Update #5: Painting the Picture

Dear Reader,

It is currently 4:44 in the morning, and I am wondering how you are. Here in Mozambique, the sun is just now sending its rays over the horizon for all the roosters in town to see. I am borrowing a laptop computer from a friend so that I can give you an update as to what is going on here in the southeastern section of this continent. Surely, though, before I begin I have to take a moment and ask after you and yours. I truly hope that this message finds you doing well. It might even be appropriate to look away from this screen for a moment and contemplate the question in earnest. Maybe even take a deep breath…? Just a suggestion.
The fact of the matter is that every time I sit down to write you, Reader, I feel wonderful. I am not sure why that is, but I think when it is finally time to sit and reflect on what experiences I have been exposed to in the course of my time here thus far, I realize how lucky I am. I certainly try to appreciate each moment of this life as it happens - - yet somehow sharing it with you brings it back, and makes it real. Thank you!
I am at the end of my sixth week here in Mozambique. Reader, so much is happening, and so much of it worth telling you about. I think that I will start with the training that we are doing. I have previously discussed the family that I am living with, but now I would like to go a little more into how I am spending my days during this 10 weeks near the capital of Maputo.
Every day I spend between two and four hours learning Portuguese (the official national language of Mozambique) in a class of 5 people, all trainees like myself. We are all at different levels, but the goal is to get as much foundation as possible before heading off to our sites where we will serve a community for two years. There, of course, is where a great deal of the learning will happen. That being said, I have been quite pleased by the amount of progress I am making with the language. I love the sound and feel of Portuguese. Our classes range over all topics, but recently have been more focused on health issues, including transmission of HIV.
That subject, as well as other diseases affecting the community here are topics we cover in our technical training sessions, which usually represent the other 3-4 hours of the day. We gather information, perspective, and training techniques as to how to accurately and effectively disseminate information. This is where the two components of my day combine, because if I cannot understand the history, culture, and context of the people I hope to help – then I will not know how to deliver information that will not languish in midair, but effect positive behavior change. This notion, by the way, is one of the inherent challenges perhaps most important in serving others. That, for me, is why I am here. I am interested in taking the time to learn first. Indeed, there are plenty of us willing to help, but how to help in a way that people truly need and is sustainable (able to be reproduced and sustain shocks without failing)… that is worthy of a lot of time and energy!
That being said, I would like to go back to training and HIV. As a health worker here in Mozambique, I am learning in depth what issues communities face. During our sessions we go into great detail. [NOTE: there are 15 of us that train together – a few of whom have parents that are familiar with this blog, and have apparently openly expressed to their sons Mark, David, and Aaron their disappointment in having to read someone else’s blog to get information about their own children. If I might have a word: if you are indeed reading this, esteemed parents, please tell your sons I am sorry for your communication issues - - they are, your sons I mean, bigger than I am, and now more than ever I am feeling that this is somehow pertinent to my overall wellbeing.]
Anyway, I wanted to take a minute to talk about HIV here in Mozambique. It is my personal goal to bring information back to you, Reader, so that you too can gain from this amazing experience I get to have here. Mozambique is a country with a population approaching 18 million. The national infection rate currently is just under 17%. That is, more or less, one in five people. I will say that again for clarity. The national infection rate of HIV in Mozambique is just under 17%, which means that (by the numbers, of course) a little less than one in five people out of that 18 or so million are currently infected [the infection rate in the United States is under 1%, though exact data is not available to me right now]. This changes by region here, so some regions have higher and lower regional rates of infection. I will not go into too many numbers, but I will discuss the issues.
What do we need to know about that infection rate? Well, first of all, there is no cure for HIV. AIDS, the syndrome in which other infections (called Opportunistic Infections) take advantage of a weakened immune system, is now responsible for entire groups of populations disappearing. Actually, it’s complications with AIDS that kills, per the literature. Second of all, infection rates are estimates. The estimated number of people in the entire world with HIV right now is estimated at just over 40 million people. The thing is, testing is a tricky subject. 1. The test available for people here in Mozambique looks for antibodies that the body forms to try and fight the HIV. The problem is that after infection, it often takes the body anywhere from 8-12 weeks to start producing said antibodies. What does this mean? Well it means that a person who is indeed infected but gets tested before their body is producing antibodies (three months), they will receive a negative result. That result, if they are infected, is called a false negative – and they got tested in what we are calling the ‘window period’. 2. Getting tested is socially not openly accepted in certain places. Why? Well first of all, there is a perception that contracting HIV is a death-sentence. Despite the fact that there are many people on this planet living positive lives with HIV or AIDS, that does not always come across in the presentations. Fear has long been a tactic for trying to force people into some sort of behavior change. Additionally, there is quite a lot of misinformation and incomplete information going around. How the disease is transmitted and what behaviors put one at risk are not clear to many. [Blood, Semen, Vaginal Fluids, Breast Milk] (I can now discuss those in Portuguese as well!) This lack of understanding and feeling of fear creates a stigma against those with the disease. Thusly, why would I want to go and find out if I have a disease that if I do have it, it means that I will be shunned by my family and friends and die alone? That is the perception of some, anyway. Also, going to get tested or asking your partner to get tested may carry the insinuation that someone is not being faithful inside your relationship. Using condoms, by the way, also carries that implication inside of purportedly monogamous relationships. How do you ask your husband to use a condom without risking, well, everything?
A last point about the infection rate. After HIV enters the system, two things seem to happen. One is that immediately the virus reproduces itself (it is a retrovirus) in high quantities. The second, and perhaps most dangerous (in my opinion) thing that HIV does, is nothing. The virus can be alive in your body and you can be completely asymptomatic (not showing any signs of sickness) for as long as 10 or more years! Years! Years! . . . I apologize, but this means that if I get tested today and find out that I am HIV-positive, it means that I could have contracted the disease in 1996! I am done with exclamation points, but no wonder the disease has spread so quickly and is so hard to control. Well, that and it is spread through sexual intercourse. [NOTE: I suppose it’s not apt to happen, but on the off chance that HIV is keeping up with reading this blog, I would want it to know that I feel it is inexplicably evil that HIV is spread through not only sexual (vaginal and anal) intercourse and exchange of infected blood (transfusion, needle-sharing, unclean cutting instruments), but from mother to child through birth and also through breast milk. Breast Milk!? You should be ashamed of yourself.] I am becoming more and more familiar with the work of HIV.
One of the days of training that I won’t soon forget was the day two people living with AIDS came to speak to our group. Translating from Shangaan (dominant ‘local’ language) to Portuguese to English, they told us their stories. I think that for me, up until that point this situation had been merely numerical. The woman that was so brave in speaking with our group (see earlier discussion of stigma) has lost multiple children, and her husband refuses to get tested – even though he has local access to a hospital (something not true for around 50% of Mozambicans). She was tested in 2003. When did she contract the disease? Good question. More important though, without a doubt, than the sadness of her situation, is the truly incredible feat of going to get tested and joining a support group. She is taking Antiretroviral (ARV) medicines, and trying to get enough food to have a healthy diet (So important for living with AIDS). I was so moved by this woman’s (and another man who came to speak as well) courage in facing what some paint as a hopeless picture. I wouldn’t hang that picture on my wall.

***********I was hoping for a good segue, but the weight of this past section made it too tiresome to come back and act like nothing had happened. So for me, this is a good point for a deep breath, a stretch of the arms, and a change of subject.*************

I realize I haven’t spoken about some of my side projects. Reader, I am so excited about having a guitar here. I brought one along (if I hadn’t mentioned that elsewhere), and have been playing daily. My progress has been encouraging, enough that I am now writing music. Most of the music I write has to do with my life here, and is mostly silly. If you get a chance to ask my family near Washington DC, they will tell you about the first song I ever wrote on the guitar, entitled ‘Milk Time’. I dedicated it to my baby niece, it was in the key of C. I am now the proud intellectual property owner of five more songs. One of my personal favorites is called ‘Machamba Não’ – a lively tune about not playing in the small field (“Mah-shahm-bah”) of corn and mandioca growing next to the house I am living in as to not kill the plants. Não means no, and is pronounced “now”. Another one, that I am hoping to perform on Mozambican television this Sunday (it turns out that there is a staff member for Peace Corps here that is a television host of a children’s variety show, and I am not the first trainee to perform on the air!), is about being a vampire in southern Mozambique. (My favorite line is about how frustrating it is that when I go into a bar and order Blood Soda – Fanta Sangue – they never have it in stock.) Actually, I am just elated it is in Portuguese and that my host family sings along! I would to be able to record some of these songs for you Reader, and will do so if ever I gain the capability.
Well, believe it or not a week from tomorrow (Saturday the 18th of November) we will be celebrating Thanksgiving with all the Peace Corps trainees and staff. We’ve got lots of cooking and baking intentions, the thought of which get me excited. Thanksgiving in my family is a special time. I have memories of amazing food, long conversations, and cool weather. Apart from being content in shorts and a t-shirt and enjoying the nice November heat, it’s not that different. I know that when the time comes, I will be thinking of you Reader, that much more.
I want to send you off with, more than anything, my final thoughts on my life here and HIV. I am so blessed to be here, and to be humbled by the courage of those around me. I am inspired daily to serve others, and despite discomfort, am able to see the big picture. HIV is a global emergency. It is the product of many things perhaps, but one of them may very well be negligence. When I go to sleep at night, I guarantee you, Reader, that I wouldn’t rather be anywhere else, working on any other project. At least, I tell myself, I finally get to do something about it! That alone is so encouraging, that I know no matter what happens I will keep moving it towards the positive.
I love you and wish from the depths of my heart that you find a way to be content today. I am thinking about a hug, right now.

PEACE (of mind)

Kevin

Ps. As references and for accurate information, please indeed go to the WHO website (http://www.who.int/en/) or to UNAIDS (http://www.unaids.org/en/). Also, the book I just finished – Mountains Beyond Mountains, by Tracy Kidder – looks into the life and work of Dr. Paul Farmer. Inspired! Lastly, thanks to the music of Beethoven, Jimmy Cliff, Outkast, and my friend Khalil Sullivan for inspiration for this message.