24 January 2009

Rolla

My Zambian grandmother is sick.

Last year, I was adopted by Ambuya Theresa, a widow, one of the strongest women I've met, full of life, mischief, constantly caring for other people, one of the most devoted Light of Hope volunteers.

I went to her familiar two-room concrete shack to visit her, and found a frail-looking young woman lying on the couch. Must be one of her daughters, I started walking to the back room. But when she sat up and looked at me--a very sad, empty face--she spoke a few words and I instantly recognized her voice. It was like being hit with a sack of bricks.

TB. Tuberculosis. In the olden days, it was called "consumption" because victims wasted away--night sweats, fever, weight loss, coughing up blood. Her friends tell me Ambuya is recovering now with medication, she was much worse. She's lost so much body weight she's nearly unrecognizable, but worse her spirit is gone. Her face was so empty I had to fight hard not to burst into tears as we talked in broken English and Nyanja.

Last year, I loved living with her. In the doldrums of Boston (not that all of Boston is doldrums) I often thought back to the early mornings, washing dishes, sitting on her front step in the evening, watching all the children play in her front yard.

video
(From last year...not the best clip ever...I was shooting this from the hip, it was getting dark, but I think you get some sense of what watching these kids play is like. If you listen closely, you'll hear Ambuya say "imwe," which means "you" and in this case she's scolding one of the kids.)

It really made me think about what it feels like to lose someone. I've never lost anyone before. People wander in and out of my life, but there's always an assumption that they're carrying on wherever they are. Even when my grandfather died, I didn't go to the funeral, so I hadn't lost him. He's still carrying on somewhere. Ambuya, too, was carrying on somewhere, until I met her again and saw that she was gone, and it felt like someone had torn her out of my chest. When she summoned the strength to stand up and escort me down the road a few meters*, it was all I could do to hold back the tears until she turned around and shuffled back to her home. I've lost her.

I went back a second time, to face my fears. Her sister was there, helping to care for her, they were having dinner. They handed me a generous plate of nshima and chiwawa (pumpkin leaves), my favorite. I nearly choked with awkwardness. I should be the one cooking dinner for you, Ambuya! This makes no sense! I said nothing out loud--in Zambia, it's an honor to feed a guest, and it would have been incredibly rude to refuse the food. There were two framed photos in that room. One of them was a picture of us together from last year--an awkward white girl grinning next to a proud, laughing Zambian woman. She pulled it off the shelf to explain to her sister who I was.

The last time I went back, she seemed more herself. Still complaining of pain in her legs (a side effect of the medication) and other problems, but every now and then a glimmer of a smile would flicker on her face. She asked her sister to pull a duffle bag of papers out of her back room, then she determinedly dug through it, until she triumphantly pulled out a small notebook. A project she had volunteered to help me with last year, to keep daily records when the team had left. Each page was meticulously filled out. My jaw hit the ground and I thanked her profusely. When I left for the last time, she again summoned the strength to rise and escort me down the muddy dirt road a few paces. She stopped. "I'm tired," she said. "Go well. See you later," and she grinned.

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*In Zambia, when friends leave, the host often walks with them down the road a ways to see them off.
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I was cutting through hectic downtown Lusaka when someone behind me grabbed my wrist. I whirled around, half expecting to find someone I knew, but instead found a complete stranger, a tall African man. I ripped my wrist from his hand and gave my best "fuck off" scowl, be he grabbed my wrist again more tightly and started talking angrily in a tribal language I don't know. (There are 72 languages in Zambia, not to mention all the Zimbabweans who are now flooding Lusaka. This year, the streets are teeming with vendors who sit on the streets, everyone says they're all from Zimbabwe.) I scowled harder, ripped my wrist out again, and scrammed, my heart beating in my throat.

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Another woman in Linda Compound who amazes me is a single mother, raising her children in a two room concrete shack. She earns $1.60/day working in the morning. In the afternoon, she farms her own maize, sweet potatoes, and beans in her front yard. Moreover, she's by far one of the most active people in her community. It seems like she spends half of her day volunteering, advising young mothers, counseling at-risk teenage female HIV orphans. And yet she still finds the time to wash all her family's laundry by hand and keep her house spotless. Not to mention that she's a phenomenally cheerful, friendly, optimistic, wonderful wonderful person.

And she's HIV positive. I had no idea until yesterday when we had an awesome conversation. She used to drink a lot and go out to bars with her friends, but then her husband died and everything changed. She wanted a new life, she wanted to be a good role model for her kids. She stopped drinking and got to work. She began to notice that she was getting very tired easily, so she went in for testing and the results were HIV positive. She started taking the free ARV medication offered by the Zambian government, and her health improved. Last year, she had another child. She quit her job, just so she could take care of her new child and make sure it stayed HIV free. For 6 months, she breastfed, then carefully weaned her child to orange juice and maheu before the baby started teething, which leaves open cracks in the gums where HIV from the breastmilk can infect the baby. Today, the child is HIV free and healthy, and the mother has started her job again added counseling other HIV positive mothers to her long list of accomplishments.

I also spent some time shadowing some of the caretakers at Light of Hope that visit patients in their homes. By and large, the free ARVs seem to be working wonders in Linda Compound. Every person we visited was HIV positive, but they all looked healthy and most said they were feeling fine. However, I'm a bit worried, because even through treatment seems to be working wonderfully here, prevention is lagging far behind. For example, Light of Hope peer educators only spread news of A and B (Abstinence and Be faithful) but leave out C (Condoms). As Elizabeth Pisani notes in The Wisdom of Whores: bureaucrats, brothels, and the business of AIDS:
  • People are more likely to transmit AIDS when their viral load is high.
  • It goes down while they're on medication, but they're still going to have spikes every now and then.
  • A person on medication is going to be healthy enough to continuing having sex.
  • A sexually active person with occasional spikes is going to spread more AIDS than a dead person.
  • ARVs must also be provided for a person for the rest of their life, which adds up fast as patients accumulate.
  • Thus, while effective prevention programs decrease needed treatment, just increasing treatment alone leads to a greater need for treatment and prevention in the future.

Also, "Treatment makes HIV much, much less scary, beacuse it makes it less fatal. Thee are fewer cadaverous people around, fewer funerals to go to. With treatment, people who were at death's door leap up and march back to the office and the nightclub...As people get less scared of AIDS, they get sloppier about prevention."

Wisdom of Whores was an excellent book to read on this trip. If you ever wanted to know anything about AIDS, read this book, it's fantastically lucid, irreverent, insightful, and doesn't beat around the bush. For example:
  • A schoolgirl in Suth Africa is ten times more likely to be infected with HIV than a prostitute in Beijing.
  • The most common risk for HIV among youth men in Southern Africa is getting married.
  • The US Congress earmarked $1.1 billion for overseas HIV prevention programs that have been proven not to work, even in the US.

Over and out.

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