Life is a Highway

On my way back from Swaziland, it was raining and pouring and Camilla was snoring...

She went to sleep and almost bumped her head when out bus slid off the road.

The Vilanculos Express Bus

(My first thought: there is no way in hell we are getting out of this mess)

Side View

Bulldozer to the Rescue

I don't even know why I doubt Mozambicans. They are so incredibly resourceful. I can only hope a little of it will rub off on me.

I learn a little more everyday...

One of my cousins recently asked me to share with her girls group what HIV means in Mozambique and I thought it would be nice to share with all of you!  Especially since I have not been writing in my blog every month like I wanted to.

Before I get into it, I would just like to say that everything here is from my point of view.  As an American (an outsider in many ways), I often feel like I can never fully understand the impact of HIV on my friends and people in my community. 

 So first of all here are a couple facts about HIV and Mozambique:

ü      16.2% of the population (ages 15-49) is estimated to have HIV (Moz has a population of around 22 million people)

ü      Young women ages 15- 24 have an estimated prevalence of 10.7% while young men in the same age group have an estimated prevalence of 3.6%

When I look at these statistics I kind of pass over the 16.2% population prevalence rate and get stuck on the fact that young women are so much more likely to contract HIV than young men.  Everyone knows that the prevalence rate in Africa is really high, but for most countries in Sub Saharan Africa this rate is leveling off and even declining.  Mozambique is the ONLY country where the rate is continuing to increase.  Scary right?  Especially when I start to think about the girls in my girls group and how much more likely it is for them to get HIV than it is for the boys in their class. 

 Why is it more likely for young women to get HIV?  The most obvious reason is that our bodies are different.  In most relationships in Mozambique, women are the “receivers.”  Our bodies are designed to “catch” sperm and go on to produce as many babies as possible until our biological clock gives out. 

 Backing up a little.  When a person has HIV, the virus lives in all bodily fluids: blood, tears, saliva, breast milk, etc….  The four fluids with the highest concentration in order from greatest to least are:  blood, semen, vaginal fluids, and breast milk.  All of the other fluids produced by our body contain HIV, but the quantity is so low that you would have to drink 5+ gallons of saliva in one sitting to get HIV (this is an estimate to show how unlikely it is for a person to get HIV by kissing, for example). 

 So when a man and woman are having sex, either one of them could contract HIV from the other.  But, because of the way women’s bodies are designed and the higher concentration of HIV in sperm, it is more likely for a woman to contract HIV than a man.  If either partner has a cut or sore (Sexually Transmitted Infection, STI), the chances of passing HIV to the other person increases dramatically (somewhere around 4 times more likely). 

 Moving on to the less obvious reason why young women are more likely to have HIV: social and cultural norms.  In Mozambique, the estimate age of sexual debut (when someone has sex for the first time) is 12 for girls and 15 for boys.  I was SHOCKED when I first heard that.  At 12 years old, I was still wearing umbro shorts and no where near thinking about boys. 

 Here, it is normal for young girls to have relationships with boys their own age (not too surprising), but also with men much older than them.  In the States, we have four different bases (everyone’s definition is different, but the idea is the same), but here in Mozambique there is really only one: home plate.  This means that when a man approaches a young girl and says “Eu gosto de ti” (I like you), there is a good chance that a sexual relationship begins.  Since there is not a culture of foreplay, most people just get straight down to business which leads to early pregnancy and the quick spread of HIV. 

 Why would young girls want anything to do with older men?  To sum it up in one word: money.  Don’t be too quick to judge.  These girls are not prostitutes (which is a really mean word – sex worker is better).  They are just like you and me.  The only difference is we have more options available to us.  In high school, if I wanted a pair of designer jeans, I picked up some extras shifts at the pharmacy where I worked.  In Mozambique, these kinds of opportunities are rare and it is much easier to have your “namarado” or boyfriend pay for your nice clothes and hair. 

 From here stems the biggest problem.  These men have relationships with young girls while at the same time have a wife at home and maybe another woman on the side.  These young girls also want someone to be there for them and tend to also have a relationship with a young man around their same age.  This is one of the main reasons why HIV has spread so much in Africa.  In development terms: concurrency.  This basically means that a person is having a sexual relationship with more than one person and each of those people is also probably having a relationship with one or more other people.  You have probably heard the expression: when you sleep with someone, you are also sleeping with all of their previous partners.  When you put it in terms of HIV and STIs, it’s true.  It becomes this interconnected web of sexual relationships, where it is likely that a person is connected to several people at the same time even if only one of them is their actual partner.  When you add HIV into the equation, it is not surprising the virus to able to spread so quickly. 

 So what about condoms?  Condoms are the best way to protect yourself against HIV and other STIs (besides abstinence, which is the only 100% effective way).  Luckily, condoms are sold almost everywhere here at a really low cost and are available free of cost at all health centers.  Unfortunately, that is where the easy part ends.  One thing that a lot of young women struggle with is getting their partners to agree to use condoms.  Because of the unequal distribution of power between men and women, women often feel unable to stand up for themselves and condoms are forgotten.  A lot of times women worry about losing their partner if they try to make any “demands” (like using a condom).  There is also stigma that comes with suggesting condom use.  If a woman asks to use a condom, her partner will inevitably ask her why.  Is it because she doesn’t trust him to be faithful?  Or because she is the one who is not being faithful?  In my opinion, this is an extremely unfair question.  The real issue here is not about who is sleeping with who, it is about protecting yourself and living the healthiest life possible. 

 One great thing that is beginning to show up more and more here in Mozambique is the female condom.  It is the same idea as the male condom, but the female wears it.  Another advantage is that some brands are not made out of latex and therefore it feels more like there is nothing between you and your partner.  It can also be reused up to five times (again, depending on the brand). This is a good way for women here to take responsibility and provide and wear the protection.  There is, however, another big challenge to overcome.  A large majority of the population (especially the older generations) do not trust condoms (male and female) because they believe some condoms have HIV put in them to infect the African people.  If they thought about the biology of HIV or if it had been explained clearly to them, they would realize that the virus can only survive in humans (hence the name: Human Immunodeficiency Virus). 

 “But wait?”  They would ask, “what about mosquitoes?  If malaria can be transferred from mosquitoes to humans, then why can’t HIV?  They are both illness of the blood.”  This is a question that ALWAYS comes up every time HIV is being discussed.  The most important thing to remember is malaria is a parasite and HIV is a virus that needs a host (human) to survive.  Therefore, the two cannot even be compared, but will always be lumped together because they are the most high profile illnesses in Moz. 

 “But what about needles and other sharp objects?  HIV can survive on those right?”  This question is a bit more complicated since Injection Drug Use (IDU) is, in some parts of the world, the main method of HIV transmission.  In these cases the needle or other sharp object has gone straight from one persons arm to the next, injecting “live” blood (not dried) directly into another person.  Most Mozambicans put a lot of emphasis on sharp objects transferring HIV instead of focusing on the fact that heterosexual relationships are the main method of transmission.  It is easy to understand why they would choose to focus on sharp objects (like barber shears or needles used at the hospital) because it puts the blame on someone else.  It is also hard to blame HIV transmission on sex since it is one thing that every person on the planet has in common (besides maybe priests) and you and I exist because someone somewhere had sex. 

 So now let’s move on to mother to child transmission.  This is another area of HIV transmission that can lead to a little confusion.  There are three ways in which a child can get HIV from its mother: during labor and delivery, breast feeding, and any time during pregnancy.  The first two methods are widely known by most Mozambican women.  If a woman takes the necessary precautions (taking anti-retrovirals (ARVs), etc…), there is less than a 2% chance that her child will get HIV during delivery.  The issue of breastfeeding is a little more complicated, but basically the children can only eat/drink breast milk for the first 6 months (this amount of time varies) of life and the mother needs to continue taking ARVs to keep her viral count (amount of HIV in her body) low.  The third and final method of transmission is any time during pregnancy.  This is also the reason why people are fighting to change the acronym PMTCT (prevention of mother to child transmission) to PPTCT (parent instead of mother) because technically HIV would be transmitted from the father (or any of the mother’s sexual partners) to an HIV negative mother and to the baby.  There is also the possibility of a HIV positive woman passing HIV to her baby if she has advanced HIV disease, which would increase the level of HIV in her bloodstream.

 

 

 

The beginning of a new year and maybe a new me?

While I was at home, several people gave me a lot of crap for being so horrible at keeping up with my blog entries. My original goal was to write one a month, but obviously, I have failed miserably. One of my New Years resolutions this year is to try to keep up with it better, but like most resolutions, this one will probably only make it to February.

One question that came up over and over again while I was at home was how has my perception of the States changed after living in Mozambique for a year. Great question.

Someone told me before I left for Moz that most PCVs come back to the States after two years disliking (I am pretty sure he said hating, but I think that is too strong of an emotion in this context) Americans and our way of life (wasteful, overindulgent, lazy, etc…). Personally, I feel like I have developed a great respect for "our way of life." I can honestly say the things he thought I would grow to resent, ended up being exciting parts of my trip home. For example, on my road trip I stopped at Sonic, Arby’s and Taco Bell (not all in one day of course) for lunch. It was incredible. So easy and convenient. I will admit though, the wrappers and the paper bags everything came in hurt me a little inside, but I guess all I can do is hope that they eventually end up in a recycle bin. Or I could open up my very own fast food restaurant or grocery store where everything is sold wrapper less and Tupperware is a requirement for entry. Any financial backers?

When it comes to food and lifestyle choices, however, I would have to say I prefer my way of life here. This has nothing to do with America as a whole. This is all about me and the choices I make everyday. In the States, I love TV and tend to watch way too much of it. What can I say? It is seriously addicting. While I am watching TV, it is so easy for me to put clothes in the washing machine, throw a premade meal into the microwave, and run the dishwasher all at the same time (I am incredible at multitasking). Here, I still watch movies and TV shows on DVD, but there is not an endless list of options that keeps me coming back for more. Or commercials that make new TV shows and movies look too good to pass up. I also do not have the luxury of a microwave or even a car to jump into if I want to pick up fast food during a commercial break. Whenever I go shopping here, I have to think about what exactly I want to eat for the next few days because getting to the market is not as simple as turning a key. I do love, however, the amount of walking that comes with not having a car. Not only have I reduced the size of my carbon footprint, but I am also in the process of reducing my pant size. Talk about killing two birds with one stone.

On to a more serious note:

While I expected to be wowed by the endless number of luxuries in the States, I was completely taken back by something I experienced driving underneath I-10 in New Orleans. Let me preface this by saying that I see extreme poverty almost everyday here, but I have not been hit so hard and so fast as I was when I was driving past the homeless shelter on that cold and rainy night. There was something so incredibly sad about all of the people huddled together trying to sleep outside in front of the shelter that tugged at my heartstrings. I kept going over and over this scene in my mind to try to figure out why I had such a strong emotional response and finally came to the conclusion that it was because it was basically unnecessary for people to have to live in those conditions in the US. Yes, the economy is bad. I understand that, but where are these people’s families? And I don’t mean nuclear families. I am including extended family in this too. In Mozambique, if a child’s parents die (HIV related or not), there is someone to take them in and provide at least some kind of family life. This not only applies to children. If you are an adult and traveling down to the capital city, you just call one of your distant (I mean like really really distant) relatives and crash on their floor. Why would you ever need a hotel if you have relatives? Family takes care of family. I will get off my soap box now, but I do hope I always remember this simple statement and take a hint from Mozambicans: being a part of someone’s family does not always mean you are blood relatives.

Okay back to a lighter note. So how has living in Moz changed me over the past year? According to my lovely friends from college, it has turned me into more of an observer rather than the person who always has to be in the middle of everything. The contributor (or one of them), if I may. In their exact words: I am more “subdued.” At first, I wasn’t sure whether to feel offended by what they said and add it to my list of things I need to work on (another New Years resolution like trying not to interrupt people when they are speaking – I just get so excited though!). The more I thought about it, the more I understood why living in Moz has turned me in to more of an observer. I have concluded it is because I am living in a place where people do not speak my first language. Understanding Portuguese is not a problem for me anymore. Trying to verbalize every single thought that comes in to my head still is. I have learned that body language and just listening to a person’s tone of voice and other subtle clues goes a long way. Even just a gentle squeeze on a person’s shoulder sometimes speaks volumes. I have also learned that sometimes less is more and that saying what I mean in one brief sentence can just as easily get my point across as a 5 minute long monologue.

It's been awhile…

It has been almost four months since my last blog entry and so much has changed and yet it feels like nothing is different. The season has changed (Feelin' hot hot HOT), I have a whole new set of responsibilities at work, there is a new and exciting person in my life, and I traveled thousands of miles to be home with my family and friends for the holidays.

Since the beginning of September, things at work have become a little crazy. I was asked by my boss and one of the high ups in the CARE Maputo office to take over all of the responsibilities of the Monitoring and Evaluation Officer for my project. I agreed as long as it was understood that I have other responsibilities and commitments outside of the CARE office like to Peace Corps and REDES (I am the National Financial Director and I still have a girls group that meets twice a week). Now, I find myself busier than I ever thought possible and missing the days of asking "are you sure there is not anything I can do today? Please give me SOMETHING to do!!!!" I miss the days of going to smaller communities and sitting under a tree while the ATSC counselors test people for HIV or driving out to local businesses and chatting with the owners while their employees took tests. I also miss the impromptu English and Xitswa lessons that always seemed to happen during lunch or slow points in the day.

Don't get me wrong, I enjoy the challenge that comes with my new responsibilities and I am really grateful for not only the professional experience I have gained but also for the opportunity to learn new and interesting things. Recently, I have been working with the data entry people in the hospital because Mozambique is striving to go digital with the HIV + clients' records to ensure everyone can receive consistent and quality treatment. Last week, I facilitated a training of four new data entry people who will head out to the more rural districts and begin the process of digitizing their hospital records. I will be joining them this week to monitor their progress and work side by side with them, entering patient information to speed up the process a little bit.

So moving on to the new and exciting person in my life… Camille.

In the middle of October, another redhead worked her way into my life. So now, not only do I share a home with one (Courtney), my closest neighbor inside the compound is also a redhead. I have come to conclusion that I am destined to be surrounded by good looking redheads. I guess there could be worse things. Not only is she a redhead, but she is my age, American AND a southerner! Pretty sweet deal if you ask me! Now there are four American southerners living in my community. I feel like we should start our own cult or something. Write Odes to the Good Ole Southern way of life. Okay, that may be taking things a little too far.

Finally, my journey home to the States

On December 17^th, I hopped on a plane in Johannesburg, landed in Atlanta, missed my flight to Little Rock (no surprises there) and saw my grandma for the first time in over a year. Needless to say, it was glorious. I ate almost all of the things I wanted to, drank probably more things than I needed to, saw as many friends as possible, successfully completed a roadtrip in three states after not driving for over a year and even went to a NFL game. Three weeks later, my flight gets cancelled the morning of to ATL, but I did, surprisingly, make it on my flight back to Africa. Mission accomplished. I am officially ready for the next exciting year of life in Mozambique!!!

Boa Entrada para todos!!! Happy 2010 everyone!!

Bairro SEED

Lena, Courtney, Me, Caspar, Flora, Andreas, Camille, and Helga

My Vilanculos Family

ONE YEAR!!!

As of yesterday, I have been in Mozambique for a year. I am not really quite sure how I feel about that statement because it doesn’t seem real, but it is a fact. I arrived in Mozambique on October 2, 2008 and went from staying in a luxurious $450 USD a night hotel in Johannesburg to flying into the Maputo airport and driving through the slums surrounding it. One really interesting thing that has changed in the past year is my perception of the Maputo Airport. When we first flew in on Oct. 2, I thought “THIS is the LARGEST airport in the WHOLE COUNTRY?!?!?!? It is a total dump.” Then in July, when my family was visiting, we flew to and from the same airport and I found myself really impressed on how nice and comfortable the airport felt.

I can honestly say the past year has not only been a great experience, but it has been really fun and everyday I thank whoever decided that Mozambique would be a good placement for me. At times, living here has been a challenge, but the good moments always outweigh the trying ones and I am really looking forward to my second year.

In a few months, I will be returning to the States and I have already made a list of everything I want to eat (too many restaurants to list), drink (imported and light beers and frozen drinks), and all of the places I want to go (I am pretty sure Pat O´s piano bar is on the top of this list or maybe it is my parents´ house). Thinking about home has really made me appreciate everything I love about the States and everything I love about Mozambique. So here is my list of 4 of the best things about Moz and the U.S.:

What Mozambicans do right:

Enjoy Life
The clock in Mozambique definitely moves slower than it does in the States. After being here a year, I have learned to appreciate (or at least accept) the hours I spend waiting for things that would take less than 5 minutes in the States. I am beginning to understand why things move as slowly as they do. Mozambicans take every possible chance they get to enjoy life and if that means waiting for a store to open/chapa to leave/someone to use an ATM, they take the opportunity to get to know the person waiting with them. One the weekends (or during the week if a person is unemployed) Mozambicans spend hours “passear-ing.” Passear means to go for a walk with no specific destination in mind. They pass through the market and chat with anyone and everyone and then visit their friend’s houses or the local barraca (bar). I found this really great quote in a book I was reading set in Botswana and written by a Zimbabwean.

“and every morning she could sit in front of her house and sniff at the wood-smoke and look forward to spending the day talking with her friends. How sorry she felt for white people, who couldn’t do any of this, and who were always dashing around and worrying themselves over things that were going to happen anyway. What use was it having all that money if you could never sit still or just watch your cattle eat grass?”
pp 162 “The No. 1 Ladies´ Detective Agency” Alexander McCall Smith

Say it like it is.
Some people find this a less than attractive quality, but I really appreciate the acceptance that comes along with it. If you are fat, people call you fat. Here is the best part: to your face. There is no hiding it. It is the honest to God truth. If you are ugly, they will call you “aquela mulungu feia” (that ugly white chick). The only small hint of trying to soften the blow is when they add “inha” to the end (e.g. gordinha – a little fat). Which leads to:

Appreciate what their momma gave them.
Negative body image is something Mozambican women only read about in the South African version of Cosmo. Women here love their bodies. Short. Tall. Fat. Thin. It doesn’t matter. They take what they get and flaunt it.

Ask and you shall receive.
One of my favorite things about Mozambique is that if you ask a person to do something for you, they will. Sometimes this comes for a price (usually somewhere around $0.20 USD), but most of the time, it is done with a big smile and a “até a próxima” (until next time). If you are willing to pay for convenience, then this is the perfect country for you. You can pretty much pay anyone to do anything for you. If I want a set of specially carved coasters (they are beautiful FYI) then I come back the next day and they are ready (for a slightly higher price than we agreed on the day before). If I am looking for this one really special capulana I have had my eye on for months, I can ask anyone in the market and they will help me find a stall that sells it. If I want a coke/cashews/piece of bread/beer/egg sandwich/orange on the chapa, I just ask one of the kids hanging around to go get me one. The downside: transactional sex (exchange of goods and services for sex).

After being away from “America” (which is what everyone here calls the U.S. with a sense of awe and wonder in their voices) for a year, I have really had the chance to think about all of the things I really miss/appreciate about the “land of plenty” (which is what I have started to call it).

What The U.S. does right:

The Service Industry
Free water and refills at restaurants and good quality napkins. Enough said.

Customer Service
It is nice to know there are people out there who actually care (or at least pretend to care/get paid to care) if I am satisfied with what I bought or the manner in which it was given to me. This is not really a problem on an individual level in Moz, but just with the huge monopoly companies that could care less if people are satisfied with their company’s product or service. For example, the telephone service provider I use is so unreliable and ridiculous. I spent 20 minutes on the phone (which is really expensive here) with customer service and traveled 12 hours roundtrip because my text messages were not working. I ended up waiting for two minutes while the clerk at a store that looks just like the one I have in my town, punched a 5 digit code in and magically my texts were working again. Please tell me why the customer service lady could not have told me the exact same thing in under 5 minutes?!?! This leads to:

Complain
Let’s face it. Americans are whiners. This statement may offend you, but I strongly believe it is the reason why the U.S. has such great customer service and a helpful service industry. Complaining gets stuff done. I wish that more people in Moz would complain about anything and everything. If people here complained about the crappy cell phone service instead of just accepting it as a way of life in Africa, maybe things would get better. This is not to say that complaining by itself makes things better. If a person complains, they need to make a commitment to see it through to the end.

Serial Monogamy
One of the factors that place Mozambicans at such a high risk for HIV is the cultural norm of concurrent relationships. A concurrent relationship is one where one or both of the partners are sleeping with one or more people on the side. This allows HIV to spread at a much higher rate than it does in the States because so many more people are involved in the sexual networks. Serial monogamy only puts two people at risk of acquiring HIV (until an infected partner begins a new relationship) unlike concurrency where pretty much anyone who is currently involved in a relationship is at risk.

So that’s all folks! Hope my first year of blog entries weren’t too terribly boring and I hope to see you all again in December! Happy One Year Moz 13!!!!!

TIA III

One of my favorite Mozambican superstitions:

"There is a huge serpent that lives in the Atlantic Ocean and when it wants to travel it goes under Africa to the Indian Ocean and that is what causes an earthquake."

A snake is a very unusual birthday present (thank you Africa), but makes me feel like a real PCV!

(In case you were wondering, the score is snake 0, guard 1)

Rough Moments = Personal Growth

If you had to tell someone that from this moment on, their life will be, now and forever, changed and it will affect not only their health, but potentially the health of their sexual partners and children, their ability to work and provide for their family, and then to top it off, their closest friends and neighbors may begin to look at and treat them differently, how would you do it? Do you apologize first? Or does that make it seem like you are apologizing to yourself for getting into a situation like this? Or do you act like it doesn’t mean anything to you to deliver life changing news? Would that make you appear callous and uncaring?

In reality, it isn’t about you. Does the manner in which the message is delivered make any difference to the receiver? Or do they only hear “your HIV test came back positive” and the rest just becomes background noise?

During training, 8 months ago, my language group took a “field trip” to the hospital to experience what happens before, during, and after an HIV test. I remember asking a lot of questions about the tests used and why you should get tested every three months, but I never thought that my curiosity in the nitpicky details of the process would be so incredibly useful. Little did I know, I would be the person explaining to another the process of taking an HIV test. First, pre-test counseling and then, the inevitable question: do you feel prepared for whatever the outcome of the test? (I am not even sure that is a realistic question. Can you ever be fully prepared for something like HIV?) Next, the finger prick and finally, the results of the test appear. One line: negative. Two lines: positive. If the test only has one line, the person is told to make sure they always use a condom, try to limit the number of partners they have, and to get tested again in three months. If there are two lines, however, the person is told the test came back indeterminate and a second, more accurate test is performed. Once again, one line means HIV negative and two lines indicate a positive test result. If two lines appear, then the counselor must tell the person in a sensitive, yet indisputable manner, that they are HIV positive.

Most of the time, this is just a process I observe, but when I was the only person who spoke English, I found myself looking for answers to all of those questions I addressed earlier. I wish I could say I thought only about the people to whom I was delivering this life changing information, but part of me kept thinking about how unprepared I felt. I kept thinking that I should have been taught how to say this the right way. How should I feel about the situation? How do I feel?

But, again, it isn’t about me. It is about the people who have an enormous decision to make. Do they keep living their lives as they did before they were tested? Or do they make the necessary changes and live a longer, healthier life with a few small sacrifices along the way?