ABC…if it were only that simple. October 30, 2007

In preparing for my work with AEGY, the past months have been full of reading books, journals, and articles about HIV/AIDS education and prevention. Below is what I’ve learning- so if not interested in healthcare and HIV/AIDS, the following may be a bit drab- consider yourself warned!

If you’re at all familiar with the topic of HIV/AIDS prevention, then the letters ABC should ring as bell as they are the current foundation of many current prevention methods. As I’ve read, I’ve soaked up a bunch of knowledge; here in Kamuli, living and working with people who are HIV+, I’ve seen reality. I will try my best to explain the ABC approach and offer my critiques of it as I go- and of course, I must emphasis that this is strictly my perspective- I am not an expert nor years of experience under my belt- so take all that I say with a grain of salt.

The ABC approach to HIV/AIDS prevention is based upon three core public health teachings- A stands for abstinence (delay of sexual debut- geared towards youth), the B for be faithful (fidelity in relationships- focus on adults), and C is for condoms (correct and consistent use- with message directed at high risk/vulnerable populations). All elements of ABC are necessary, the emphasis of which method of prevention is based upon the targeted population. It is important to mention that this approach encompasses much more than just ABC- if it were this simple to prevent the spread of HIV, there wouldn’t be nearly so many heart wrenching stories of those affected. ABC also includes the following areas: voluntary counseling and testing (VCT), treatment of STDs, opportunistic infections, and HIV (with antiretroviral drugs), destigmatization of people living with AIDS (PLWA), reduction of poverty, increased political openness, effects of gender inequalities (increase in women’s status and education, violence, discrimination in sexual behavior).

The American funded, PEPFAR (President’s Emergency Plan for AIDS Relief) initiative has adopted the ABC method as its prevention focus and has received much criticism worldwide. Those from the religious right are upset that condoms are being encouraged and those on the left claim that there is too much emphasis on abstinence. Each side has their views and their own statistics to back it up and yet, from the general perspective here in Kamuli, ABC seems to be quite sufficient in educating the public, especially youth, on how to protect themselves from infection.

Placing too much emphasis on only one letter is to neglect the needs of the others- for example, if only the C is focused upon, HIV would continue to spread rapidly in Uganda as many of the cases of transmission are a result of infidelity with multiple partners in rural places where accessing condoms is virtually impossible. Besides, culturally speaking, advocating the use of condoms is absurd. For condoms to be effective (mind you, only 80-90% effective) in preventing the transmission of HIV, they must be used consistently and correctly which again, is unlikely due to the environment that is rural Uganda. Also with too much emphasis on C, a community is vulnerable to risk compensation- condom promotion can lead to greater sexual risk taking which is a result of a perception of reduced risk making the risk taking seem more attractive (sort of like wearing a seat belt makes you feel safer when driving a car and therefore you’re more likely to speed). Of course, though, encouraging the use of condoms to those individuals who are at risk is extremely important and mustn’t be ignored. It’s a matter of risk reduction opposed to risk elimination (A and B).

Often in literature, Uganda is praised for its early efforts in combating the AIDS epidemic with this approach. The government was quick to admit that there was a problem and openly addressed sexual behavior (interestingly enough, many Ugandans I’ve encountered believe that their leaders responded so promptly to HIV/AIDS was because that a majority of the military was becoming infected- if the government didn’t act, there would be no army left- just one thought…). Much of Uganda’s success is attributed to letter B- being faithful. Ugandans were bombarded with messages of “zero-grazing” and “love faithfully”- with much focus being upon men. It is quite common to attend an AEGY support group and find it mostly comprised of women. Women are not ashamed to admit their status, as many were infected by their husbands. These women abstained from sex until marriage, were faithful to their spouse and but still were infected- unfortunately by the infidelity of their partners.

As a bit of an aside, I’ve been learning about laws here and thought it appropriate to share a few pertaining to this topic. Interestingly, here in Uganda, homosexuality and underage sex are both illegal. According to Ugandan law, sexual responsibility for males is at age 14 and for women, age 18 (note the difference between genders!). This means if a teenage girl becomes pregnant and is under the age of 18, her partner, if over the age of 14, is arrested, fined, and imprisoned. Abortion is illegal as well, leading to many to seek the procedure in unsafe rural clinics performed by untrained lay people. Clearly, these laws effect the youth of Uganda and need to be considered in prevention efforts.

Factors like poverty, illiteracy, instability, displacement, gender disparities all are present and very real here in Kamuli making any prevention strategy difficult to implement. Nothing is ever as simple as ABC…

Home. October 17, 2007

Home. 

Being far away from home and going through an emotional time as this, I’ve been missing it a lot.  It’s caused me to think home in a new way, too, and what follows are my thoughts. 

I got a letter from one of my lovely, dear friends shortly after my arrival here in Kamuli.  I could attempt to paraphrase her words, but I fear they’d lose their value would be lost in translation- so I’ll just quote her directly as her thoughts capture something so deep, so profound, they’ve become questions I ask myself and reminders I say each day.

“It has been a few weeks and you are still in Africa.  A new place that I hope smells and feels more and more like home each day.  I hope that you feel yourself growing and stretching in ways you never before thought possible.  All this in the same of Jesus and because you know that life is best lived when lived in love and for the sake of others.

If we really believe that our home is with Jesus, then should we ever feel totally content where we are? This is the question I have been asking myself recently.  When we wake up, what goals and desires do we have for the day? Are we aware that God is everywhere and thus we have nothing to worry about? Even when no one understands us, the culture we are in does not match up to what we are used to… we still have a home in Jesus.”

As two months have passed, Kamuli is becoming more and more like home.  This truly is an answer to prayer but it also has implications to my connection with those of you at my “other home” as I call the States here.   As this is becoming more and more my community, I’m coming to face the reality for this to occur, the community I left behind must inevitably become less and less. This of course, certainly does not mean that my love for any of you there is any less or that I’ve completely disregarded all thoughts about the people and places left behind.  Of course, I think of you often.  Of course, I love you.  Don’t be ridiculous!  What this does mean, though, that for this season of my life, I’ve made a decision.  I’ve chosen to make a commitment to the people here in Kamuli, to intentionally be focused here, now.  This is my home. 

Now please don’t jump to the conclusion that this means that you should no longer email, snail mail, or call me. Quite the contrary, I still do want to hear from you, very much!  I feel the need, however, to clarify expectations of responses on my end.  I assure you, don’t lose sleep thinking I’m not reading the emails you send- I read them, I really do!  It’s the replying to them that is the problem.

That’s the tension in which I now live, the balance of past and present and future, too.  Gosh, I wish I could remember what our Baccalaureate was about right now- it had something to do with this theme… actually, it might have just been “BE”.   Maybe someone can help me here and refresh my memory… after all, it was only 4 months ago!  Anyhow, I’m not there, but if I’m not all here either.  I’m torn in the middle.  Learning to nurture relationships from afar is tough while putting forth effort into building new ones here. 

I will communicate when I can, if you don’t hear from me, please don’t worry! It probably just means that I’ve been busy developing relationships or riding on motorcycles or running through rainstorms. Or the electricity has been off for a week.  I’m here, no worries.

mpola mpola October 17, 2007

            Mpola mpola  (slowly by slowly) I’m learning to live one day at a time. Take for instance this moment, I am breathing- the air goes in, fills my lungs, and then goes out.  My heart, likewise, is beating, I can feel it, lub-dub it goes.   My eyes, too, are blinking- open, close.  I’m alive and well and I’m beginning to recognize and celebrate this for the amazing gift that it truly is.  When death becomes real, life inevitably takes on new meaning… This year takes on new meaning… in someway, somehow, living here in Kamuli, Uganda is about so much more…  I won’t lie, the pain of losing Krysta is still fresh but hope is found in each new day.  I can’t quite explain it, but this year has become a way for me to remember and honor Krysta’s life… it’s somehow a tribute to her and all that she was and could/should have been.  It’s a year to intentionally love others and offer them the life that she so tragically lost.  If one student listens to the message I share and chooses to change their behavior and thus avoids exposure to HIV, this year was worth it.       

            Before coming here to Uganda, I made a decision, a commitment to myself.  At the end of everyday, I vowed to ask myself one simple question.  No matter what the day was like, as the sun sets and the stars begin to fill the night sky, I pick up my journal and write a response. “What has Jesus taught me today?”  Having this deliberate awareness of Jesus’ workings has challenged me to look for Him and enabled me to see Him moving in places, in people, in ways I never expected.  As I’ve been answering this question over the course of this past week, it’s been a bipolar mix of responses.  But tonight, as I write, I am overwhelmed with one thing and one thing only.  Actually, it captures quite well my entire experience thus far in Uganda, and well, my life.   In everything, no matter what the circumstance has been, God’s grace is sufficient for me.  Even (and especially) when I think I can’t handle it anymore- that’s when His grace is extra sufficient. 

            When I was in kindergarten, I used to come home from school and watch Mr. Rogers on the television- I loved that program and his closet full of sweaters!  In his book, “The World According to Mr. Rogers”, Fred writes,

“Confronting our feelings and giving them appropriate expression always takes strength, not weakness.  It takes strength to acknowledge our anger, and sometimes more strength yet to curb the aggressive urges anger may bring and to channel them into nonviolent outlets. It takes strength to face our sadness and to grieve and to let our grief and our anger flow in tears when they need to.  It takes strength to talk about our feelings and to reach out for help and comfort when we need it.”

            God’s grace is sufficient for me even though life can, at times, be difficult beyond explanation.  We live in a world where there is so much possibility- for great beauty and terrible pain- for sickness and health- for grace and terror- for life and death.   I’m learning that tomorrow is always uncertain.  I’m learning the importance of remembering who we are, where we’ve come from, and all the people along the way that got us here.  I’m learning its important to talk to people and reach out for help and comfort when needed.  I’m learning that it’s important to hold tightly onto all that’s true. 

            Love, in all its different forms, seems to me to be the one true thing there is.  I pray that you may know it now, and always.

            At the end of the day, I have to believe that someday, somehow, it’s all going to make sense and it’s all going to be made right.

October 10, 2007

The last time I saw her, was last Christmas.  I was home from school for the holiday break.  I spent that night catching up with old friends from high school whom I had (unfortunately) lost touch with since leaving the halls of Northwestern Lehigh.  As the night wore on and the hour got late, the time for our former close-knit group of friends to part ways came to pass.  As we all left Kim and Josh’s home, being the only one there that lived in a similar direction as Krysta, I volunteered to give her a ride home, little did I know this would be the last time I saw her.   In that 15 minute drive from Kim’s to Krysta’s, we talked about college, me at Messiah and Krysta at NYU.  We talked about our hopes and dreams for the future and laughed at the foolish of our past.  Looking back, it was a rather idyllic moment. Or perhaps when memories are all you have to hold onto, anything can be remembered in that way.  As I said goodbye to Krysta that night, I promised I’d be in touch and that Kim and I really would come up to visit her in NYC that spring.  Unfortunately, senior year got the best of me and all those good intentions to visit Krysta never manifested itself into action.  For what it’s worth, I’m sorry Krysta for not following through on my word, I’m sorry Kim that we never went to visit as now we never will.

            You know that moment when you’re holding your breath under water and you’re trying to swim the entire length of the pool without coming up for air?  Your lungs begin to feel as though they are on fire and you feel as though your chest is going to burst as the pressure mounts up inside.   You surface, gasp for air, and feel the pain of oxygen entering your lungs as you take that first breathe.   That’s sort of how I feel right now.  I’m treading water, trying to stay afloat, gasping for air. 

           

I’d known Krysta since kindergarten and throughout the years our friendship ebbed and flowed but on graduation day, she was certainly amongst my circle of close friends. This past weekend, I’ve been remembering- holding onto any hint of Krysta that I am able to recall.  Like many of my other high school friends, Krysta and I drifted apart during our college years.  The times together we had since our childhood flooded my memory and consumed my mind.  I can remember back to elementary school and gifted class where Krysta, Alison and I used to laugh at a boy in our class who had crazy red hair and was nicknamed ‘Squid’.  Recalling our times in middle school at FCCLA, student council, and field hockey also brought back a rush of emotion.  High school was marked as a time of good friends, bonfires, chex mix and bop-it, all-nighters.  Those were good times…

This is my attempt to capture in words what it’s like to mourn the loss of a friend from afar.   I am not an eloquent writer, I am just a person who has lived and love and lost.  I am alone, or so it seems, in my grief and so I write.  I’m told that writing can be therapeutic.  Without anyone to grieve with me, anyone to cry and comfort me, I turn to writing to process these tears and this sorrow.  This is my way of remembering Krysta, of grieving her untimely death, and sharing with anyone who will listen how wonderful it was to have known her and how I will never be the same. 

           

Days later, as I sat in a crowded internet café in Kamuli, I received an email telling me the news of Krysta’s death.  The viewing had already occurred, the funeral, too.  Krysta’s body lay in the ground before I even knew she had taken her last breath.  Oh God, I can’t even begin to describe that moment and how it felt.  Shock. Denial. Intense Anger. Guilt. Extreme sadness.  Uncontrollable tears.  In a matter of minutes, I went through each of these emotions- all the while sitting with my eyes glued to the computer screen and the opened email.  Gosh, I can’t imagine what the person sitting at the next computer must have thought!

There are no words to express how indescribably awful it feels to be thousands and thousands of miles away from home as you face the loss of a loved on.  There are no words to convey the depth of sorrow felt in one’s heart at learning what it means to say goodbye to someone so young.  Krysta, a close friend of mine, passed away last Sunday (9/30/07).  She was only 22 years old.  She had suffered from epilepsy for a bout two years; these seizures (along with complications) took her life. 

I once prided myself in how well I handled death.  You see, I had this theory of suffering and death and how these intense emotions give birth, make it possible, to experience true joy and life.  Let me be the first to toot my own horn- I had it all figured out pretty good!  I mean, as a Christ-follower, too, I have a source to draw hope and strength from in times of walking through the ‘Valley of the shadow of death’.  In fact, as ridiculous as this sounds, I had actually started to write a blog about my theory of pain and suffering and death as I’ve been experiencing it here in Uganda doing AIDS work.  The piece was shaping out to be a brilliantly eloquent exposition, my best intellectualization of death viewed through the lens of life. 

After all, I’ve spent the last four years of my life in hospitals as I trained to be a nurse.  I had patients who died.  I worked for just as many summers at a camp for children with cancer.  We lost campers each year.  I volunteered at a hospice my last year of college and provided companionship with those in their last months of life.  My clients all died.  I spent 2 months in Zambia a few years ago and saw disease and poverty claim the lives of many.  I’m now living in Uganda, working for an AIDS organization, developing relationships with people who will certainly not live to see too many more tomorrows.   

All this to say- death is not unfamiliar to me.  It’s quite common, actually.  Yet, even with all this ‘experience’ with death, Krysta’s has really thrown me for a loop. None of these experiences prepared me to lose someone I love.  All my past encounters with death were peripheral, Krysta’s was central.  All the others I’ve lost scrapped the surface of my heart but Krysta’s death seems to have pierce right through it.  This is the first time in my life that the devastation of death has personally affected my world.  I’ve come face to face with abstract theories on pain and suffering and can be the first to say that they do not satisfy a grieving soul.  When someone you love dies, things become fairly simple: you hurt, you cry.  I’m not ready to find meaning in Krysta’s death.  I’m not ready to be told that it’s going to be okay.  I’m not ready to read all those reassuring Scriptures about God working all things together for the good of those called according to His purposes.  I’m not there yet. But I am ready to cry.  And remember.  Maybe tomorrow I’ll find meaning, but for now, I’m learning to give myself permission to grieve, to shed tears over the loss of Krysta’s life- laugh at certain memories, cry at others.  I am allowing myself to be overwhelmed with the sadness and sorrow of loss- I’m tired of always pretending to have things together.  It takes a lot of courage to look death in the eye and keep on looking.  I’m not sure that I, in myself, have that courage but I do know that Krysta’s life deserves more than just a passing moment of sorrow and one sad hour of reflection.  I’ve heard it said that when someone dies, the world will never be the same without that person in it.  It’s so true.  Krysta will be terribly missed, she touched the lives of many- including mine.  I will never be the same because I knew her and I hate that the world had to say goodbye to her so soon.  We are defined by our relationships as evidenced by the pain we feel at the loss of one. Krysta defined many lives and there are many lives in pain tonight as a result.

The hardest thing about all this is not just losing Krysta, but having to do it alone.  I feel so far removed from all the others who I know are grieving over the same wounds.  I’m living in a culture where death is so common- trying to explain that this is the first time I’ve lost a close loved one makes little sense to them.  I have been making friends here but none of my relationships are at the level where I can process such intense sorrow.  I feel like I’m suffering in silence, alone.  I don’t know if any of my high school friends read this blog, but if they do- to Kim, to Heather and Rachael, Brian and Josh, Andrew, Dan, Nate, and Jon (among others), I am so sorry…  I am so sorry for the loss we’re all facing, so sorry that I wasn’t there.  I wish I could have been there to cry alongside you all.  To hug and comfort you(and be hugged and comforted as well).  For whatever its worth, know that I’m thinking of each of you and praying for you.  Please do the same for me. 

Its in times such as this that home feels so far away.  Times of sorrow, as in times of joy, the distance seems the greatest.  My heart physically aches, I can feel it beating in my chest.   I guess what I’m getting at is that right now, I’m hurting.  My heart is heavy.  I’m not ready to move on yet, to find meaning.  I’m standing still and grieving.  Remembering.  Crying.  I’m not rushing through this, it’s a process that takes time.  Death, along with living in a culture so foreign from all that’s familiar, my spiritual awareness is somehow heightened.  Emotions are more intense as my vulnerability is a day to day reality.  In this moment, my initial instinct is to retreat into my thoughts- form a little safe haven for myself, sheltered from the seemingly cruel, uncaring outside world.  Thinking, somehow, that inside, away from others, I’ll be safer.  Perhaps, though, Anne Lamott is onto something when she writes that the opposite of my instinct to close down  “staying open and loving is safer because then we’re connected to all that life and love”. 

Today is for tears, tomorrow is for hope. 

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After writing this, I was able to take some time away from Kamuli for a few days.  This weekend away created for me space to think, remember, and mourn- it also allowed me to spend time with Gann, the MCC Uganda Rep and Michelle, the other SALTer.  This trip, I am convinced, was divinely timed as Gann and Michelle were much needed sources of comfort.  Day by day healing comes.

Just an average day… October 3, 2007

The Average Day…

 

6:45- wake up to the sound of roosters crowing, cows mooing, and my host siblings getting ready for school

7:15- drag my lazy butt out of bed

7:30- bathe in a basin

8:00- eat breakfast (either bread, boiled cassava, or porridge)

8:15- walk to work (20 minute walk through town)

8:35- arrive at work

9:00- hop on motorcycle & head into the field- either to a school for education program, to a client’s home for a visit, or a support group session   

1:00- home for lunch (often either matooke, cassava, posho, and beans)

2:00- back to work for an afternoon in the office

5:00- head home for evening

*evenings vary from church activities, to visiting neighbors and friends, to spending time with host family, etc.

8:00- tea & bread

10:00- dinner (often matooke, rice, Irish potatoes, sweet potatoes, millet, with groundnut sauce, a meat, or some other kind of soup-type dressing)

11:30- head hits the pillow, eyes shut tight, I’m out like a light.

 

*A little more on food: Atkins diet would never work in Uganda- it seems like all I eat are carbs- and lots of them! Matooke is the staple food- sort of looks like thick mashed potatoes but made from a relative of the banana- tasteless for the most part.  Cassava is another starch that is a root and grows even in droughts, also tasteless.  Posho is made from cornmeal, it’s quite good with g-nut sauce.  Sweet potatoes are different from ones at home but are equally as good, one of my favorite meals.  Millet is the consistency of slime- has no taste but makes for a fun meal as it is stretchy.  Irish potatoes are normal potatoes.  As a guest in their culture- I’ve been told I’ll most likely be viewed and treated as such for the duration of my time here- I eat a whole lot.  Everywhere I go, meals are prepared and my plate is piled high with food.  “I’m full” doesn’t seem to be a part of the Lusoga vocabulary, so I just keep eating and eating- as not to offend (food is one of those touchy things that if not handled properly could cause great strife in relationships).  Thankfully, I really like the food- Mom, have no fear, I’m eating well here!  I walk a lot and sweat quite a bit, so hopefully my clothing will still fit me 10 months from now!