Wednesday, September 28, 2011

Home-based Care Visit. Polana Canico, Maputo City, Mozambique

RE the photo above... My friend lost my pen while we were out on the visit I describe below. (Strange how I was initially annoyed at losing a pen, particularly when you read below about the subsequent experience I had!) About 45 minutes later while we walked to another house in the neighborhood, I glanced over at some bushes only to see a little boy chewing on ... you guessed it... my pen. He seemed to be enjoying it far more than I ever had. His picture is above. As I tried to show him the picture I took on my digital camera he ran away crying. I felt so bad!
As for the rest of the story.
My first day back to work after returning from a visit to the USA to see my children and parents in Arizona was SO profound I decided to write about it. And I got some pictures together for you to see. I got to the VSO office and my Program Manager, Quim, said "Are you ready?" Not knowing quite what I was ready for, I said "Sure!" We were heading out to a home-based care visit with a two person delegation of visitors from Ireland. One of the visitors was Averil Power who is a Parliamentarian, a Senator from Ireland. The other, Gerry Thompson, is from VSO Ireland and works in fund development. Lovely people. They were extremely engaged, willing to experience to some very extreme situations. Averil is the one in the suit and heels. Gerry is in the VSO shirt.
The photo series begins with a visit to Polana Canico, Maputo City to the headquarters of an association that is made up of women who volunteer to go to the homes of other women and families who are infected with and affected by HIV/AIDS and are in need of home-based care. All of the women volunteers, themselves, are infected with HIV/AIDS, and many of them were formally people who received home-based care from the association. There are a number of these associations around the country. They have very little funding. The women are working for the most part in their own communities so, beyond helping family members, they are often helping their neighbors. You will see pictures of us approaching the house and you will see the sort of trash and garbage and poor living conditions that you have seen in some of the other photos I have sent.
The association doesn't have funding to give caretakers equipment to use. The women care-givers will go out and buy things and make their own kits. One of the care-givers who is very involved in this particular visit is Janet. Her kit, for example, had a rubber apron, rubber gloves, a mask, some soap, some cloths, and some other things I didn’t see. When we got to the house of the women for whom they were going to care, she told us that the soap is a gentle soap that she brings with her, and that won't irritate Natalia's fragile skin; as there is no soap at the house Janet always brings hers. Celia, another woman in the photos, also had a kit she had made. Adelia, the third volunteer, did not have a kit and did not wear gloves and a mask, a practice which is risky. In fact, there is a lot of conversation about the heavy risk that home-based care-givers take and the incidence of infection - acquiring HIV/AIDS - and of exacerbating other illnesses in someone who is "dormant" or stable; how being around illnesses that AIDS ravaged systems can no longer fight off are contagious, and can this trigger a dangerous decline in health for the care-givers as they are all HIV/AIDS infected, even though they are in remission or are "healthy" and responding to treatment. This risk is a testimony to the women who do care-giving work not only for their loved ones, but for their neighbors. It is incredible that they take the risks they do to help out others suffering; the notion of "paying forward" taken to an amazing personal and risky extreme.
The people they help tend to be very very ill. The pictures you will see of the woman who is ill, Natalia, are alarming. She is in advanced stages of AIDS. She had not received antiviral in the past so that is now something she is receiving through the association. Natalia lives in a one room hut that she shares with two grown daughters, ages 20 and 22. The daughters were not there when we visited and had not been there for two days. Natalia is too ill to get out of bed. In fact she cannot sit without assistance so she had not even been moved since her daughters left two days before. Janet is a care-taker who lives nearby. There are also two other caretakers you will see but Janet is the one who does most of the care for Natalia. When we arrived there was a pot - a small pot - of soup with a cover on it. It had been left there two days earlier and had not been touched - Natalia had not eaten for two days. The soup was not fit to eat anymore and the women had not brought any food with them, not knowing the daughters were away visiting. They would have to return with some food for Natalia.
The care-givers have been trained to make food that is nutritious and helps digest the ARV drugs which are very hard on the body if not taken with the proper food in large enough quantities. The association does not always have enough food to distribute so neighbors will try to supplement. Janet had made the soup and added herbs from her own garden. Janet told us that she had been as ill as Natalia a couple of years ago and had recovered. While she was helping Natalia she started to cough on and off; I don't think she is actually doing too well herself.
While at Natalia's house, the women peeled layers of blankets and sheets off of her and took some out to wash and air. They threw out the bad soup. They washed the floors. More importantly they gave Natalia medication, checked her body for sores and signs of infections on her skin. Janet bathed Natalia, and asked me to come and take photos while she did this. I took a series of shots while she bathed Natalia’s upper body, though to me it felt invasive, but Natalia and Janet wanted me to get photos so other people could see what the reality of AIDS looks like and the care that the volunteers give. I wasn't comfortable photographing the bathing of Natalia’s lower body and I stepped out for that time.
The other people I was with were nervous, just as I was, that I was taking photos. One of the volunteers explained to us, saying that it was important to document the work they do and to see the need that is there for support, as well as funding for things as simple as soap and cloths and basins to use to wash people.
When we arrived at the house, it was buzzing with flies. You will see that Janet carefully washes Natalia's eyes as there were flies on her face when we got there. The air was claustrophobic and close feeling, stagnant, and sickly. I was ashamed that I worried about what I might catch by breathing the air, while these women were handling the bed sheets, washing Natalia, and so on. I was just standing there taking pictures. Once the doorway opened up (there was a cloth in the doorway earlier) and the floors were cleaned, and the bedding changed as much as possible while Natalia was still laying in them, there were no longer flies in the house. It felt cooler and cleaner and the air was refreshing instead of stifling.
When the women were done washing Natalia, they carefully tucked her in with clean sheets and blankets. It was very warm out but she needed many covers.
The other visitors looked stunned when we left the house. Maybe I did too - I don’t know. No one was taking my picture.
We walked about 5 minutes to another house and met a woman named Maria. She shared that she had also been deathly ill over a year ago - maybe two - I didn't catch that. The association had saved her life and helped her start a small fry bread business. You will see pictures all about that. Also you will see Averil and Gerry and Quim and their interest in what Maria was doing. She wanted Averil and Gerry to have some of her bread and gave us a plateful; it was too hot to eat right away - we took it with us. We bought some tangerines while we were there; Maria wouldn’t accept money for the fry bread so it was a way to be able to help out.
Something that I notice, and troubles me still is that while many of the women here will make amazing recoveries, like Janet and Maria, there are many women will not recover. Natalia may or may not survive. I think there was a sense of such relief to meet Maria because she was doing really well - but the number of women, men, and children who don’t make it is staggering. People are so quick to have an ease of mind by meeting a person doing well, someone who has recovered and is making a living albeit one with a limited income. It is too easy to think that, of course Natalia will get better - Maria did, Janet did... but the reality is that Natalia has a long and dangerous road ahead of her, and there is great uncertainly about her future actually before they can be relieved for her. Even Janet - who seemed so vibrant and was there nursing Natalia, introducing us to other women, showing us her house with well deserved pride - had started to cough, a deep chest sort of cough, while I was the only one in house with her while she bathed Natalia; a cough she seemed to try to hide when she was out in the open washing the sheets and bathing basin. I felt immediate concern for her; and I felt a sort of foreboding that she had extended herself beyond the limits of what her own AIDS stricken body - which has obviously been in recovery and remission - could tolerate. I watched her washing her hands and thought, "This is not a just care-giver. This is a woman who truly gives all that she is, all that she has, love beyond relationship."
The visit ended on a really good note. Janet led us on from Maria's to a very trim and clean house with a simple but lovely garden running along the pathway. The house was hers. She had built it after her recovery with the help of her family. A two room house made of thatch and wood. Upon entering there was a sense of peace and wholeness. You will see photos of it. What a wonderful culminating experience. She is a special lady.
The farewell hugs were lingering. You can't go through an experience like this with people so remarkable, such as Janet, without creating a special bond. It was hard to say goodbye - perhaps because the lives of these remarkable women are so obviously fragile. Ironically, they are the strongest women I have ever had the privilege to meet.
That’s the tour. Here is the link to the photos. Photos for Home-Based Care Visit,Polana Canico, Maputo, Mozambique
Feel free to share...
August 2011

Monday, November 8, 2010

Does it Matter Who's on First? (Clarifying previous posting order)

About posts, comments, link and photos.

Posts. If you follow my blog, you will know that I posted quite a bit of information recently. For some reason, the postings don't appear in the nice "1st, 2nd, 3rd..." order that I thought they would and rather than continue to mess with publishing again (the blogger help suggestion that I imagine annoys those of you who get emails when I publish) etc., I am sending this out to encourage you to view the latest positings in order. I particularly think the first three are better read in order. You can select from the menu on the left side of the page.
Comments. I love to get them. If you are among those who send comments - thanks! It is great to hear from you and I apologize if I don't get back to you immediately. Sometimes I don't know that you have sent something for a while.
Link and Photos. You are welcome to share my link ( with anyone else. I have been asked that question. And that goes for the photos as well. If you use a photo for something else I just ask that you credit it back to me. My initials are fine. I post as 'elk' on photos but you are welcome to use my name, Biss Kuttner.

Tough Times (4th of 5 Five for Oct. posted in Nov)

Tough Times. For Zane. Who is persistent in telling me that he wants to know how I FEEL.

I have a good friend who did a great deal of research about going overseas to do development work as he is also working overseas. He would relay to me that after about two months many volunteers would get very homesick or depressed in their placement.
I haven’t found myself to be homesick. I miss my children very much. That is the hardest part of being in Mozambique. I miss the immediacy of contacting other family members and seeing my parents. I miss friends who, the longer I am away, the more I realize how large a part of my day to day life they were. But, honestly, I haven’t had trouble with being in Mozambique.
Some of being here is fantastic! I am not sure if my stay here will always be this full of new and interesting things but it is incredible. Most of the time I just tell people about the exciting things. The beautiful things. The amazing things. There are many. Many wonderful people. Many wonderful customs. Many beautiful places. As for the flip side – I guess I have felt it is too hard to relay the other stuff. Some things are just so overwhelming that I can't process it all, much less find a way to share it.
If you have read any of the blogs in this October set you know that I have spent three intensive weeks seeing terrible living conditions, and coming face to face with abject poverty, as well as people who struggle to survive day to day. The first ten days or so, I didn’t acknowledge my personal connection to what I saw. I was observing, being the messenger, trying to engage without being engaged. The third week into interviews and touring neighborhoods, I lost my shield. I could still professionally report and maintain objectivity but at the end of the day, my connection as a fellow human being allowed the bleakness of it all to flood in.
I haven’t shared about “how I feel” in my blog, although I get requests about that all the time. It has seemed too personal for such a public forum. But I am making an exception this time because if you are one of the people asking to understand what it is like here doing what I am doing, then it is as important to share the hard things as the rest of it all. And I think it is important, as other fellow human beings to allow yourselves to try to connect with the reality of “here,” to experience this world so foreign to my own and probably yours, because we are all part of the global “us.”
The places I’ve been and the people I’ve spoken to come from all walks of life. I’ve met the Prime Minister of the country. I interviewed the Minister of Youth and Sports. I have interviewed many people involved in development work from top management to front line work. But the most intense interviews, and the ones I actually feel the most privileged to be able to do, have been with those people for whom the study I’m working on is being done. Those identified as being among the most vulnerable in urban Mozambique.
I say “privilege” because it has been through great courage and unselfishness that people spoke to us and allowed us into their private lives. Consider your own life. How difficult it would be to allow a stranger to sit in your home and ask you to honestly share the difficulties you face, especially if sharing that information might harm your chances of job somewhere, or your status among the people in your neighborhood, or merely your own sense of pride. On top of that, I am a stranger – and they are trusting that I am coming to speak to them as a peer, a person interested in what they have to say, and that what they have to say is most critical to the work we are doing.
In my darkest moments, what I find myself thinking about is how vast the problems are. How monumental the task is to eradicate the sort of poverty that puts people on the brink of life and death on a daily basis. I think, “what is a ‘bad day’” for someone who lives in the conditions I see around me. And from there it is an easy slide into questions in my head about "what am I doing here" and "does it matter anyway." I fell small and ineffective, as though there is nothing I can possibly do that makes change happen. I described it to someone as feeling as though I am pushing peddles on a paddle boat, trying to push harder and harder, only to find that the paddles aren't reaching the water. Nothingness. No matter how hard I try, there will be nothing.
Some of the things I have been doing are so hard to handle that I expend a great deal of energy trying not to think about them. But they have to be thought about. It has been rough. People have let us into very personal aspects of their lives and their lives are awful in so many ways. It isn't that I am typically caught up in any one person’s personal life - or feel responsible to helping this person or that person. You can’t do this kind of work and do that. It is that the people we speak with are representative of thousands of people living here in horrible, horrible conditions. And, honestly, I do get to know some of the people we interview. I meet them on the street, or at their vending corner and I say hello, and get a big greeting and we chat. Just as though I were meeting a friend at home in the USA in the grocery store. But I know it isn’t the same at all because I know what they go home to my flat, they go home to a completely different landscape with incredible challenges.
People in these tough neighborhoods love their children and do their best to take care of them every day just like I have with my family. They look for ways to shelter, to feed and keep their children alive. I haven't had to think like that. I have had to think about feeding, sheltering, and educating my kids. When that last bit is the prevailing factor every day – not education, but how to stay alive or ahead of any singular negative impact that will spiral your family towards life and death - well, life looks completely different.
Other times when I’m lying in bed at night and all is quiet, I think about how much doesn't have to be the way it is - but it does just because it is that way. And it will be a long time for things to get better. I force optimistic slogans trying to override the futility I feel. I try to think that every day is a possible moment for people here to make changes. There is just so much work to do.
I have seen so much. And I have been told so much that is beyond my imagination. There are pictures I have flashing into my consciousness that I don’t want to think about. But they come unbidden.
For example, In the city I went to up north, I spoke with three different groups of young people who were taking about problems and challenges in their neighborhoods. One was a group of university students the same ages as my kids. They are part of an organization that does some very good things in the community including going and helping at an orphanage that has very little resources. They didn’t mention crime as being one of the problems, which I found interesting so I asked about it. They said petty crime is still a factor but very violent crime was down. When I asked what had made a difference, I expected some sort of community watch system, better policing, something along those lines. They said some word I didn’t know and moved on to another conversation. When I had them stop and explain the word they had said this is what they said. There was a time when violent crime was rampant in their neighborhoods. And criminals wouldn’t stay in jail when they were arrested; with bribe money and pressure from gangs of bodily harm, police would let them go. Finally the community got tired of criminals being let out of jail, particularly ones who then came back to hunt down people who turned them in. They grew frustrated knowing that their neighborhood wasn't important enough to protect from these guys. So they created their own justice. They catch these guys, put a tire filled with gasoline over them and light them on fire. As the guy burns to death in the street, kids will even run at them and hit them with long sticks. I’m told it happens about once a month in different areas of the city. It is called "linchamento." And, they said. This is the reason hard-core crime - murder, rape, etc – has drastically declined in their neighborhoods.
That is something I never want to see - a person being burned alive. I told Quim, the person I was with up there in Beira, not to turn on any streets where there was smoke. I can't even get my head around what I think about the moral implications and really - I don't believe in this context I am going to judge the community based on something like that. I imagine that were this situation talked about around a table in the USA there would be people screaming “human rights” and how wrong it is, while others would be saying vigilante justice has to take over when other more civilized ways break down to be nonexistent. What kicks in for me is on a more incidental level - I can't get the thought out of my head that kids are brought up seeing guys burning to death in tires and so on and so on.
I put something like this in context with the population who are made up of people who came out of a bloody and nonsensical civil war, a guerilla war, not even two decades ago where, by the end of the war, there was no ideology or political fight going on. By then, people were fighting to stay alive - fighting for food and fighting because if they didn't fight, they would be killed. In Beira, the city that this story is all about, the majority of "rebel" or guerrilla fighters and their families came to live. The war started after the Portuguese left in 1972. So the largest demographic (15 - 36) as well as any one older are the people who survived that experience and their families. They are the population of the country for whom life and death is being seen through a completely different lens. It still doesn't make sense exactly - but it doesn't seem so unthinkable if I were to imagine how people who lived through such circumstances might think about justice. And how I might feel if I felt that there was no option for protection for my family from my government.
I know that to be here I need to be constantly learning and I want to try and understand. I have to be vigilant. I have to be observant. And I have to keep asking ask questions. But even there - when I heard about the “linchamentos” – this sort of thing draws me up short. There are just going to be questions I don't even know to ask.
So, that is the sort of thing that I sometimes think about at night. Like I said in the beginning, I can feel so insignificant. I feel like crying – and I do. I feel confused. I feel angry. I feel frustrated. I feel frightened. I feel tired. Very tired.
Feelings aren’t something I can control. Being who I am, though, these feelings have to be harnessed and used to help me make sense of what I am doing here and what I have in front of me. In this country, there is an incredible resilience. People living these complicated, vulnerable lives talked to us because there is a belief that somehow, some day, things will be better. They see fellow countrymen and women who are successful and live well. It is possible. As long as there is hope, there is room for change. Who am I to doubt? I alone am not going to change the way things are here. But maybe as part of a larger picture there is a reason for me to be here. Most of the time, I feel enough hope to imagine what can be. That is why I am still here. Because I also feel challenged, responsible, imaginative, driven, creative, excited, and I feel hope.

In and Around Beira
The Grande Hotel, Beira