HIV/AIDS technical advisor

The position in subtle variations is so ubiquitous across this region of Africa that my coming blends in with the seemingly endless flow of HIV/AIDS programs and personnel. I have an office in the city government and liaise with the City AIDS Coordinator amongst many others. My principle assignment is basically to grasp the current extent of the HIV/AIDS response in the city, provide key indicators of its performance to the city government, and assist them in improving their coordination of the response.

An estimated 88,000 individuals reside within Zomba city, with a daytime population easily surpassing 100,000. 15 health facilities operate within the city boundaries, including a regional hospital, a mental hospital, and institutional hospitals and health centers at the police, prison and military campuses. 53 community based organizations are registered with the city government with mandates to provide social services, including HIV prevention, care and support, to city residents. The National AIDS Commission and countless NGOs have been implementing HIV/AIDS programming here for over a decade.

The national prevalence of HIV/AIDS is currently estimated to be 12%. Though the prevalence is thought to be even higher in the south of the country, where Zomba is located, with urban areas even more affected. Here prevalence rates are estimated as high as 18%, translating to nearly 1 in every 5 individuals living with HIV. The epidemic is generalized, affecting all groups, with women experiencing higher prevalence rates due to biological and socioeconomic determinants that increase their risk of acquiring HIV. There is no one here who has not been directly affected by the epidemic; the loss of loved ones, the risks of pregnancy, childhood and adolescents, the economic instability of a diminishing workforce. HIV/AIDS is omnipresent, an oppressive plight within the warm heart of Africa.

That said HIV/AIDS is an elusive evil, one that lies beneath the surface of the social fabric. It is a virus that suppresses the immune system of those infected; increasing susceptibility to opportunistic infections that can quickly erode quality of life, if left untreated. As such its outward expression is of a host of infections that lead to skin lesions, persistent coughing and wasting. Its acquisition is marred by the social taboo of discussing sexual practices that are tightly intertwined in the cultural and socioeconomic reality of those affected. In a society that values high parity and sees being overweight as a sign of success, HIV/AIDS brings shame on a family. Thus in difference to those infected and affected, HIV status is handled with discretion.

The burden is carried silently as those affected toil in the fields and markets. Nor is it the only hardship that must be endured. It is the latest and arguable the most deadly in a long line of diseases that compromise the health of African society. HIV/AIDS is also an addition to every other hardship that comes with living an impoverished life; the grueling physical labor, the uncertainty, the parade of material objects that are out of reach.

If poverty is an oppressive lack of information and options, HIV/AIDS exacerbates the situation; pushing the dreams of the young couple out of reach, robbing the old of their children and burdening them with more grandchildren then they are capable of caring for. In this context, it seems reasonable that the pain caused be gently hidden from view and a focus be given to family and more immediate challenges.

As treatment and care programs are being scaled up, people are living longer and speaking out. Gains are being made and Africans are learning to adapt in ways that not only ease the dangers of the current epidemic but also prepare them for future challenges. But the scars have been left on a generation of children that see the suffering and continuous funerals as the norm in a childhood devoid of choice and opportunity.

What does it all mean for an HIV/AIDS technical advisor? It means that daily I stare into the invisible eye of an injustice that is crippling those selling me bananas or kind enough to ask me how I am doing. Such a reality is enough to take your breath away. It is also a dilemma so large in its totality and complex in its composition that it can thwart the efforts of thousands of motivated and good intentioned individuals. On the best of days, it is an immense beach slowing being eroded by a tide that makes uneven passes at its miles of dense sand. At worst, it is completely out of reach, something visible but untouchable floating through space and time claiming those around you, frustrating your best efforts in strangling it before it can claim another life.

Zomba Urbana Sister City watsan project

Zomba Plateau

Chameleon

Internet!

I now have daily access to the internet and with it any excuse I might have had for not writing more often has evaporated. So you can look forward to more frequent posts from me. I am going to keep writing on the day to day stuff, but am also hoping to write more on the technical issues of health system strengthening that I am facing here.
Stay posted...

Nsima with relish. Let me explain.

Nsima is ground corn flour that is cooked like porridge until it thickens and is then scooped into large paddies. Nsima is the staple food in Malawi and is eaten with relishes. Here is where a little variety comes in. If you are lucky, the relish consists of two parts. There are boiled greens served with some ground nut powder and a tomato-based soup with pieces of meat, either chicken, beef or goat. To eat, you pinch off a piece of the nsima with your fingers. You ball the nsima up in your palm and then either dip it into the soup, which is quite salty, or pick up some greens with it. Thus the ‘relish’ adds a little flavor to the nsima.

That is my lunch for about 5 days a week, as I joined the memo at work where about 10 employees go together for lunch. I pay 600 Malawian Kwacha (~4USD) a month to buy the corn flour and an extra 100 MK (~65 cents) every day I eat with the memo for the relish. One of the men goes around the office in the morning to collect the daily contribution, and the women start cooking around noon after someone makes the trip to the market to purchase the relish ingredients. They do the cooking in the ‘kitchen’, a small room with a large sink and one table. The cooking is done on small charcoal burners which they light outside and then bring inside and set on the floor. When the food is ready, it is divided between the available plates and the aroma of the relish gets everyone’s attention and fills the small kitchen quickly.

Eating this meal is learned during childhood. As such, it has made me feel a little childish as I first attempted to ball the nsima in my palm and eat the relish without making a mess. Conversation is usually lively as people pause from eating as they ball the nsima in their hands. It is in Chichewa, so I rarely have a firm grasp on the discourse. However, the random English word usually gives way to the overall theme and I am able to contribute a well timed phrase now and then.

It is a heavy lunch. Afterward, I say my thanks (zikomo kwambiri! Chakudya chabwino!) and I head back to my office. It is there that I try intently to become quickly engaged in some interesting work activity before the ball of nsima in my stomach robs me of my ability to concentrate as all my energy switches to the digestive process.

On the way to work

A man pushes a young boy on a bike. A mother smiles as she carries her daughter. I am riding in the passenger seat of a car, and as we pass through this small trading center on the way to work, my eyes connect with theirs. For a moment I forget where I am. The context of the situation is lost to the simple expressions of joy seen in their faces.

This connection is precious in a place where you are often set far apart from those around you. Yes, I live in their community and I shop in their markets and at their stores. I travel their streets and say hello to their kids, but I am foreign to them. The place where I was born and the color of my skin are the most apparent, but also the least significant. They make me a foreigner, but they don't set me apart as our differing perspectives do.

Knowing other places, other people, other ways of living means that we see the smoking tailpipe, the innocent laughter of children, the piles of tomatoes and the bicycle taxi in a different light. The fact that I choose to be here—and could leave tomorrow—creates a distance between us. I could get a job that pays more in a month then they will earn in the next ten years. Basically, we have a different set of options available to us. No doubt, I have more. Though they too have access to options that I don't. The lives that they live are as inaccessible to me as my life is to them.

So as I move through this place I reflect on what it is that sets us apart and what unites us.

While it is the differences that draw our focus, that which we share is by far in the majority. It must also be our hope for a better tomorrow.