December 2005

To Val 12/10/05
Val,
If you are reading this, I am sorry to tell you that Hlobsile did not make it.  Apparently she died last week while I was visiting Tanzania with my sister.  I regret I was not able to be with her those last few days- she fought so hard.  I will always remember that day I went to the hospital to visit her. She was sitting all by herself outside in the sunshine in the new blouse you bought her, alone, sun on her skin. God she was sick.  Her struggle to wrestle a little life out of her ravaged body was inspiring but wrenching at the same time.  We should all try so hard to live.  We should all want it so much. Am sorry.


Z’s mother 12/12/05
Z's mother was buried today.


12/11/05

UNAids: 'Prevention strategies aren't working'

 Emmanuel Goujon

Abuja, Nigeria 

 08 December 2005 07:51

 It is time to rethink the strategies used so far in the fight against HIV/Aids as they have shown their limitations, particularly in Africa, according to Michel Sidibe, the Malian who is deputy head of UNAids, the body coordinating the fight against the

pandemic. "Sadly, the epidemic continues to spread. There are three reasons for thinking that our strategies and our approaches arent adequate," he told Agence France Presse on the sidelines of the 14th International Conference on Aids in Africa (Icasa) that opened Sunday in Abuja. "First, every year we see an increase in the number of infections. That proves prevention strategies aren't working", he explained. "Moreover, even if were scared to say so, we havent been able to cut the number of Aids-linked deaths in Africa and that proves that drugs are not being made available," he added.

In 2005, 2,4-million Africans died in the pandemic.

Currently about 500 000 Africans are on anti-retrovirals whereas UNAids estimates that a total of 4,7-million children and adults on the worlds poorest continent are in need of such treatment.

Thirdly, Sidibe emphasized two new factors exacerbating the problem: the high rate of infection in women, especially in young women, and the way that children are for the first time being hit by the epidemic. "There is a danger that the combination of those two factors might create a social catastrophe that could in the long term prove one of the most difficult to manage in Africa. The continents elite have not, as yet, measured the gravity of the danger," he explained. According to UNAids figures, sub-Saharan Africa is home to just over 10% of the world's total population but accounts for more than 60% of the total number of people infected by the virus worldwide. The deputy chief of UNAids pointed to a dangerous trend: "Its something one notices even in the West: the new cases of HIV infection are occurring in the poorest sections of society."

In the face of such gloom and doom, Sidibe advocates "a more creative approach, more hands-on and more in keeping with cultural reality" for prevention and better coordination between the different parties in the struggle.

"There is a multitude of actors and a multitude of sources of funding, but no coordination, meaning that public servants and associations spend more time in their offices writing reports and drawing up funding requests than they do implementing projects on the ground", he said. Sidibe feels that, for it to be effective, the fight against HIV/Aids must go hand in hand with the development of democracy on the continent.

"To manage this type of crisis, one needs a strong and democratic state that has the interest of the public at heart, because without democracy there is no obligation to get results", he said. - Sapa-AFP

New girls 12/14/05

Three new girls, ~12, 11, and 6, and their tiny brother, maybe 3, arrived at the orphanage yesterday.  About a month ago their sister was hit by a car and was killed.  Shortly thereafter, their mother, the second wife to their father, killed herself by eating weevil poison.  Rumor has it that the father forced fed her the tablets to get the insurance money for the death of the child.  There was not enough evidence to arrest him.  Since that time, the father has been abusing the children and the grandfather collected them all and asked to have them placed at the orphanage.  They showed up in the grandfather’s pickup, sad and tentative.  After ensuring with the house mother that they could stay (the tiny boy will go the the boy’s orphanage in Manzini), the grandfather took the oldest girl home to collect their clothes.   A few hours later, as I was walking to town, I passed the girl walking alone with a bundle of clothes on her head and a bag full on her arm.  They made her walk the 4 miles back to the orphanage with all the clothes.  It’s like that here. 

October- November 2005

Quick update 10/8/05
For people who are trying to keep up with things in Swaziland, I apologize for the infrequent entries.  Here is a recent update:
Bheki has enjoyed the longest stretch of good health since I have known him.  He may have turned the corner,
S. is still on ART, doing exceedingly well, and is now attending the local support group.
The woman with 7 children, living way out in the rural community, tested herself, is positive, and is receiving treatment for herself and her baby. 
The little girl whose hand was burned off and who is badly burned elsewhere was discharged.  I still am hoping I can find some help for her from somewhere as her chances here in swaziland are poor.  Anyone???
The situation with the youth with KS is not encouraging.  He has been compliant with the arvs but the KS is fast growing and his leg seems to be turning to stone before my eyes.  The doctor sees no need to change the ARV regimine because his CD4 count has rallied over the past year (from <5 to 200 per microliter of blood).  There is no treatment for KS other than ARVs in this country so I am not sure what will happen with him. 
Have not seen the two little ones with gogo for a while and will go see them soon.  Last time they were doing well.
The children living with their mother in the abandoned structure in the woods are still there and the situation is still grim.  I see little Ayanda walking to and from town by herself and am constantly worried for her safety in a country in which child sexual abuse and rape are so common.
I ran the Mbabane swazi half marathon with Nelisiwe (Nelie), one of the girls from the orphanage who has been running with me for a few months.  It was her 13th birthday and they weren't going to let her run because she was under 16.  I begged, pleaded, and pouted, and one of the registrars agreed provided I stay with her the entire run (my intention anyway).  We finished in 2:20. It was great.
We have been in country one year Oct. 1.
Don't forget us, people are dying here in unimaginable numbers.


Another day, another death 10/25/05
 The kid with KS died this morning.  I went to see him yesterday afternoon at the hospital.  He was so small and frail.  He was 18 but stood about 5 inches shorter than me and weighed 40 kilos when I first saw him.  By yesterday he weighed much less. It is ghastly what this disease can do to a body, especially a young one, when left unchecked.  Blood was coming from his nose when I saw him last and they were unable to access a vessel for IV insertion.  His family looked at me as if there was something I could do.  Nothing now other than to grieve with them.
I understand that sometimes, rarely, KS can appear after treatment has started, and it can be resistant to ARV treatment.  This thing started and spread so quickly it left me reeling.  When I first saw the youth, a few weeks ago, there were some lesions in the groin and on the inside of the lower leg.  By yesterday his whole leg was involved, the groin area, and beginning on the other leg.  Living in a country with radiation and chemotherapy might have saved him.  Even being able to offer him another regimine with an ARV that was more effective against KS might have helped him.  That we could have done but the doctor was resistant to changing the arvs a few weeks ago because his CD4 count was higer over this past year, suggesting that the medication was working.  CD4 counts don't maytter much when you're dead.


Joel’s day 11/18/05
I had hoped to come up with something profound and eloquent, maybe even inspirational, to leave you all with on this momentous day, but still there are no words.  The loss of him, the absence of him in the universe, is still the most profound thing of all.  Lately I've been remembering how I felt those first few months, how I wondered that any parent, any mother, could recover from such a loss, the loss of an only child, the loss of color and light, the loss of the most precious thing, that unique and unquenchable spirit- quenched. You would think that the death I've encountered here would help dull the sharp edges of his own death.  It has not. Distance from that day simply allows me to feel it more because to let it all in that first year would have been more than my own heart could take.  So I sit here raw, fighting back, biting back tears in this very public internet cafe.
I received a text message from Z last nite that his mother is in critical condition in the hospital up north where we did our training.  For those of you who do not remember, or do not know who Z is, please go back to my archived post of January 2.  It is important in order to understand the workings of the universe, of my universe anyway.  I fell in love with Z at a time when I thought the Baker Street Boys had gotten the last of it, the last of the love for young kids, young adults.  It is serendipitous that, on the day I mourn Joel, I am traveling north to be with Z as his mother dies.  I am grateful for this opportunity to be out of myself, to stretch my heart just a little more this day.
I wish you all peace and love. To the Baker Street Boys, the Deaf Dog kids, Tom, Ginny, and everyone that knew, loved, and shared Joel  with me, know that I know your hearts are with me on this special day. Take a second to look at his picture on his page and read the Jack London quote and know that he would say "it's all good" even if it seems like it isn't some days, this one in particular.  And keep in your hearts the millions of Africans who have died, are dying, and will die on this continent in the next few years, whose mothers also grieve.

September 2005

Unusual good news 9/8/05
Turns out it was someone else's 21 year old that died.  My neighbor was discharged in relatively good health and is home now.  I do not yet know if she has gone to have her CD4 count done or if she has been put on ART.


Girls camp 9/10/05

I had a 5 day “day camp” for the girls at the orphanage and the girls in the community the week of the 5-9^th of September.  This was supposed to be a period of school break for all the kids and it seemed a great opportunity to create a venue for HIV education, female empowerment, and just plain fun.  Unfortunately 2 of the high schools were back in session so we were missing some of those girls; however, we ended up with 60 girls and it was a huge success.  The idea of a camp to empower young girls was not mine, the Peace Corps does this program-wide, generally as an overnight experience.  One of the other volunteers did this in her community recently and it seemed that the orphanage would be a perfect location to host such an event.  It was important that the educational component, to take place in the morning, be done in SiSwati. It was more important that the kids understood than that I understood.  I enlisted the help of 3 “peer educators”, youth that have been trained to teach other youth about HIV, life skills, communication, etc.  I had additional help from Nompilo, the HIV+ woman I mentioned in one of my earlier posts, who is one of the most inspiring women I have had the pleasure to know, and a woman from an NGO in Manzini who turned out to be solid gold. The afternoon sessions were all fun and 6 – 7 different female Peace Corps Volunteers helped each afternoon with a variety of arts, music, drama, games, and sports events.  When I asked the girls what they enjoyed the most, they all agreed it was the people who had come to spend time with them that week.  Can’t buy that.

Sad little girl 9/13/05

Simphiwe and I went to the hospital this morning to visit a little girl who had been badly burned after falling in a fire, probably the cooking fire.  She is two and tiny with a sweet, sad little face.  Her father died before she was born and her mother died when she was still nursing.  She lives with her gogo who is staying at the hospital with her.  Apparently the gogo stepped away for a minute to check on something and returned to a screaming, burning child.  The full details are unclear.  Her right hand is completely burned off and the arm is seared past the elbow.  2 fingers on her left hand are burned beyond use and her left arm is also burned.  Most of her beautiful little face has been spared, the burns severe under the jaws and chin and just edging up her lower face.  They say her clothing stuck to her as it burned and her belly is still bandaged.  You can see the burns on her thighs and chest.  She looks confused.  It was painful to watch her try to put her sweater on- as if she didn’t know that she couldn’t hold on to it with her partially spared hand and as if she didn’t understand why not.

Simphiwe took information from the gogo in the hopes we can find them some help somewhere.  Being female in Swaziland is difficult at best.  Being female in Swaziland without one hand and only partial use of the other will be impossible.  I don’t know how she will live when gogo passes away.  It must have been very difficult for Simphiwe- she looks a bit like his darling 4 year old daughter.

This afternoon I was on my way to town and found little 7 year old Ayanda, the child living in the abandoned structure in the woods, on the road to get something from the market for her mother.  We walked silently to town and back, hand in hand, with rain threatening in the near distance.  Somehow language is sometimes unnecessary.  Sometimes it even gets in the way.  Her little hand in mine, so trusting and so vulnerable, was all that existed, was all that mattered.

Kaposi Sarcoma 9/14/05

Spent the morning in the ARV clinic with and 18 year-old male that our Rural Health Motivator (RHM- rural women trained to help sick members of the community) brought to me the other night.  He and his 27 year-old sister have been on ART for about a year now.  For both to be HIV+ and on ART means they were probably infected 6-8 years ago, I suspect by a family member.  The youth was brought to me because the RHM was worked about his leg. He had a “condition” that was getting worse.  In front of the RHM, his mother, and me, he dropped his trousers exposing a pretty severe case of Kaposi’s Sarcoma down the entire length of his leg with concomitant severe swelling of the entire leg.  KS is common in sub-Saharan Africa, is almost exclusively associated with HIV, and appears predominantly on the legs here.  Fortunately, KS is extremely responsive to ART and even pretty severe cases will resolve once treatment has started.  That his condition was getting worse, and that his sister is currently very ill and in the hospital, might suggest a “compliance issue” with the medications.  Unfortunately, poor compliance is not uncommon here.  People frequently stop taking their meds as soon as they start to feel better.  I am not sure how clearly they understand the ramifications of noncompliance.  A drop below 90% compliance is dangerous and will lead to the emergence of ART resistant strains of HIV.  I fear we will see a plethora of these resistant cases in Africa.  God knows what we will do then.

They took his blood for a CD4 count today and we should get the results next Thursday.

July - August 2005

The girls 7/2/05

It’s funny, there’s so much to write about the girls and yet it is so difficult to put pen to paper and share our lives.  I think they should never have put me here.  I love these girls too much and even now it breaks my heart to think of leaving them.  It was awful at first and for quite some time I wondered if the Peace Corps hadn’t made a big mistake in my placement.  Although I had worked with kids before, it had always been teenage boys.  And with Joel in Petaluma, Baker Street was always full of big, lanky adolescent males, lounging around my living room like big Labrador retrievers.  So when they told me I would be placed in an orphanage with ~25 girls, I was not sure how to feel. It was slow going in the beginning. There are, of course, the language difficulties.  But, beyond that, it is not my style to jump right in and start playing games or being the “bestest of friends.”  I was a stranger in their midst and it was their home.  I respected that.  And they were noisy.  There are actually 23 girls plus the house mother and her two children, a boy and a girl.  And the girls love to sing and shout and laugh, all day long, at the top of their lungs.  Being a relatively quiet and private person, especially in unfamiliar surroundings, I felt that I was ill-placed.  But I sat with it.  And sat with it.  And sat with it.  And slowly our worlds began to converge on each other.  I noticed it when I realized that the sound of pounding feet past my window at 3:30 in the morning, as the older girls go to begin preparing the morning meal, had changed from an annoyance to a sound that now leaves me lying in bed grinning.  There is no better way for the day to greet me than the sound of pounding feet past my window.  And I realized their laughter, constant and loud, now filled the air rather than invading it.

The youngest girl is Ncobile (the “c” pronounced as a click).  She is 8 chronologically but developmentally about 5 or 6.  When she was 6, her mother threw her in the fire.  She spent a year in the hospital and no one thought she would live. She has been at the orphanage for about a year.  Her backside, from lower back to upper thigh, is one solid mangled piece of scar tissue.  And those are the scars you can see…  She is tiny and reminds me of a little bird.  She comes to my rondeval three times a day so I can supplement her food, which for all the girls consists of little more than a daily ration of beans and cornmeal, with protein enhanced powdered milk and a vitamin enhanced Ovaltine-like substance.  The other girls say she is improving.  It is hard for me to tell.

And Busie, god I love Busie.  She is about 10, small and tough, and generally in some state of undress, her dislike of clothing underscoring a touch of wildness or an unwillingness to be tamed that appeals to me.  It speaks to some spark in me that still defies convention despite my many years on the planet.  Busie’s mother died when she was about 5.  Her father is alive but she can’t live with him.  She said he was mean to her.  When a Swazi child says someone was mean to him or her, a statement like that from children who are routinely and legally caned and beaten at school and accept it without complaint, you must know they have been badly treated.  Additionally, sexual abuse of young girls is common in Swaziland, occurring routinely at home as well as in the schools, and it is my understanding that most of these girls have suffered this at one or the other location.  There are generally about 2 stories a week in the Swazi Times about another teacher or headmaster who has been accused of or found molesting children- two times a week in a country the size of Rhode Island.  And the abuse at home is not generally reported.  In the rural areas children and wives are considered property.  When something is yours,you can do what you want.  But back to Busie.  I love her. 

And this is just the first two.

A mother’s dilemma 7/26/05
I just learned from the housemother, who lives at the orphanage with her 7 year old son and 11 year old daughter, that her son must be gone by the new year or they will all 3 have to leave. This is a woman who lost her husband several years ago, was made to leave his homestead by his family, moved in with her brother, who abused her children, and sister-in-law who told her to leave, and finally found a place with the orphanage.  Like most women here, she owns nothing and has no opportunity to improve her situation. She is uneducated and gets the equivalent of USD40/month for running the orphanage.  She has resorted to looking for orphanages to place her son, upon whom she dotes, so that she and her daughter are not thrown out to make their way on the streets.  What the hell kind of choice is that????


Just 21 8/16/05

She’s 21.  Her baby died 2 years ago, surviving only a couple weeks of life.  The community home-based caregiver came to ask me to see her last night.  She assured me it was not “too far”, but far seems to have a different meaning here.  We take our shoes off as we enter the tiny, dark room in a mud hut that has become so familiar here.  It is dusk and I can barely see inside the room.  A child of 5 or 6 sits on a makeshift bed.  A body lies face down on a mat on the floor. It is she.  They tell me to sit on a mat a few feet away but I take a place by her head instead.  I can feel the heat rising off her body.  A thermometer would have only served to scare me more.  She could barely lift her head up and I wondered how she could lay like that, this grown young woman, belly and face down on the hard concrete floor.  But she has been like this for 2 months now, face down on the floor.  She has been sick much longer.  I tell them I will hire transport in the morning, first to the VCT for HIV testing and then to the outpatient clinic.  I have someone walk me home so I can send back a few tablets to bring her fever down and some gator aid to rehydrate her.  She is incapable of keeping food down. The oral thrush is so thick it would seem she is talking through cotton balls.  I wonder at the awful stigma of this disease that allows a mother, her mother, to watch her 21 year old daughter come to this before she calls out for help.

This morning, not unexpectedly, the taxi driver charges extra because I am white and because she is sick.  These are not taxis, as we know them.  Rather, men with old, beat up personal vehicles park at a corner in town and wait to be hired by anyone in need of a ride somewhere. 

It was cold and rainy and the wait at the BVCT was not long.  The results were not unexpected; she is to show up next Wednesday to have blood drawn for a CD4 count.  She is positive.  Pity she did not test before the baby died, or before she gave birth.  43% of pregnant women here are HIV+ and most are still not testing, nor are they being encouraged to test by the prenatal clinic staff even though a single dose of Nevarapine can prevent transmission to the infant.  The wait at the OPD clinic is less successful.  The doctor for exam room #3, where we’ve been assigned, does not arrive until 3, and we are number 28 in his line.  He has been working straight since 8 and has probably delivered a fair number of babies, done a couple surgeries, and made rounds on the ward. 

She is prescribed some medication for whatever opportunistic infections she has and is instructed to come in for a chest x-ray as soon as possible.  The doctor agrees she should be taken to the ward, but there is no space.

I help them to the hired transport and send them home 20 rand (the price of the taxi) and with assurances I will come see her soon.  An old woman on the corner who knows me says, “ah, Nozipho, thank you,” and suddenly I am swallowing back tears I did not know were there.


Esibhedlela 8/26/05

I went to see her on sunday.  When I arrived at the wretched little hut, a group of local church people were praying and singing over her, the men just outside the door and the women on mats inside the room.  I was invited to come in and sit down.  I sat next to her again and held her head.  She needed more than prayer, she needed a hospital.  The group was willing to pray but, piling in their old pickup, they were not willing to transport her to the hospital.  Her sister walked to town to once again hire transport.  We got her to the hospital and fortunately there was room on the ward. 
I visited her Monday and she looked much better.  She was still not eating so we bought her something to drink.
She died last night.

June 2005

In the woods 6/24/05
 

This morning Simphiwe and I went to visit two women who are living in the woods just outside of town in an abandoned structure.  They have 8 small children between the two of them and no means of support.  The women chop firewood illegally for whatever few pennies they can sell the wood for.  One of the women has 5 children and all of them are sick.  The oldest girl, about 5 or 6, is possibly HIV positive, with oozing sores all over her body.  She has not been tested but her father died 4 years ago. The youngest child is only months old and is still suckling. These women have nowhere to go and no hope for help.  When a woman’s husband dies, she is often forced to leave the homestead.  If she has no home to go back to, she resorts to living wherever she can (for several months they lived behind a gas station in the neighboring town) and often will be forced to trade sex for food and money to take care of the children.  Often times women will find another man for a while who beats them and sexually abuses their children.  It is common here.  I am in training next week but agree to show up a week from Monday to take the woman to the VCT to see if we can’t get the child who is very sick on ARV treatment as soon as possible, and perhaps get all the children and the mother tested at the same time.  My fear is that the mother will become sick at some point and die, leaving these tiny 5 children in the woods to care for themselves.  There are no homeless shelters for women here and I am wondering how we might go about setting one up.  

May 2005

5/14/05

Since I last wrote, baby M has relapsed and has been in the hospital.   When the sores rebound, they do so with a vengence.  He was discharged yesterday, after 16 days in the hospital, still not well.  For 2 years this poor child has been sick and there seems no end to his misery.  Lately he has had transient periods of health, followed by relapse. Babe M has been at work, so the little 13 year old sister has been caring for the child.   When they discharged the baby yesterday, she wrapped him in a blanket on her too small back and headed home.  I sent them off in a khumbi,, not wanting her to trudge the several miles home barefoot, carrying the child and all his belongings.  They wave goodbye from the back of the van and my heart is heavy at the sight of them.

Bheki's wife, Lungile, has also been sick all this time.  She left the hospital in Manzini where she has family.  She has been back in the hospital here for several days.  She is near death- the sores in her mouth and throat prevent her from eating and the vomiting and diarrhea are just on the sidelines in case she does.  She was finally placed on ARV therapy yesterday and I am hoping for a recovery.

Lungile 5/16/05

Lungile is dying.  The ARVs came too late.  She is not able to hold down liquids much less the  panoply of pills that might save her life.  I spent the afternoon with her and watched her progressively slip away.  The yellowish, pus filled sores that line the inside of  her mouth and throat are starting to creep out at the corners of her pretty, delicate mouth. When I first came onto the ward she was cognizant.  Unable to speak, her eyes gave some sign that she was aware of my presence.  In an act I found poignantly futile, her auntie was pouring a capful of liquid into her mouth that simply dribbled out the side of her lips and onto a dirty washrag that was placed under her chin.

I left Lungile long enough to visit Lindie, Linda’s mother, whom I heard had lost her baby in delivery.  We found Lindie on the maternity ward.  She looked at me mournfully.  “Nozipho, my baby is late.”  People never use the word death, or any variation thereof.  No one dies, they are late, they are gone.  She makes room for me beside her on the cot and we hold each other for a bit.  I have nothing for her but my tears, which I give gladly.  She says she wants the doctor to “close her”.  She does not want to be pregnant again. I kiss her all over her beautiful sad face and tell her I will be back tomorrow.  I tell her to have Linda come see me so I can be sure he is taking his meds.

By the time I get back to Lungile, she is no longer aware of my presence or her surroundings.  The woman in the cot next to her died while I was out and there is a heavy empty space where her bed used to be. Lungile’s eyes are open a fraction with only slivers of white showing.  I sit and hold her hand and think how lovely she is, even in what are probably her final hours.  I think how much she looks like her 7 year old, the baby, whom she will probably never see again.  I wonder how Bheki will manage.  Gogo, of course, will take the children, but with no job and no hope for one even in the distant future (unemployment for men Bheki's age is at 40%), how will he pay school fees, buy clothes, books, etc?  And above all, how will he bear the loss of this lovely young woman who has shared this difficult life with him?

I look at Lungile who is dying because she had sex.  Pure and simple. How can this be? Where is the fairness in this?  The distended belly, the lifeless body, yellow fluid oozing from the corners of her mouth as she lays there- this all from sex.  How can this be?  A continent dying from sex.  Something so natural, so necessary, now so deadly.

Now gone 5/17/05

Lunglie’s auntie just came by.  Lungile died at 11 last night.  We sat on my doorstep and the aunt let me hold her while she cried, rare here to openly cry, especially with a stranger.

Lungile, like Nokuthula her sister-in-law, young, beautiful, with 2 small children, now gone.  Who will tell her story?  Who will remember her?  Who will know that for a brief moment she stepped lightly on the planet?

Cd4 counts and flow cytometers 5/20/05

I have been trying to get someone at a higher level interested in getting another flow cytometer for the country so that we can get CD4 counts more often than once a week.  I wrote the Director of NERCHA, the governmental agency that oversees HIV/AIDS efforts here and he says it is out of his hands, that the Ministry of Health is just not interested in putting the money into this effort even though we could get help through organizations such as the Clinton Foundation.  Here are the subsequent email exchanges with him which just about say it all:
Dear D,  Thanks for your efforts on our behalf.As to the flow cytometer, if the Ministry could just sit with me at the ARV clinic on Wednesdays, for hours and hours as the line snakes out the door and those who are too sick to stand lie on dirty coats on the floor, if they could just sit at the bedside of someone who is dying because they fell through the cracks, because a week can mean life and death in Swaziland... I am attaching a picture of Bheki Kunene and his two children.  I sat by his lovely wife's bedside 2 days ago as she was dying, I watched her life slip away. I want people to remember them. People are dying not only because they have AIDS, but because they have AIDS in a country where the medical infrastructure is collapsing and not able to handle current patient load, much less what the patient load will be 8 years from now, when about one half of the adult population will be dead, dying, or very ill.  I see people die simply because they fell through the cracks. I have heard you speak and I know you agonize over this.  Surely there is something we can do.  alyson

Hi Alyson, you will recall my words at your graduation as PC volunteers. 'Welcome to the hell of the real world' and that 'this will be a life changing experience'. The frustrations you feel, I feel have full sympathy with. At a management level where we are trying to do what we can to assist a whole nation of sufferers it is almost unbearable to cope with the lack of sympathy and capacity and down right obstructionism we encounter. People just don't seem to care for their fellow human beings suffering and death. But as a Christian that is what motivates me. I will continue the struggle in spite of them and do what I can. Ultimately we will have the satisfaction that we succeeded in spite of them. Keep up the good work. You know you have our support. D  

Joel 5/31/05
He would have been 20 today, that big magnificent kid with the great smile.  Yesterday I went to visit Robben Island, where Nelson Mandela was kept prisoner for 18 years.  Joel had great respect with Mandela and with the struggle to end oppression.  He would have appreciated the day.  He would have agreed with me as well, I think, that there are still 2 South Africas, much like there are 2 Americas, and that equality is still far from reach.  Ah, Joel, too, is far from reach and I miss him sorely.

April 2005

Sick at gogo’s 4/17/05

Bheki is sick again, or still.  Julie and I were waiting for the market to open before we headed up to the youth workshop and on eof Bheki’s relatives, a cousin I think, comes to tell me his is ill- very ill.  He is at gogo’s.  Julie looks at me and she knows I will not be going to the workshop afterall.  It is morning and the day is already baking my skin as I head toward home to collect some Oral Rehydration Sablets and some Gator Aid and head to gogo’s homestead.  I cannot remember where I am going and am fortunate that some women, seeing me, have stopped on the path ahead to find out what my business was way out there.  I explain that I need to find the homestead of “gogo wa Bheki” because I have heard he is sick and he is there.  The younger of the 2 women takes me with her to point the way.  It is not too far.

I pause at the boundary of the homestead and call out “ekhaya”.  I hear a weak voice respond but I wait, hoping someone will appear to take me past the dogs.  No one comes.  I call out again and again the same response.  I realize it is Bheki himself calling out to me. I find him lying on an old straw mat on the porch, half covered by a worn dirty blanket, his long feet sticking out.  He is unable to lift himself, unable to sit up.  It I heartwrenching to see him simply try to prop himself up on one elbow. I place my bag on the porch.  In addition to the Gator Aid and ORT, I have also brought beans and juice.  Gogo shows up from somewhere and I give her the beans. After placing them in the cooking hut, she comes and sits in a chair on the porch.  She sighs heavily, but she is grateful I am there.  Bheki explains he has been very sick for days- vomiting and diarrhea.  There is no money for the hospital, where he belongs.  At the equivalent of 2USD/day, I wan well afford for him to be there and tell him he will go today.  His mother is coming late in the day from her home in a community quite some distance and she can stay on the sponge pad by his bed.

He sees the juice and asks for some to take with the 2 ORTs I place in his hand.  Within a minute of two of downing the tablets and juice, he jerks up and leans over a green plastic washtub by his feet as the juice an tablets are rejected.  He attempts some water and that too comes right up.  Small wonder he is unable to sit up.  He says he has been trying to take his ARVs, but they too are vomited up within minutes.  The ARVs have been the only barrier between Bheki and an AIDS-mediated miserable death and my concern is deepened.  For the next few hours I just sit with him on the porch, without need for conversation, knowing it is enough to just be there.  A few people come and go.   A beautiful young woman in an old dress, with a young baby strapped to her back, has been scrubbing the floor of the cooking hut.  I learn that she is Sdumo’s wife- “Sdumo who is sick”, Sdumo who is now dead.

At some point Bheki asks to move to the couch inside.  He is tall and lanky but he only needs a little support from me.  I sit in the chair at his feet.  A neighbor comes in and sits.  I know him.  He is a good man and concerned about his friends and his community.  And today he is drunk.  He wants me to be his second wife.  Bheki’s brother comes in and sits across from me with a young woman.  I am not sure who she is.  Eventually the mother shows up.  She is small, thin, and hard looking and does not share the beauty of her children- Nokuthula, now dead, and Bheki, who’s almost there.  I learn that of her 9 children, only 4 survive.  How does she bear it?  Because Bheki is too weak and the walk too long, we wend the brother to town to hire transport.  When the driver shows up he charges an extra E5 because Bheki is sick.

We get to the hospital and eh is examined by a young doctor I have seen on a number of occasions. After much dialogue he agrees to admit Bheki.  Watching the nurse make several failed attempts to find a useful vein for his IV, I feel faint, nauseous.  Finally she succeeds and his is on his way to the ward.  I leave them there feeling confident that fat has once more wrested Bheki from the arms of the death that awaits him.


4/18/05

I go to visit Bheki and his mother.  They are hungry and I am thrilled to be able to bring them some food.  Bheki wolfs down some beef and thick corn meal and the food stays with him.  Already he looks well- he is sitting and smiling.  I wait for the doctor- a different one this time- who asks questions and leaves.  It will be at least a day or 2 before Bheki is sent home- re-hydrated and re-nourished.

Birthdays 4/19/05

I head for Mbabane today to have dinner with Julie and Joe.  We are celebrating my birthday (and the King’s).

Ncono 4/20/05

Bheki was released this morning.  He is “ncono”, better.  Much better.  I learn that his wife is still very ill and is in the hospital at Manzini.

The little ones 4/21/05

Simphiwe, vakashile, and I went to the neighboring community to visit the gogo with the 2 little ones.  It has been a while since I have seen them and I will be away for the long weekend.  We arrive with a couple bags of corn meal and they are happy to see us.  Both boys have recovered from the flu- dirty and ragged, but well.  Still no mother.

We go to see Mazaza.  It is cold and he is still under the covers, so we peek into the dark hut to greet him.

How it all ends 4/26/05
I am late posting these journal entries and so they are a bit out of time.  I understand some of these entries will be published in a Peace Corps-affiliated journal called WorldView magazine, in a special edition devoted to HIV/AIDS.  I encourage you to all get a copy of the edition, due to come out sometime in May or June.  Their website is: http://www.worldviewmagazine.com/issues/about.cfm and I imagine they can tell you where to purchase or obtain this particular issue.  There will be a number of articles about the HIV pandemic and I encourage everyone to get a copy, and one for a friend.  The whole world should stop to look at what is going on in Africa and you can help make that happen.
So, anyway, I will be feeding you the next several entries bit by bit; however-, the events have already happened and I know how it all ends.  I know how it all ends anyway.  We all die.  All of us, each and every one of us.  We all die.  Some of us sweetly, in our own beds, surrounded by people who love us.  Some will die agonizing deaths in sub-Saharan Africa, gasping for our last breath through TB-riddled lungs.  No matter- we all die in the end.  So what you do today, how you play this all out, that's what counts.  Go out today and make the world a better place.  Change one life, you change the world.  Really.