"Wena, ga o mogare" -- (You, you are not the virus)

The kids looking over the finished product of HIV messages that they created.

"I am what I am because my mother made me to become what I am. / So don't laugh and make fun of what I am, because I am what I am..." -- an excerpt from a spoken word piece written by one of our HIV positive teens during the camp.

If you are a faithful blog reader, you’ll remember that last November we had a camp for the same group of kids that I have been meeting with every month over the past year. We’ve had ten support group meetings in total, two camps, two events with caregivers of the teens, as well as an informational meeting with community stakeholders (government office department heads, local NGO directors, and a dozen or so chiefs from the area). So we’ve come a long way from our first meeting last September with five teens and a really really really nervous me. I knew from the first day that this was one part of my service I didn’t want to screw up. I’ve stressed out, laughed, listened, been inspired, and cried over these kids. Without the chance to work with them, my service wouldn’t be half of what it is.

Tie dying!

This time our camp was five days with about 50 kids from about a dozen villages in our area, including some from the other side of the river which is incredibly isolated. And we had health care workers from almost as many villages, including some from villages that don’t yet have an HIV positive teen support group but which want to start one. They were able to see what we do and will hopefully build from there. It feels like we have started a movement.

Tie dyed bandanas drying outside.

This camp focused on using different forms of creative expression to encourage the development of healthy coping strategies and psychosocial support. We brought in a spoken word artist to do a poetry session with them. We tie-dyed (or tried our best). We sang and did dramas. We painted pill boxes so the teens would be able to more discretely take their pills (and not forget them!). We created a giant patchwork (inspired by the AIDS Quilt in the US) with messages about HIV and Botswana and their lives. We created posters with prevention and support messages to be hung in their communities at the clinics/town halls. We had condom Olympics to teach about safe sex (yep, you read that right. Re: condom water balloon tosses, condom demo relay races, condom tug of war). It was quite an adventurous five days. Twenty-some months ago I remember uttering the following words to my program manager during a conversation about my future site placement, “The only thing I don’t really want to do is teach sex ed to high school kids.” Fast forward two years, it’s one of my favorite things to do.

Water balloon toss with condom balloons. They got soaked!

Through all of these sessions and activities, it was an amazing thing to see the kids open up in ways they haven't done before. One boy, usually with a blank stare fixed on his face, could be seen running around screaming playfully at the top of his lungs and even competing in the talent show with his ridiculous dance moves. Another girl who hardly speaks in meetings boldly took one of our nurses by the hand to lead her through the tie dying process, explaining every step as they meant. These may seem like minor things, but for some of these kids to let their guard down in this way is a huge accomplishment. 

Another Peace Corps Volunteer doing a condom demo with a health educator.

The most meaningful part for me came from a session we had about issues of disclosure. The teens went around and discussed the first time they learned they were HIV positive—who told them, how they felt, etc. I imagine it was the first time voicing this memory for the kids, and for many it was undeniably a painful one. I was surprised at the different stories they were told—one was told by his mother that he cut himself while playing when he was a baby and happened to mix blood with someone HIV positive. Another was told that he received a blood transfusion from his HIV positive cousin in the clinic as a baby. To be fair, some of the stories they were told might be true, but the nurses seemed to think they were lied to. For the age they are, most likely it was mother-to-child transmission, and the parent/caregiver was not entirely truthful in telling them. Another was only told he was taking pills for an “ear problem.” Another girl was only told by her mother that her pills were called “ARVs” but not what they were for. One day while sitting in the classroom when the students first learned about HIV/AIDS in school, she made the connection that she is HIV positive. I imagined a nine-year old girl sitting in her classroom realizing the truth about her status for the first time and being surrounded by HIV negative classmates, while she felt completely alone. Another student was told he is HIV positive by his teacher, but to this day was never told anything by his parents or caregivers. And yet another girl was told, plain and straight, by her mother, “You have HIV. If you do not take your pills, you will die young.”

The teens painted and personalized their own pill boxes. 

During this session about disclosure, a topic many of them had not bridged yet, we discussed who you should disclose to, how and when you should do it, and even what you can say.  And then the health care providers I was facilitating with did an amazing thing. They said to the kids, “Wena, ga o mogare. Wena, o wena,” meaning “You, you are not the virus. You are you.” To these kids, some of them just twelve years old, it was maybe the first time someone had phrased their status to them in this way. You have HIV, but you are not HIV. You, tsala ya me, are you.

A health educator talks to the teens about prevention of mother to child transmission.

Another important moment came in teaching the teens on the last day about the risk of reinfection and the realities of having an HIV negative partner. The day before during one of the sessions, the teens were introduced to the idea of different “types” of HIV, whereby even if you are HIV positive, you can still contract another strain of HIV that might be resistant to a certain treatment. The teens were really disheartened to learn this, as they thought once you have HIV, you have HIV. End of story. Some of the girls were even asking if they could ever safely have a baby. So we talked to them about these issues, about the risk of reinfection and even the possibility of having a sexual partner who is HIV negative. If your viral load is low, the risk of infection to your sexual partner also drops. The message was: it is okay to love someone who is HIV negative and even to want to have a baby with them. You can protect yourself and protect them at the same time. Although there are risks, they can be mitigated. While it took a while for them to grasp this message, it is such an important one. 

 

"Mr. and Ms. Teen Club" beauty pageant  (one of the pageant questions was
 to correctly do a male and female condom demo).

During those five days of little sleep and constantly being “on,” I had a couple of moments like this last one where I felt almost a sense of euphoria because of the overwhelming feeling that I am exactly where I am supposed to be in the world doing exactly what I am supposed to be doing. One of the 13-year-old HIV positive girls who I work most closely with said during the camp that she was grateful to be learning about these topics, because there are some kids who were not there who are not so lucky. I am acutely aware of how significant and rare those moments of purpose and fulfillment are. They feel like a welcomed reward for all of the loneliness, anxiety, stress, tears, and truly countless struggles I been through over the past two years. It is a powerful and redeeming feeling to know that you are the source that initiated something at its beginning. It is equally powerful to know that it was, and continues to be, worth it.

More pictures from the patchwork the teens created: 

 

This teen wrote down the poem she wrote and performed during the poetry session earlier in the day . It's one of my favorites.

Our learning space featuring some of the artwork from the week. 

To Live and Die in Botswana: A Funeral Account

Okay, so this might seem like a weird thing to blog about to some of you. Funerals? Really? Maybe it’s the Anthropology major in me, but I was fascinated by a funeral that I went to recently and wanted to share the experience with you. That's what blogs are for, right? 

NOTE: It may seem strange that I took pictures at a funeral, but so so many other people were as well...I found it strange at first but then jumped in and snapped a few of my own.

Traditional church apparel which differs slightly between churches. 

Even after living in my village for almost a year and a half, I had never been to a funeral before. Sure, there were opportunities, but I was a little bit wary of viewing it as a spectacle. If it was the funeral of someone I knew closely, then that would be different. But to go to the funeral of someone I had never met just to witness a Tswana funeral? That felt distasteful. A recent conversation with a friend, however, changed my mind about the matter. That plus the fact that I have adopted the “try absolutely everything you can before you go” attitude during my last few months here. She invited me to the funeral of the father of her children’s sister. So, that would be her ex-boyfriend’s sister.

The night before the funeral I even called her. “Are you sure it won’t be weird?” I asked. “I don’t want to offend anybody…” I even tried explaining how in America it would be very strange to go to someone’s funeral who you had never met. She assured me it would be fine, even respectful. She explained to me that going to someone’s funeral, regardless of whether or not you knew them or their immediate family, is a way of showing them love. Similar to how the whole village is invited to a wedding—no invitations necessary. So I decided to go.

People packed into cars on the way to the church service.

The whole event started on a Sunday at sunrise at the family’s compound. It was hosted by the individual’s church mates, as is customary. That morning, I didn’t even know what to wear. All black? I had seen people here wear all kinds of colors to funerals, so I settled for an outfit of muted colors, just in case. There were dozens of tents set up throughout the yard by community members and family members who had been there for days engaging in all-night prayer sessions.

 My friend met me at the road dressed in a bright yellow-and-pink dress. She immediately tracked down a scarf for me to tie around my head (I was running late and stupidly forgot one). We joined a crowd of people standing overlooking the church mates carrying the coffin from inside the family’s house out into the hearse. They were dressed in traditional white and blue church garb. Once the coffin was in the hearse, there was a chaotic frenzy where everyone ran to get in a car to go to the church service. The person-to-car ratio was probably something like 10:1. I have never in my two years here seen people cram into cars quite like they did that day. And after two years in Bots, that's saying something! I had no idea what was happening, as usual, so I followed my friend’s lead.

Inside the tiny thatch-roofed church.

We drove to the next village over where the deceased woman’s church was located. Inside, the coffin sat on a small stand and there was lots and lots of singing. People also took turns talking about the deceased woman between prayers, even sharing the circumstances around which she passed. The woman had been sick for a while and left behind a couple of children, including a five-year-old boy. He was the only child in attendance at the church service and burial. I was surprised that it didn’t seem like a sad occasion—there was clapping, foot-stomping, maybe only a couple of tears, but even those ones were wiped away quickly, if they were there at all. The church mates held some candles and sort of danced around the coffin inside the incredibly cramped mud-walled church. Most people stayed outside because there was no room inside.

After the church service, which took about 45 minutes, we went to the burial plot in yet another close-by village. Batswana are always buried in the same cemetery as their fathers. Up until this point, there was very little grief outwardly expressed. But the attitude at the cemetery was completely different. Before, people were taking pictures and videos and even smiling during singing and chanting and praying. Here, people collapsed on the ground, wailing with grief. Others were physically carried out to the periphery of the crowd, almost seizing with spirits.

Procession outside of the church with the church mates. 

At one point, my friend doubled over, heaving with sobs. She fell to her knees and started wailing. I wasn’t quite sure how to act, so I dropped to my knees beside her and rubbed her back. Eventually she calmed down, maybe after a good 10 minutes. A few people tried to get her to leave the ceremony and go sit further away until she could collect herself. One older woman came up behind her and rubbed her hands forcefully down my friend’s spine. It struck me in that moment that my friend was grieving in a deeply empathetic way, imagining a similar circumstance for herself where she would leave her own children behind and without a mother. My friend has 18 month old twins, a six-year-old, and recently gained custody of her deceased sister’s 13-year-old twins. She is the pin which holds her little family together and I can’t imagine what would conspire if she lost her life too young.

We sat there in the sand for the rest of the burial as the red soil billowed and dissipated from shovel movement in the mid-morning sun. A couple of men took turns filling in the grave which had been hand-dug prior to our arrival. The church mates sang some beautiful songs, and soon it was over.

We returned home where the extended family was presented to the crowd of attendees, and like at any good Tswana event, food was served. (Note the picture of cow heads hanging from a nearby tree at the family compound). 

At the end of the ordeal, my friend turned to me and apologized for "doing a mistake" earlier in the day at the burial. She was apologizing for her reaction and expression of grief during the ceremony. She thought maybe I was afraid. I assured her that everything was okay and that she most certainly did not make any mistakes in the way she vocalized her emotions. I recalled her saying earlier in the day that children are generally not permitted to attend the funeral, because the parents don't want them to see these expressions of grief. It struck me then that I was like a child in that moment--clinging to her, unsure of what was going on, looking to her for direction. It is so often how I have felt on this journey in Botswana. No matter how much I try to pretend I know what to do or how to act, I was reminded on this day, however indirectly, that I am still a child of Botswana. 

(not so) Tiny Botswana Story #6

Disclaimer: This post is heavy and a little bit graphic. But entirely real and something I feel is important to share.

I recently heard an account from a social worker in a village 20 minutes away involving an 11-year-old girl. The girl was having trouble sitting properly in class. She would sit sideways, and the teacher would yell at her to sit nicely in her seat. But she didn’t seem to be capable of sitting properly. The teacher talked with the girl after school and it soon became apparent that the girl was being abused by her uncle.

The student, who is in the equivalent of fifth grade, lost her mother last year to HIV and her father has been either dead or missing for a number of years. She is an orphan at the hands of HIV, like so many other children in Botswana. As an only child with no grandparents or other aunts or uncles, her uncle is the only family she has, and he is solely responsible for her care. He has been raping her repeatedly for an undetermined period of time.

Upon confronting him, the uncle became aggressive and warned the social worker to “stay out of his family’s business.” The uncle’s wife (or rather long term girlfriend, as many people in this area can’t afford to get married though they call themselves husband and wife), was outraged when she learned from the social worker what was happening. Apparently, she suspected something was going on, because her husband would regularly get out of bed at night to “check to make sure the gate is closed” or to “go to the toilet.” The few times that the wife went out to check on him, she at least once found him coming out of the young girl’s room.

This past weekend, my friend and another colleague traveled on the bus with the girl over ten hours to a town halfway across the country to a home for orphans where the girl will stay for at least six months. They also completed a rape kit at the hospital there with the hope of prosecuting the uncle. It amazes me that someone would have to travel so far to access those services, while rape is not an uncommon occurrence here. They bypassed two other hospitals on their way which either don’t have the proper equipment or trained professionals to do the rape kit. In the meantime, my friend also expressed concern that the uncle could kill his wife for speaking out against him in front of the social worker. These types of “passion killings” are a huge problem in Botswana and very much a reality.

After telling me this information, my friend confessed that this young girl’s issue weighs especially heavy on her because she has been through almost the same situation. When she was also an orphan and in fourth grade, a man was raping her as well. She had to get two stitches from the damage he inflicted on her. The man who raped her was luckily put in jail for fifteen years. When he had about five years remaining, he managed to escape from the facility that was holding him. The police managed to find him, put him back in jail, and extended his sentence. This news was too much for the perpetrator, and he ended up killing himself in prison, likely by hanging.

I could tell you half a dozen other stories similar to this. Some involving men raping toddlers on public buses without anyone knowing, some involving men raping four-year-old girls and causing so much damage that the child had to have a catheter and urine-collection bag connected to them. The common nature of these stories is disturbing and also far too real in this country which boasts peace and low levels of crime and corruption. Maybe the true issue lies with under reporting of these instances.   

TBS is back and so am I

It's been a while since I posted anything, so I thought I would bring back these Tiny Botswana Stories (TBS). They are vignettes into the lives of people who touch my life here. I hope this gives you some insight into life in Botswana. I seem to be drawn to sharing the more saddening and occasionally heartbreaking ones, only because those are the ones that I seem to carry with me. But I'm conscious of that and will try to bring along some positive ones as well--because there are a lot of them, I promise.

Read on. //

Tiny Botswana Story #5

We recently got another Peace Corps Volunteer at the Senior Secondary (High) School in my area. He has been writing letters to students to help them practice their English. One student told him about some medical issues she has been having, specifically vaginal discharge since over 5 years back. Upon sitting in a health class recently where they were learning about STIs, she realized the symptoms she had been experiencing were not commonplace. It turned out she had an untreated STI. She did not know the source of the infection, only that it had been plaguing her for so long. At the urging of the Peace Corps Volunteer, she phoned her mother to try and find some answers. As it turns out, her grandmother had suspected witchcraft in their home and had brought in a man to have sexual intercourse with the virginal young girl as a way to combat it. Years of suffering were clarified that day. But it still breaks my heart that it took so long for her to know that truth. And it will undoubtedly take her even longer to come to terms with it, if she ever can. 

Tiny Botswana Story #4

One of the nurses here at the clinic is attempting to get Master’s degree through the internet. The university she is using is based somewhere in India, despite the fact that it has the word “Americana” in the title. For the first few months she was enrolled in the course, she would come to me frustrated and seeking help on how to download her assignments and modules from the clinic computer with internet (and also with a ton of viruses). It's a whole lot of school work that she had to do each week on top of working full-time at the clinic. If she falls behind, she 's pretty much done. 

Unfortunately, on her personal computer she didn’t have any Microsoft Office products, and none of the files were opening despite my attempts to download other off-brand typing programs and PDF readers. We eventually found a way around this by converting the assignments to PDFs and transferring them on a CD to her computer, but every few weeks she has to be connected to reliable internet to take an exam. That means she spends her own money to go to Maun (a 6-7 hour bus ride away) to use an internet café with ridiculously slow internet to take an exam at a very specific and uninterrupted time. And sometimes the cafes are inexplicably closed or the internet isn't working.

 A few weeks ago, she ended up having to purchase her own internet data to use on a dongle (like a USB personal hot spot using the cell phone network). I know for a fact that purchasing enough data to use for a few hours of test writing is anything but cheap. I’ve watched and listened to her struggle and persevere in ways that I don’t know that I would have the strength to do. The barriers she has to overcome to further her education are large and discouraging. She still has several months left in her program (maybe over a year?), but at least she knows I'm rooting for her. 

Tiny Botswana Story #3

Yesterday my co-worker and I went on home visits to do contact tracing with the co-workers for someone who has Tuberculosis. That means giving health education about TB and also investigating whether or not any of the co-workers have symptoms of TB. This particular person is very infectious and has only been on treatment for three days (the first two weeks of treatment the patient is still very contagious). 

On the way back we went to visit a few patients at their homes, as the health educators here often do. We entered the yard of a man who is a psych patient at the clinic. We found he wasn’t home, there were only young kids at the house unattended. My co-worker told me this morning that the psychiatric patient was actually home and in the house, and a couple hours after we were looking for him to check-in, he went into the bush and hanged himself with a soft wire. His mother found him later in the afternoon yesterday.

Psychiatric support at home and at the medical facilities in this country is severely lacking. There is one psychiatric hospital in the very southern-most corner of the country where all of the resources are for the most part. We have a psych nurse at my clinic who has just arrived, but the problem is the patients rarely come and see him. There’s never transport for him to follow-up with the patients, so as a result they often don’t get the help they need through counseling or medications. Occurrences like this are not uncommon.