, speech, lecture, workshop, seminar, poetry slam, open mic night or reading I’ve ever attended that was supposed to in some way influence me or change my mind, could you from that calculate my risk behaviors?
Maybe. But probably not.
But it doesn’t exactly predict how I’ll act. And thus whether I’ll act in a way that might lead to me acquiring HIV.
So how can I report, honestly, that the guy over there that attended the workshop I’ve put on has been at all informed, has taken in the information presented to him in a meaningful way, that he relates to himself the benefits and risks of male circumcision and that his decision around this matter for himself might be changed. Can I report this quite honestly when I know for a fact he came for the free lunch?
And what about the woman over there, who just sat through the clinic health talk on multiple concurrent partnerships? Can she conceptualize what this means for her (sure she can repeat what has just been said, and she can tell me all day long what it is I want to hear.)? Does this mean that I can safely assume that she’ll have the sexual negotiation skills and confidence to confront her partner, and the independent financial resources to leave her partner should he refuse to give up his other wives, or even to go to the clinic to test for HIV with her? Is all this a success if it just ends up getting this woman a fresh beating?
You can see where the numbers and reporting are just the first wave of angst.
It’s hard to look at a report designed for the duel purpose of keeping track of what we’re doing (this is indeed the only evidence we submit that we are really doing anything-for those of us this far out it’s not like the Peace corps is just going to randomly wander through our villages-I’ll say it again, it’s a mission to get here) and reporting to funders (one might expect that it’s sort of in everyone’s best interest to produce high numbers of those reached- and thus effectiveness as it’s these funders who keep us in jobs-this has been a moral dilemma to me, as I had always envisioned the Peace Corps as a place in which the goal would be to “work myself out of a job…” And the HIV rate in this country has done nothing but go up since I’ve been here) and not feel a sense of confusion, and I daresay, failure?
Because really in the end, all the paperwork and reporting and questioning leads to one bigger, more personal end.
If the Peace Corps is my life (Which arguably it is, at least for these two years. It’s pretty difficult to separate the personal from the professional when you live in these circumstances, with these sorts of goals) and these are the predetermined measurements of my success, and I feel this much confusion and uncertainty over reporting my “accomplishments” and whether I’ve achieved success, then what am I doing? Am I doing the right thing? Must my goals and feelings of success as a person in an individual be intrinsically tied to the level of success present in this village-ie the increase or decrease in the number of HIV infections? Has this been worth it? Am I successful?
These are questions I ask myself everyday. And the answers have never come to me via the reports I agonize over and resignedly hand in every three months. I’ve had to redefine success. Again and again. And it rarely comes in a numerical form.
Because success has come to look and feel differently to me.
Do I know that making art projects around the village is going to have any impact whatsoever on the prevalence of HIV in my village, or in Botswana? Nope. But I do know that several children have taken a project through from design to completion and can see their efforts on the walls of their hometown. I can see in them a sense of pride in their accomplishment. Some of them have made a connection between the use of alcohol and HIV. Some have been inspired by the notion of recycling objects to make art.
Can I foresee if reading books in English and discussing the themes and watching the movies and journaling about their reactions is going to keep five precious girls from contracting HIV? I wish to God I could. But I can tell you that I have seen their comfort level of reading, comprehending and expressing themselves in English increase, for some of them, dramatically. And I am willing to bet that these skills will help them enormously when they’re in medical school, a plan that half of them have, with their primary goal to be to find a cure for HIV and to help their people.
So how do I measure success? I know it when I feel it.
I consider it a success when I see one of the nurses, after watching me practice reading aloud in English with some school children for 45 minutes while they waited for him to finish with patients so that he can help them complete a questionnaire they’ve been sent to complete, take real time to help them finish their assignment and make certain they understand. Last week a nurse shouted an answer at them from a doorway.
I consider it a success when the woman who sells me airtime texts me after I’ve given her some magazines because she’s expecting a child and wants to know more about healthy eating and how she should prepare health wise for the baby. Prior to my suggestion she had never before taken advantage of the library within 100 meters of the door of her shop.
The children with whom I practice writing their names and multiplication tables in the dirt have steadily decreased the time it takes them to answer my quiz like questions and increased their willingness to look me in the eye. Learning is becoming something that is fun for them. They’ve come to trust me and know I won’t beat them if they get the answer wrong.
And there’s no box on the form for that.
How much credit can I take for any of these things? Probably not much. But for me that’s the definition of Peace Corps. We don’t come here to achieve success in the typically American sense. We have to find it in other ways, to search and dig and redefine it for ourselves. For me that has meant that my feeling of success comes when others achieve something, when I see that they are becoming closer to their best selves, and that they are improving the way in which they interact with and manage their worlds and what they want from it, when they raise their own expectations of themselves and others.
Did I come here to solve HIV? Nope, that one is way bigger than me. Did I come here to personally have an impact on a massive reduction of HIV? Even at my vainest moments I’m not that delusional. Might I have helped someone who could potentially do these things for their own country? That’s the dream. Have I been successful? That’s the one I take to bed with me at night, and hope that in the end, the answer will come out to be a resounding “yes”.
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