Tonight we nearly cried in a restaurant. Steve cried. He was desperate. We were all shocked.
Steve is a social worker from Kenya. He speaks fluent English and is very intelligent. He prides himself on belonging to the same tribe as Barak Obama, the Lua, who are all said to be intelligent.
Steve has worked in many places throughout Africa. Over the last 3 years he worked in Uru, a conglomeration of villages near Moshi, spread over 1750 square kilometers, in a tough and mountainous area. He worked for an NGO until he was fired due to internal politics.
This weekend Steve went back for a visit. That is why he cried. So many of his close friends had died in that time. And he told us what was really happening. That is why we were shocked. We thought we had heard it all, seen it on TV, read about it. But even though he told it with a sense of humor, it was still shocking.
The story is so convoluted, so desperate, so ridiculously tragic, that it is difficult for me to remember. Here is just one small aspect of it. As a social worker and educator, Steve organized groups of people with AIDS. I cannot call them patients because no one is looking after them. In his absence the groups stayed together and held meetings as he had instructed them. This weekend he met representatives of one group, a group comprised of 60 women. Out of the 60, 50 had AIDS very badly, with A CD4 of below 200. The other 10 had it to a medium level. Only 10 of the group could make it to town to get ARVs. He doesn't know if he will see the rest, because they will die soon.
There are 175,000 people in this catchments area. 45% have AIDS. Forty five percent. There are two brand new medical centers in the village. No one works from there, they are empty shells. The medical equipment lies unused, but the organization that provided them can proudly proclaim success. They are unused because no doctor or clinician will work there, it is too rural. There are no counselors for education, because they are too expensive to train.
When AIDS started spreading, no one knew what it was. They blamed it on Juju, a spell cast by the nasty neighbors. When they called the mganga, the traditional healer, to cure the disease they used scarification, a technique of making small cuts in the skin and putting herbal medicine in. They do this with dirty unsterelised knives. Result- immediate infection with AIDS. In my clinic in Dar es Salaam, a patient told me how this happened to her. Not every infection is through sex.
This is coffee country. The western demand for organic coffee accelerated the spread of AIDS. They uprooted all the non organic crops, and there was no work. The locals, who belong to the intelligent Chaga tribe, traveled far and wide looking for work. And when they are away, they sleep with prostitutes. Frequently. Then they come home for Christmas, and the party begins. For two weeks everyone is drunk, and promiscuity abounds.
Meanwhile, those who stay to work the coffee plantations get paid on a daily basis. They bring the money home and drink the very potent home brew. More promiscuity, and the next day, no money for food.
The young women have sugar daddies, older married men. And the young men have sugar mummies, similar. So from the younger, sexually active generation, it spreads to the older generation. Now they are dying too. By the time the young people marry, they have it. They cannot refuse or blame the sugar parents, because they are respected elders. Then the children get it at birth. But not all of them, for some unknown reason some revert from sero positive to negative. So when the adults are told not to have kids because they will get HIV, they see it as a conspiracy to stop population growth. This disease is full of conspiracy.
The mothers can't breast feed, because that will transfer the disease, so the babies are malnourished. Or they get gastroenteritis from infected food, and die anyway.
So AIDS spreads, and now 65% are dying from it. The orphans are living with the remaining mothers, who can't feed them, let alone go to travel to town to get ARVs. Occasionally Steve took them to town in his car for testing. And occasionally they died on the way. Those who made it were asked to fill out long forms. They refused, saying that they will not fill out such a long form if they will die tomorrow.
Now, if they do manage to get to town for ARVs the mothers put them in their bag and never use them. That is because they know that if they take them or give them to the kids, they will die very quickly. They have seen it before, and they are not stupid. The reason they die is because they are malnourished. To take ARVS you must eat 5 regular healthy meals a day. Otherwise the poison is too strong. Seeing all the kids eat is a very diluted porridge with a bit of sugar, there is no way they can survive ARVs.
The malnourishment is not only due to poverty. There are cultural reasons. The land is rich, and you could grow anything on it. But the locals like bananas. They love bananas. They eat them with every meal; fried, stewed, steamed, or with tiny bits of meat. And while bananas have a few good things in them, they are not a complete diet. But the locals refuse to eat anything else. They scoff at those who eat fruit, they let the mangoes rot, or else they export them. Anything but eat them. Steve tried all he could to explain this, but it didn’t work. So they are malnourished because of prejudice and culture.
Steve, and many others, tried to explain about condoms. The locals took it as a sign that there was a conspiracy to limit their population and refused to use them. The Chinese government sent over a ship load of condoms to Africa. They were two sizes too small at best, so all those who tried them never tried again.
Some research showed that circumcised men got infected less. Who knows by how many statistically significant percent. So many were told it was a good idea to be circumcised. Those who bought the promise and got a circumcision believed it would give them full immunity. They got infected. In Kenya, Steve's tribe was told they had to all get circumcised. They refused. Someone on TV asked where all the nurses will come for that amount of circumcising. There was no answer.
No one wanted to be tested for AIDS. Too much taboo and stigma involved. To get around this, a proposal came up to disguise the Testing centers as cyber cafes. In other words, you go to a cyber café and willingly or not, you get tested. Needless to say, that idea died.
A particular Christian denomination called "Assembly of God" that is popular in the region, preached that it is a sin to take the medication, because God will save you. If you have ' the disease' you are a sinner, but seeing God will save you, you are absolved. Then you die.
ARVs are difficult to get, the distance to town is too great. The mothers walk 15 km to town with one bunch of bananas on their head and sell them for $2, and because it is night when they finish, they have to get back by bus, which costs 50 cents. There is no time to collect ARVs. So along came a well meaning organization and gave money for the people to ride into town for ARVs. For one month. The poor souls that were unfortunate enough to participate in this scheme died very soon after the month was over. These drugs are not meant to be taken for a month. This is a long term disease. These drugs are not meant for the malnourished, for those who can't afford them, for those who can't access them. Steve was mad about this. No wonder the locals hate the drugs, because whoever gave them is not there, on the ground, to see what is happening.
Some say this disease came from the green monkey. Surely there is a lot of monkey business in the way this virus fools about with man's logic.
From dream Symbols: A monkey in your dream, symbolizes deceit, people are working to advance their own interest. To dream that you are feeding a monkey denotes that you betrayed by someone whom you thought cared about your interests.
It reminds me of when I met Wilfred in the computer shop earlier today, and told him of the project. He said; 'AIDS is big business in Africa, don't mess with it'
Steve knows nothing about homoeopathy, except the little he heard from our friend Caragh. His first question was, is it herbalism. When he was assured it was not, he was satisfied. More than that, he was eager. He went out and spoke to the chiefs this weekend. The people there didn't ask questions. They didn't want to know if we were medically qualified. They didn't care where we came from, or what diplomas we had, or about research, or scientific proof. They just asked for us to come. And before they met us, they set aside a room in the health center. I was happy, mixed with fear and trepidation. Steve said that they were happier.
Steve is a social worker from Kenya. He speaks fluent English and is very intelligent. He prides himself on belonging to the same tribe as Barak Obama, the Lua, who are all said to be intelligent.
Steve has worked in many places throughout Africa. Over the last 3 years he worked in Uru, a conglomeration of villages near Moshi, spread over 1750 square kilometers, in a tough and mountainous area. He worked for an NGO until he was fired due to internal politics.
This weekend Steve went back for a visit. That is why he cried. So many of his close friends had died in that time. And he told us what was really happening. That is why we were shocked. We thought we had heard it all, seen it on TV, read about it. But even though he told it with a sense of humor, it was still shocking.
The story is so convoluted, so desperate, so ridiculously tragic, that it is difficult for me to remember. Here is just one small aspect of it. As a social worker and educator, Steve organized groups of people with AIDS. I cannot call them patients because no one is looking after them. In his absence the groups stayed together and held meetings as he had instructed them. This weekend he met representatives of one group, a group comprised of 60 women. Out of the 60, 50 had AIDS very badly, with A CD4 of below 200. The other 10 had it to a medium level. Only 10 of the group could make it to town to get ARVs. He doesn't know if he will see the rest, because they will die soon.
There are 175,000 people in this catchments area. 45% have AIDS. Forty five percent. There are two brand new medical centers in the village. No one works from there, they are empty shells. The medical equipment lies unused, but the organization that provided them can proudly proclaim success. They are unused because no doctor or clinician will work there, it is too rural. There are no counselors for education, because they are too expensive to train.
When AIDS started spreading, no one knew what it was. They blamed it on Juju, a spell cast by the nasty neighbors. When they called the mganga, the traditional healer, to cure the disease they used scarification, a technique of making small cuts in the skin and putting herbal medicine in. They do this with dirty unsterelised knives. Result- immediate infection with AIDS. In my clinic in Dar es Salaam, a patient told me how this happened to her. Not every infection is through sex.
This is coffee country. The western demand for organic coffee accelerated the spread of AIDS. They uprooted all the non organic crops, and there was no work. The locals, who belong to the intelligent Chaga tribe, traveled far and wide looking for work. And when they are away, they sleep with prostitutes. Frequently. Then they come home for Christmas, and the party begins. For two weeks everyone is drunk, and promiscuity abounds.
Meanwhile, those who stay to work the coffee plantations get paid on a daily basis. They bring the money home and drink the very potent home brew. More promiscuity, and the next day, no money for food.
The young women have sugar daddies, older married men. And the young men have sugar mummies, similar. So from the younger, sexually active generation, it spreads to the older generation. Now they are dying too. By the time the young people marry, they have it. They cannot refuse or blame the sugar parents, because they are respected elders. Then the children get it at birth. But not all of them, for some unknown reason some revert from sero positive to negative. So when the adults are told not to have kids because they will get HIV, they see it as a conspiracy to stop population growth. This disease is full of conspiracy.
The mothers can't breast feed, because that will transfer the disease, so the babies are malnourished. Or they get gastroenteritis from infected food, and die anyway.
So AIDS spreads, and now 65% are dying from it. The orphans are living with the remaining mothers, who can't feed them, let alone go to travel to town to get ARVs. Occasionally Steve took them to town in his car for testing. And occasionally they died on the way. Those who made it were asked to fill out long forms. They refused, saying that they will not fill out such a long form if they will die tomorrow.
Now, if they do manage to get to town for ARVs the mothers put them in their bag and never use them. That is because they know that if they take them or give them to the kids, they will die very quickly. They have seen it before, and they are not stupid. The reason they die is because they are malnourished. To take ARVS you must eat 5 regular healthy meals a day. Otherwise the poison is too strong. Seeing all the kids eat is a very diluted porridge with a bit of sugar, there is no way they can survive ARVs.
The malnourishment is not only due to poverty. There are cultural reasons. The land is rich, and you could grow anything on it. But the locals like bananas. They love bananas. They eat them with every meal; fried, stewed, steamed, or with tiny bits of meat. And while bananas have a few good things in them, they are not a complete diet. But the locals refuse to eat anything else. They scoff at those who eat fruit, they let the mangoes rot, or else they export them. Anything but eat them. Steve tried all he could to explain this, but it didn’t work. So they are malnourished because of prejudice and culture.
Steve, and many others, tried to explain about condoms. The locals took it as a sign that there was a conspiracy to limit their population and refused to use them. The Chinese government sent over a ship load of condoms to Africa. They were two sizes too small at best, so all those who tried them never tried again.
Some research showed that circumcised men got infected less. Who knows by how many statistically significant percent. So many were told it was a good idea to be circumcised. Those who bought the promise and got a circumcision believed it would give them full immunity. They got infected. In Kenya, Steve's tribe was told they had to all get circumcised. They refused. Someone on TV asked where all the nurses will come for that amount of circumcising. There was no answer.
No one wanted to be tested for AIDS. Too much taboo and stigma involved. To get around this, a proposal came up to disguise the Testing centers as cyber cafes. In other words, you go to a cyber café and willingly or not, you get tested. Needless to say, that idea died.
A particular Christian denomination called "Assembly of God" that is popular in the region, preached that it is a sin to take the medication, because God will save you. If you have ' the disease' you are a sinner, but seeing God will save you, you are absolved. Then you die.
ARVs are difficult to get, the distance to town is too great. The mothers walk 15 km to town with one bunch of bananas on their head and sell them for $2, and because it is night when they finish, they have to get back by bus, which costs 50 cents. There is no time to collect ARVs. So along came a well meaning organization and gave money for the people to ride into town for ARVs. For one month. The poor souls that were unfortunate enough to participate in this scheme died very soon after the month was over. These drugs are not meant to be taken for a month. This is a long term disease. These drugs are not meant for the malnourished, for those who can't afford them, for those who can't access them. Steve was mad about this. No wonder the locals hate the drugs, because whoever gave them is not there, on the ground, to see what is happening.
Some say this disease came from the green monkey. Surely there is a lot of monkey business in the way this virus fools about with man's logic.
From dream Symbols: A monkey in your dream, symbolizes deceit, people are working to advance their own interest. To dream that you are feeding a monkey denotes that you betrayed by someone whom you thought cared about your interests.
It reminds me of when I met Wilfred in the computer shop earlier today, and told him of the project. He said; 'AIDS is big business in Africa, don't mess with it'
Steve knows nothing about homoeopathy, except the little he heard from our friend Caragh. His first question was, is it herbalism. When he was assured it was not, he was satisfied. More than that, he was eager. He went out and spoke to the chiefs this weekend. The people there didn't ask questions. They didn't want to know if we were medically qualified. They didn't care where we came from, or what diplomas we had, or about research, or scientific proof. They just asked for us to come. And before they met us, they set aside a room in the health center. I was happy, mixed with fear and trepidation. Steve said that they were happier.
(Photo from bottom left: Jeremy, Margot, Caragh, Steven and Siobhan)
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