Saturday, September 3, 2011

Going Home, or why I might consider an MPH again if I'm not too jaded

When I think about returning to my Peace Corps village I think about biking through the dense pine forest plantation to Mama Yuni’s mud room that serves as a “café” of sorts and hanging out in Mama Resti’s smoke-filled kitchen. I was worried about returning this time – what if they didn’t remember me, what if they had died, what if everything was different, so many “what ifs.” I only received a few letters in the four years since last I visited, so I went back with many questions of what to expect.

The first change I noted was that public transportation options to the village have doubled in the past four years to two different buses, and the 20 km ride to Itimbo from Mafinga was significantly less crowded than in the past. We even got seats. But the ride was also significantly less beautiful. Two years ago a fire swept through the massive pine plantations and all of the trees were cut down. It looked like a barren wasteland littered with towering piles of sawdust. The forestry managers are starting to replant with a mixture of eucalyptus and pine trees, though it will take 20 years before it’s restored.

When we got off the bus to the village we encountered many more buildings and shops and a couple of houses even had satellite dishes on top. Electricity hadn’t arrived in the village, but some people could afford generators and solar panels to power their TVs. I nervously walked toward Mama Yuni’s old house wondering what else had changed when we met her walking toward the mill with a basket of corn on her head. After getting over the shock of seeing me – we haven’t exchanged a letter in years – she excitedly hugged me and escorted me back to her house. A ten-year-old boy trailed behind us. It took me forever to realize this was her son, who I hadn’t seen since he was three.

Mama Yuni’s world is full of changes. Her eldest daughter is now the mother of two, and they all live in the nice, new-ish cement house together. Two of her children are in secondary school, though school fees have more than doubled. She no longer runs an mgahawa cafe. In fact the old mud room collapsed in on itself when Mama Yuni was in Dar taking care of her dying mother. Like half of the village’s Catholic congregation, she has been “saved” and now attends the village’s new second branch of the zealously religious Assemblies of God Church. Near as I can tell that mostly means she no longer makes and sells beer, and her prayers at meals and in the evening are much longer and much more fervent. And she, like the rest of the village, now has a cell phone.

When I got my first cell phone in 2003, I used to hide it because it was considered so strange. I’d only have it on for an hour per night because I had to bike to Mafinga, one and half hours away, to charge it. Now, people have solar panels and generators around the village and make a business out of charging phones. Everyone has one dangling from their necks, and they use them to call friends on the other side of town, just to say hi. Twenty-one year-old Yuni is constantly sending text messages, just like every other young adult in Africa. Pre-paid airtime vouchers are available at every kiosk. Women still cook over open fires while balancing their pots on three rocks, but at least now they can do it while calling anywhere in the world.   

Soon after arriving at Mama Yuni’s house and immediately being fed, Mama Resti found out we were in town. She came down to the house and entered singing and dancing. Her goofiness factor, one of my favorite of her traits, was running strong. I guess she didn’t forget me either. Her life hadn’t changed as much as Mama Yuni’s, though she too has two new grandchildren and a beautiful new cement house. She has also lost her parents and her brother. Her husband still lives in a different village and still isn’t very nice to her. She’s the only one who learned to raise bees when I was in the Peace Corps who still does it, and she seems to delight in eating a spoonful of rich, thick honey in the evenings.

Returning to the village was in many ways like returning home. It was so nice to see friends, to hear how things had changed, and how they had continued on. I had the same conversations I always have –why I’m not married, why I have no children, how my sister is doing, how are my parents. I was awestruck by stories of horror – Mama Resti’s brother was murdered for money so her relatives hunted down and killed the murderer in return. Another woman was beheaded when her cloth wrap was caught in the spinning belt of the grinding machine and it pulled her in. I was treated as if I had never left, and Jeanette was treated like I was when I first arrived ten years ago. She was force fed tons of food and patiently taught Kiswahili while sitting in the kitchen. (The universal conclusion is that she’s very bright and learns quickly.)
Mama Yuni and me

Mama Resti and me

On our second day back we attended a show put on by a group from Mafinga. Their aim was to change men’s behavior so that they would become more involved with home life. The event contained the usual mixture of dance competitions between children and skits that tell men not to sleep around and to actually help their wives at home. When one village man was asked if he ever helped bathe his children, he looked scandalized before answering what he knew was expected of him – no, but he would be willing to try. I somehow doubt that…

Jeanette and I skipped out of the performance to go escort 18-year-old Lili to the makeshift testing center. Once a year, the group from Mafinga comes to the village to provide free HIV/AIDS tests. We told Lili we would get tested as well, but when we got to the house, people were competing for a spot. Four years ago, hardly anyone knew their status in the village and no one really wanted to know. They didn’t see a point. Now, ARVs are available for free, theoretically, in the village and in Mafinga. Fifty-five people get their meds in the village each month. Now that AIDS isn’t seen as a death sentence people are more inclined to know their status. I was shocked and elated. Just four years ago, when I was interviewing people about AIDS, I never would have foreseen this.

The testing process seemed very straight forward. You get a number, the testers take a sample of your blood, you go outside again to wait, and then they call you back in after the results are ready. Mama Resti went to be tested, just in case. When she came back out she looked ashen. Jeanette and I had already decided to forgo the testing so more villagers would have a chance, and we returned home with her to find out what was wrong.

Mama Resti was told that her blood was dirty –the common, indirect way of saying she was infected with AIDS. The “counselor” didn’t provide her with any counseling, any information on what to do next, and any information on what causes infections. He just wrote down “CTC” on the ripped off corner of paper that served as her results and said to go to Mafinga. She wasn’t even sure that it really meant she was infected. We decided to go to Mafinga with her the next morning so she could be tested again and find out what to do.
We arrived at the CTC, which turned out to be the AIDS treatment center, and walked into a room full of people waiting for services. Posted on the walls were large handwritten signs declaring that they only accepted new patients on Tuesdays, Thursdays, and Fridays, a helpful fact never mentioned by the man from that same clinic who tested Mama Resti the day before. After making fun of Mama Resti for coming to the clinic with a white woman to help her, the woman in charge told her to go get an out-patient file from another part of the hospital. That process alone took an hour and a half.

After bouncing around the hospital for a bit longer seeking services, Mama Resti was finally admitted to the AIDS clinic. She tried to explain that she just wanted to be tested again, but everyone seemed to ignore her. The lady yelled at her for not coming with her husband and not getting tested with him. She didn’t listen when Mama Resti said that her husband lived in a different village and didn’t listen when Mama Resti said she felt unsure about the results and just wanted to be tested again. The machine to test her wasn’t working, the lady said. She could go to another village, maybe, but she doubted it. It was confusing. Eventually Mama Resti was sent to wait in a long line in the back and about an hour later she returned to us in the waiting room. She said that she was given drugs to take once a day for the rest of her life and that she should come back in a month to get more. They didn’t explain the importance of the drugs, of staying healthy, of how to avoid infecting others, of anything. And they didn’t do the only thing she wanted – to get tested again.

We stood outside the office and discussed what to do. The people in the clinic made it seem as if she couldn’t get tested again anywhere and that it wasn’t important. As we were discussing having Mama Resti come with us to Iringa (an hour and a half away) the next day to get tested again, one of the doctors in the clinic who Mama Resti had spoken to earlier during that chaotic morning saw us out his window and called me over. Not Mama Resti; me. He said she didn’t look comfortable and wanted to know why. I explained, again, that she wasn’t sure of her results. That the rushed, chaotic nature of the day before left her feeling unsure, like maybe the results weren’t right. All she wanted was to be tested again. This time, because I said it, he listened. He came outside and escorted us to the clinic where they do rapid results AIDS tests. A place that we tried to visit earlier but wasn’t open at the time.

Mama Resti was seen immediately. The woman took drops of her blood and spread them on two different types of tests. As we waited for the results she explained to Mama Resti how infections occur and made sure that she understood that she couldn’t get it just from handling dirty clothes of an infected person. While we talked she kept glancing at the tests. Eventually, she just kept staring at them. I asked her what was going on, and she said to wait while she called the doctor in. He came back from the other clinic and also looked long and hard at the tests.

Both tests said Mama Resti was negative. Both tests. The day before, the rushed counselor had made a mistake. Either he let Mama Resti’s test sit for too long and it showed a false positive, or he mixed up her test with someone else’s. That means that someone in Itimbo could be infected but thinks he or she is not. It means that more tests than just hers could have been wrong. It could mean many horrible things, but just one wonderful thing: that my friend is okay.

When we got back to the village we went to see Mama Adam. Four years ago, when I was back in the village conducting interviews for my thesis research, Mama Adam told me that her husband and his second wife had both been ill for a long time and had recently died. I strongly encouraged her to get tested for HIV. Though she was scared, not long after I left, she did. She found out that she was positive. She said that for about a year after getting her results, some people refused to go visit her for fear that they would also get sick. She was heartbroken and didn’t know what to do, until others in the village told her that she could get free medicines in Mafinga. Now, people are over their fears and many of the infected people are part of a group called “Living with Hope” that has small projects and a support group. She goes to get her medicines every month in Itimbo, provided for free by the same group in Mafinga.

The problem is that they don’t give her enough drugs. She gets enough for about half of the month and has to buy the rest, if she can afford them. It’s unclear if others actually buy more or not. The “counselors” never explained to her that she has to take it every day. If she doesn’t, she can still get sick. The medical students we traveled with in Malawi explained to us that the main problem these days for patients with HIV/AIDS is noncompliance. If patients don’t take all of their drugs, then the drugs don’t help. Here, the government, supported by aid agencies, is giving out partial treatments and not full treatments. People can’t comply because they don’t have enough medicine, and they don’t know the importance of taking it every day anyhow. The half-assed program isn’t really helping anyone; it’s just providing false hope and wasting money.

The whole experience made me feel frustrated and impotent and hopeless. What could be an effective tool for fighting a devastating disease just causes more problems. People get false test results, get shuffled through a system of people who don’t listen, are left feeling stressed, and are given only half an answer anyhow. But what can I do about it? How can I make sure this doesn’t happen again? Truth be told, Mama Resti is probably right. The only reason she eventually got re-tested is because I was there - a white person who could potentially get the clinic in trouble with their donors. They didn’t know that really, I’m just Mama Resti’s friend and nothing else. So I’ve helped one friend. Now what? How do I make it so the people running the program actually start to care? It’s frustrating and painful and leaves me with the same questions I’ve had for years: what’s the point of “development,” does it work, what role do I have as a western, as an educated woman, etc.

I loved going back to my village. I loved dancing and singing with my friends. I loved feeling so comfortable and so welcome in a world where I shouldn’t fit. People I hardly knew greeting me with enthusiasm and kindness. Jeanette finally experienced the genuine hospitality and openness of Tanzanians who were genuinely happy to have us visit. But ultimately, I realized again that the village is a world that I can’t go back to except to visit. And a world that leaves me with all of the questions I’ll probably never answer but probably never stop trying.             
Mama Yuni and her clan (minus Charlie)

Turns out I can still carry water on my head. I've graduating to carrying the same amount as a third grader.

1 comment:

  1. Thank you for taking the time to share this story. It was as enlightening as it was disheartening. - Kathryn