Monday, November 30, 2009

Today is World AIDS Day

Today, December 1, is World AIDS Day. The theme for 2009 is Universal Access and Human Rights.

Here are some basic facts about the HIV/AIDS epidemic from the recently published UNAIDS Towards Universal Access report:

There are 33 million people living with HIV globally.

Sub-Saharan Africa accounts for two-thirds (22 million people) of the global disease burden.

There 15.5 women in the world living with HIV. 60% of the cases of HIV in Sub-Saharan Africa are women, so there are 13.2 million African women who are HIV-positive.

90% of the pregnant women needing antiretroviral treatment for themselves and/or prophylaxis for their babies come from 20 countries--19 of which are in Africa (the 20th is India). Those African countries are Nigeria, South Africa, Mozambique, Kenya, Tanzania, Uganda, Zambia, Malawi, Zimbabwe, Ethiopia, Cameroon, the Democratic Republic of Congo, Côte d'Ivoire, Burundi, Angola, Chad, Lesotho, Ghana, and Botswana.

Of those countries listed above, mothers2mothers works in South Africa, Kenya, Zambia, Malawi, Lesotho, and is currently initiating services in Uganda, Mozambique, and Tanzania. m2m is also in Swaziland and Rwanda and is in the planning stages in Namibia.

91% of HIV-positive pregnant women in low and middle income countries come from Sub-Saharan Africa, with 70% of those African women in Eastern and Southern Africa and the remaining 30% in Central and West Africa.

1.4 million HIV-positive pregnant women gave birth in 2008 in low and middle income countries.

Of the 2 million children living with HIV globally, over 90% were infected through mother-to-child transmission in utereo or during labor or breastfeeding. mothers2mothers (shameless plug) focuses on the prevention of mother-t0-child transmission.

mothers2mothers will reach 300,000 clients this year and is expanding into additional countries next year. We employ 1,500 women who are new mothers living with HIV to counsel pregnant women and new mothers who are HIV-positive and to help them navigate the clinical maze in which they often find themselves, not to mention supporting them to live positively and healthily.

Please, take a moment today to reflect on the HIV/AIDS epidemic. You can help in the fight against HIV/AIDS, and financial support is only one of many options. You could take a year off and volunteer, or you could volunteer on Saturdays. Or you can lobby your representative(s) to make HIV/AIDS prevention, medical treatment and support, and equal rights for those living with HIV/AIDS a priority at local, state, national, and global levels. And, this is very important: know your status. Get tested regularly, even if you think you could never contract HIV.

Imagine an HIV-free generation. We can do this. We can see this in our lifetime.

Thursday, November 19, 2009

Rosie, the Queen of Crayola, Gets a Nose Job

Two weeks ago, I got in a fender bender while driving to work. Although I am not supposed to deny or admit guilt as per my auto insurance handbook, let's just say that there was distractingly nice sunny weather and a particularly nasty intersection involved. Oh, and also a strangely stationary Peugeot that magically did not turn when I thought it did, leaving me very surprised when the front of my car and the back of the Peugeot were impolite to each other. Please note the use of adverbs employed to qualify the situation. The girl driving said Peugeot was very nice about the whole thing, and information exchange (in the middle of a busy morning turn onto a major street--talk about awkward), breathless call to insurance, a slightly sketchy getting-lost-bit while trying to find the mechanic in Woodstock, and a jointly filed police report (which was a unique experience in itself), I was ready to get my car fixed.

I sustained a series of broken headlights and blinkers on the left side (and, maybe it's not weird but I know nothing about cars, the light covers are made of glass, which made a spectacular auditory addition to the sickening crunch of metal-on-metal on impact) and some damage to the panel and front bumper. The other car had a bent bumper, which I assume will have to be entirely replaced. So, nice work all around. I had to draw pictures for the insurance company and the police report detailing what happened, but I can't post pdfs as pictures on my blog, so you won't be able to enjoy them. Which is unfortunate for you because they were very artistically executed. I couldn't bring myself to take a picture of the damage, so that will also remain undocumented.

A bit of background on the car: Rosie is a 1993 automatic 3-series baby blue BMW. Despite the make, she's seen better days, and her cracking rubber seals, slight shuddering, weird dial clicking, and a host of other small quirks speak to that. However, she gets me where I need to go, has AC, gets decent gas mileage (or L/100K) for a large-ish BMW, and is automatic, unlike the majority of cars here. I couldn't face a manual and adjusting to the other side of the road.

And as for the name: in her early days, she was known as Ingrid, but it never sat right--she's not classy enough. Rosie, the Queen of Crayola, came about organically. I was listening to a lot of Paul Simon, and I'm a fan of "Me and Julio Down by the School Yard (goodbye Rosie, the Queen of Corona). I've also been missing New York a lot--shout outs to you all in the Dojo and Curry Hill and Chicago and where ever else you are; miss you guys--which is part of the reason for the Paul Simon marathon. On top of that, Byron, who has a penchant for making olfactory observations about my surroundings, including "your place smells like pets" (thank you, Byron, I do want a pet), identified the odor emanating from car as particularly crayon-like. I think this has to do with a plastic melting and/or decay issue, but it smelled just like a freshly-opened yellow and green box of Crayolas, points still flat and symmetrical. Rosie also has a charming habit of getting blue goo on anything put under the back seat--opinions vary on whether this is melting plastic or some kind of oil to keep the seats moving back and forth smoothly--but I somehow suspect that her particular scent is related to that issue. Anyway, this is how Rosie, the Queen of Crayola, came about.

I dropped Rosie off at Peter Panelbeaters (sidenote: I always wanted to say Peter, Peter Panelbeater but was unsure whether that would elicit a laugh or a very confused and awkward conversation elaborating on how that connected to pumpkin shells and keeping your spouse financially supported). And of course, during the week she was away there was nasty Cape Town weather--rain, wind, and cold. Luckily there are very nice people at work that were willing to chauffeur me around, so I was OK for the most part.

I got the call Friday that it was time to pick her up, and so I enlisted Morgan (and her, Byron, and Wenli's car, Edna, a white Toyota Conquest) to get me to Peter Panelbeaters in Woodstock. Cape Town is hard to navigate in that while one street might look OK, a wrong turn will quickly take you into a sketchy part of town, and scary enclaves exist next to busy areas, tourist spots, and very fancy neighborhoods. Once you get into a somewhat dodgy area, like Woodstock or Obs, making the wrong turn can be a bigger problem.

My card was declined, and so I had to find an ATM in Woodstock or risk not getting Rosie back all weekend because the panelbeater closes at 3pm (thank you, South Africa. I really don't know how anything gets done around here without playing hooky from work, though if I had a shop in Woodstock, I'd probably close at 3pm too). It's a sort of industrial, near-the-train-tracks place, with lots of legitimate and what look like not-so-legitimate car shops. The woman who runs Peter Panelbeaters told me that there was an ATM nearby and sent Charlie, a nice man from the garage, along with me, Morgan, and Edna, to find it. Charlie was meant as protection, and after learning that my former landlady had been mugged over the weekend after leaving the bank, I felt that this was a good thing.

Morgan is very brave, and I feel grateful to her for allowing me to drag her out of work and around Woodstock. She's a good driver, and does an excellent job with a manual transmission, but being new to the trade, she doesn't always feel confident about it. She shouldn't feel that way since her shifting skills are just fine, but driving with a stranger who also happened to work with cars professionally, she was understandably a bit nervous about stalling.

Long story short, with Morgan double parked in heavy, minibus-taxi-laden traffic, I sidled up to an outdoor ATM vestibule (like an open telephone booth) adjacent to a very, very shady looking garage that I think might more accurately be called a chop shop, and withdrew cash as Charlie stood behind me, arms behind his back like a bouncer (he was small but capable looking), while men of a less-than-wholesome appearance circled around. I've never been more nervous withdrawing money, since I would never under normal circumstances ever go anywhere near an ATM in a neighborhood like that. Luckily, nothing happened, and Charlie got us back safely, after warning us that we should not venture onto backstreets here because we look like we don't belong in "gangland." Thanks to Charlie and Morgan all around.

So now, Rosie is back, and cleaner and sleeker than ever. Her "spa treatment," "week at an exclusive resort," "drinking lots of water," or whatever it is Californians say when they're recovering from cosmetic surgery, did her a lot of good. She looks well rested and so much younger. keep in the habit of photo sharing, here are some pictures from the walk I took last Sunday with Morgan, Byron, Wenli, and a friend of a friend of Wenli's. These were all taken within five minutes of my new apartment. As you can tell, I got vaguely excited about the settings on my camera.

Pine trees burned in a fire

The view up Devil's Peak, with stand of eucalyptus trees

Proteas (?) or some kind of fynbos or coniferous plant burned out in a fire to look like flowers

Charred log, looking up towards Devil's Peak

Table Mountain and on the right, the Disa Park towers, where I almost lived (the shoebox sized apartments)

Monday, November 16, 2009

Sierra Leone Revisited

My favorite billboard in Sweet Salone, courtesy Helen Weld

There was an article, with very good photos, in the Los Angeles Times on Sunday about Sierra Leone through the lens of health. And I have to say, with sorrow, that it captures the situation dead-on. As Helen, who brought me to Sierra Leone way back in September 2008, wrote, this is all so sad and too familiar. Those of us who have lived and worked in Sierra Leone are not shocked by these stories or these statistics. The fact that one in eight women in Sierra Leone dies in childbirth is not surprising.

It was strange to read about key players that I have met or knew about, including the First Lady. It's a small country, but it faces huge challenges. Sierra Leone was an incredibly difficult place to live, and the farther away I get from it, the more unbelievable my whole experience seems. Sometimes what I experienced there is a ghost--forgotten, or pushed aside, only to reappear, to rise out when it's not wanted. I'm honestly still working through a lot of what I saw, what I did, what I lived. It was one of the hardest things I've ever done. Much of what I wrote about last year did not and could not capture the sheer insanity of the situation because I did not, and still do not, feel comfortable putting much of what I experienced out in a public place. Not because I went through a hard experience that I don't want to share, but for other reasons, and particularly because a blog is so public, even if few are reading mine.

I don't have the faintest idea how Sierra Leone or any supporting governmental or non-governmental organizations are going to begin to address the problems there, because they're at every level and cover every sector imaginable. Deep scars and anger, which I witnessed firsthand, from the civil war; corruption at all levels; an exploitative economy based on diamond mining that only enriches a few and subsistence farming of few nutrient rich vegetables; massive environmental degradation made worse by cheap and quick mining practices and the use of wood stoves for lack of anything else; utter lack of basic infrastructure from roads to electricity to clean water; devastating tropical diseases including malaria and yellow fever and diseases of poverty including typhoid; lack of rights for women and a worrying trend towards sexual violence during periods of unrest; crime that has no deterrent beyond vigilantism; and a health system that is beyond broken and seems beyond repair at points--and these are only the first scratches on the surface of a much deeper and more complex reality. In my own experience, there was no waste facility at the hospital, which meant that I watched dogs and vultures eat human tissue thrown out behind the operating theatre and children play with used syringes, which also littered our patients' garden. There was no running water at the hospital, which meant that our patients suffering from fistula, including ones with foot drop, or limps due to nerve damage, had to carry buckets of water on their heads from the hand pump well several times a day to wash themselves, since they were constantly leaking urine that gave them painful chemical burns if left uncleaned. I had a letter sent to a government official requesting treated mosquito nets for our patients so that they would not contract malaria, which could make them anemic and therefore delay surgical repair of their fistulas or cause life threatening risks, only to find that I'd committed a political faux pas because the official had "eaten" the nets. There were electricity cuts to the Bo Government Hospital, where I worked, on a regular basis, including extended blackouts that lasted several days, despite the fact that the hospital was supposedly on an emergency grid. This meant that the autoclave for sterilizing surgical equipment would not work and surgeries were performed by flashlight, if at all. I saw life saving equipment, vehicles, and other materials misused, misappropriated, and disappear. I saw people die because they did not have enough money, or because medical personnel were too overwhelmed or undertrained to offer treatment. I saw things that, as I wrote above, I cannot detail here.

It's very easy to get lost in this, even if there are good people living their lives and struggling for survival every day that are defying the odds, people who do not steal and who are able to surmount the lack of infrastructure. People like the strangers that helped me and a group of friends without regard for their own safety. People like the patients I worked with every day, who are able to laugh despite the fact that many of them were shunned and abandoned by their communities. I saw some of these women forgive their families for pushing them away and return to live their lives. Sometimes I'm not sure if we, as a global community, can even start to pick up the pieces of Sierra Leone. But I feel that something must be done. There's still time.

Friday, November 13, 2009

Shamelessly Plugging My Job

So, I've been doing a lot of work over the past months, in a support and research function, around getting mothers2mothers ready for various meetings with Very Important People in the US. I'm not plugging myself here (unless you want me to brag about my PowerPoint skills...actually, maybe not) but rather mothers2mothers, which has just gone through an insane period of growth and has had enormous success in the past few years. To give you an idea, in 2007, we had 150 sites offering PMTCT counseling through Mentor Mothers, and we reached 55,000 clients. In 2009, we will have 600 sites in seven countries and will reach 300,000 HIV-positive pregnant women by the end of the year. This is 20% of all HIV-positive pregnant women in the world.

As Gene once said (and I paraphrase), that's the sort of thing you hear that makes you break down and cry.

mothers2mothers was the recipient of the 2008 Skoll Foundation Social Entrepreneur Award, and we've been making ripples in the social entrepreneurship, philanthrocapitalism, and venture philanthropy realms since then. Recently, my boss met with Skoll to talk about our success. You can see the Skoll post written about the meeting here, but I have also reprinted part of it below. The excerpt discusses m2m's "heresies"--the things we were doing that were radically different from most public health NGOs that we didn't even know were unique at the time.

Gene has a great set of lessons that he’s learned in the process of “building a program for today, but an organization for the long term.” I think they’re worth repeating:

  • Do one thing well - beware mission creep.
  • Don’t say yes unless you mean it - don’t morph what you do just to try to meet funder requests.
  • Magical thinking isn’t a strategy - we may all want something to be different, but we need to work with what we have.
  • Pay people fairly for what they do - mothers2mothers pays their local community mentor mothers, whom they train intensively on the preventive medical practices and coaching techniques needed to make the program successful. (Sadly, this concept is not widely embraced among providers of public health assistance in Africa, many of whom still insist on volunteer community health workers.)
  • “Development” and “Advancement” are euphemisms for sales, marketing and investor relations - call things what they are. There’s nothing wrong with this.
  • Technology won’t solve everything - mothers2mothers isn’t about the medicine, it’s about behaviors and practices.
  • Neither will process - it’s not about outputs, it’s about impact.
  • Neither cash nor caring are scalable commodities - you need to constantly replenish these.
  • Overhead is not evil - the best ideas, without an effective organization to deploy them, won’t succeed.

And, in keeping with my attempt to post more pictures, here is a photo from Wenli's blog that illustrates how "nice" the "spring/summer" weather has been so far. So glad I brought a fleece blanket to the Muizenberg beach.

Wednesday, November 4, 2009

Small But Slightly Worrying Snake

There's a snake on the path to my apartment. It's quite small (the pictures make it look bigger than it is, but I didn't want to put anything next to it for scale and have it risk biting me). It hasn't moved in a while, so it's possible it's dead (again, I took the "better safe than sorry" approach and didn't poke it with anything). It's a beautiful chocolate brown with a blackish or olive-ish underside. It has a very small head--thinner than its body, with a pebble-like pattern. The scales are smooth and shiny. The snake is quite fat for its size, which might mean that it's a hatchling that hasn't reached its full length yet.

I'm pretty sure it's not a mamba because I've seen one before in Sierra Leone. It was during the clearing time, when the farmers burn their fields before replanting in advance of the rainy season, and it must have slithered out from a controlled burn. The boys and the caretaker at the house killed it with rocks and then burned it. They told me that it was very dangerous, but I thought they were joking with me because it was a friendly green color and didn't display the normal venomous snake qualities I have been trained over years of hiking (and merely living in rural Southern California) to identify in North American rattlesnakes: triangular head, rattles, dull and prominent scales, beautiful skin patterns, etc. I didn't know it was a green mamba until later, when I read about mambas and remembered this one's black mouth, a telltale sign. In retrospect, I'm glad I didn't know it was a mamba until after I'd left.

Online resources aren't very helpful, but I'm pretty sure this snake not a viper/adder (they have many of the same characteristics as rattlesnakes and have that same don't-mess-with-me nasty look around the eyes). And probably not a cobra. But I read that you should avoid brown snakes in Africa. So I'm not going anywhere near it and will continue hoping that it will not slip under the door, as a gopher snake once did back in California.

And if you happen to know what kind of snake it is, please let me know.

Tuesday, November 3, 2009

On Moving, Tolkien, and Beating the Devil

My first apartment

I’ve moved. My lease on my place downtown was up, and even though I love the apartment, I couldn’t afford it anymore. Plus the lease on my parking space was also finished, and I wasn’t exactly keen to park on the street. Real estate in Cape Town is a tricky affair. It’s not so bad, as it is in New York, that you have to read the Obits to find a place, but it’s close. From what I’ve heard, real estate agents are not very helpful (I didn’t get one, though I was close to it once I really started having trouble). Like most denizens of Cape Town, I used Gumtree, the local Craigslist, to search for a place. You have to be on your toes, refreshing the page every half hour or so and calling places immediately upon posting, and you have to be OK with rejection. For every five replies I sent out, I got a single response, and most of the time it was to say that the flat wasn’t furnished or didn’t have parking or was already taken. Once you have requirements—in my case, a fully furnished place, with a parking spot, in a security complex, in a safe neighborhood, for under a certain amount—things get harder. I looked at dumpy places, a few that were so small I didn’t think I could live in them (the test was whether I could turn around in the kitchen or not), and one place that was so popular—the location was amazing—that there were people lined up to view it. I arranged to look at a couple of places in slightly sketchy neighborhoods before deciding it wasn’t worth the risk.

View from my new place

All the places had a view, though. It may be impossible to live in Cape Town and not have a view, and it’s breathtaking every time, even though it might mean that on a clear day if you stick your head out the bathroom window you can see Lion’s Head. I almost took one of those shoebox flats because it had a full panoramic view of Table Mountain, but the miniscule kitchen, and the fact that the closet was in the bathroom, did me in.

After a long search, I found a good place. It’s located in the Vredehoek neighborhood, in Devil's Peak, right under the peak of the same name (the mountain to the left of Table Mountain). Apparently, it’s also “Windy City” as one co-worker called it, and she warned that I wouldn’t sleep at night. The fact that a nearby street is called “Windburg” does not bode well, though Vredehoek means “Corner of Peace” in Afrikaans. And so, I moved into Devil’s Peak on Halloween. The apartment is small, a studio, with a kitchen, washing machine, and large balcony. A bar separates the main area from the kitchen. The complex itself is quite large, and not a building so much as a cluster of apartments. It reminds me somewhat of a resort I once stayed in on the outskirts of Tucson, Arizona. Oh, and the views are spectacular—the ocean, the mountain, and the city are all visible.

The Shire/On the way to Stellenbosch

With the certainty that this will reveal my nerdy-ness even more, Cape Town and South Africa in general often feel very Lord of the Rings-y (as a good friend calls it). Tolkien was born in what was the Orange Free State, South Africa (I actually didn’t know this—someone told me recently), though he moved to England at a young age. However, I can’t help but think, upon moving here, that South Africa must have imprinted something on young Tolkien’s imagination, though I know that his travels in Switzerland and England played a huge part in shaping his Middle Earth (the Jungfrau and Silberhorn, or Young Lady and Silver Horn mountains; the English bogs and countryside; English towns named Kingston Upon Hull and Swiss ones called Grindelwald...).

At Kirstenbosch Gardens

“Windburg” and other place names certainly evoke Tolkien’s works for me, as does the stark, stunning beauty of Cape Town and the surrounding area—the jutting mountains, bits of green between the rocks, the howling wind, the wildflowers. Trees possess names like silverleaf (or silwerboom); flowers, King, or Honeypot, Protea. Outside the city, there are little farmhouses in green fields with little brooks and ponds. There are lush forests that can feel welcoming and ordered in a natural way, or dark and old and a bit foreboding. There is wine country and steep, rocky, barren land, seas dashing themselves on rocks, and winter nights with warm, simple food.

A silwerboom

Mulling over all of this brought me to origin tales about Cape Town and its unique setting (I used to rock climb, so I will admit that I also looked into the actual geology, but I won’t torture anyone with it here).

It’s said that a Dutchman, Jan van Hunks, lived in a little cottage at the foot of a mountain that was called Windburg in his day. He was known far and wide as an exceptional and dedicated smoker and had won many wagers on his talent. Jan’s wife did not allow him to smoke his pipe in the house, and so, he would wander out onto Windburg to enjoy his favored pastime. One day, while smoking on the slopes of the mountain, he met a stranger carrying a pipe. They struck up a conversation that turned to a series of boasts about which of the two smoked more. This, naturally, led to a contest between Jan and the stranger. They smoked and smoked until they created a cloud that floated up and over Table Mountain. Finally, Jan prevailed, and as the stranger turned to go, his red tail peaked out from under his clothes. Van Hunks realized that he had beaten the Devil himself. The mountain was renamed Duiwelspiek, or Devil’s Peak, and the cloud of smoke that the two created still wafts over Table Mountain when the Southeaster, or Cape Doctor, is blowing. It’s now called the Tablecloth, and when it appears, it’s said that Jan and the Devil are at it again.

Lion's Head (doesn't it look like Weathertop?)

Table Mountain features in an epic poem, Os Lusiadas, by the Portuguese poet Luís Vaz de Camões. The poem is seen as the Portuguese Iliad or Aeneid. At the beginning of the world, Kronos and his siblings, the Titans, were overthrown by Kronos’ children, the Olympians. The most mainstream version in Greek mythology details that after the battle, most of the Titans were imprisoned in the deepest pit of Tartarus, while the remaining were granted places in the Olympian pantheon by Zeus. De Camões veers from this line, writing that the Olympians banished the Titans to the farthest reaches of the earth. Zeus had the Titan Adamastor imprisoned in stone at the southernmost tip of the world, forming Table Mountain. Centuries or millennia later, Adamastor was angered by the navigator, Vasco de Gama, who trespassed on his territory while rounding the Cape of Good Hope in the attempt to tap the spice wealth of India by establishing a sea route to Asia. Adamastor tossed the Portuguese ship in storm after storm, but the piously Catholic De Gama and his crew prevailed over the “heathen” demigod, eventually reaching India (and, in case you were interested, another sailor associated with the Cape is the Flying Dutchman, but I won’t get into that story here).

A !Xhosa origin story tells that Qamata, one of the focal deities in the !Xhosa pantheon and the child of the sun god and earth goddess, Thixo and Jobela, wanted to make dry land, but the sea dragon Nkanyamba interfered. Jobela created four giants to aid Qamata in his efforts. After their task was complete, Qamata turned the giants to stone to keep watch over the land in the four cardinal directions. Umlindi Wemingizimu, the Watcher of the South, became Table Mountain.

Table Mountain, with Tablecloth, seen from Lion's Head

It speaks to the tumultuous and convoluted history of the Cape region, and all of South Africa, that there are stories from so many backgrounds. From the first Khoi inhabitants (in keeping with the uneven nature of African history, I could not easily find much information on the web about pre-European incursions) to the Portuguese, then Dutch, and then British, South Africa has been crisscrossed by many peoples and fought over for centuries. Everything in the Cape is a mix of indigenous Africa, Europe, and Asia (from the slaves brought over to work), from the Afrikaans language before the “impure” non-white elements were expunged; to the food, which combines curries and meatloaf; to the "coloured" population itself.

PS: I'm not sure why this post (and others) has different font sizes--I don't know anything about the actual Html/code side of blogging, so I apologize if it's weird or jarring to you. I have no idea how to change it--I think it's a code error.