“That’s one small step for a woman…”

On Monday this week, I had one of the most satisfying feelings of my entire time in Itipini and it was derived entirely from one simple event. This woman walked unaided into the clinic.
Her name is Pakama and she has both HIV and TB. For the last several weeks, I’ve been involved in her care, taking her to the clinic and the hospital for various appointments, as I have with many previous people in similar circumstances.

The difference with Pakama is that when she came across my radar screen, she was already taking anti-retroviral drugs. With other patients, our goal has been to start ARV treatment. For Pakama, the problem was that the ARV regimen she was on conflicted with her TB pills such that neither of them were very effective and she began to get weaker and weaker. When she started her TB treatment, she was capable of walking to the clinic all by herself for her daily pills but for at least the last three weeks, we’ve been bringing her the pills in her shack, where she was virtually always lying in her bed, under as many covers as possible.

To their credit, a nurse at the ARV clinic noticed the conflict in the pills Pakama was taking and told her to stop the ARVs until she could see a doctor about it. That is where the problems began. I won’t recount the whole sordid history of the ensuing two and a half weeks, but it took at least three trips to the doctor, one to the ultra-sound, and several more to the ARV clinic before Pakama was finally able to switch her ARV regimen to one that would work with her TB pills. There were numerous unnecessary hurdles to cross, all of which had to be crossed by a woman who could barely support herself and needed to be carried and wheeled everywhere. Basically, Pakama was referred to a series of doctors who didn’t know a thing about her medical history and so treated her symptoms - constipation and an upset stomach - and prescribed her over-the-counter medications instead of addressing the root cause of the illness.

(The same nurse at the ARV clinic knew exactly what regimen she had to switch to but was unable to prescribe it herself. When it finally happened, all it was was a barely legible scrawl on Pakama’s records indicating the switch. Because that scrawl came from an MD, it was legitimate. It infuriates me how many trips it took to get a doctor to say the same thing the nurse said at the beginning.)

During that time, Pakama became very weak and lost energy and I began to sense her overriding will to live that impressed me when I first met her was ebbing away. Unbidden, the negative thoughts began to crawl into my mind and I became convinced that Pakama was about to fall through the cracks of the medical system and we would show up one morning to learn she had died.

But she didn’t. We got the new ARVs and I was with her in her shack when she took them for the first time, barely sitting up in her bed. A few hours later I came back and she was sitting in another part of the shack, having her hair done by the neighbour, and back to her usual bossy self. It was amazing how quickly she had been transformed.

Most of that initial transformation was probably illusory, however, and we continued to make house visits for her. She seemed to be getting better but it was a very slow convalescence. Much of her time was still spent in bed.

Until, that is, Monday, when I turned around in the clinic and saw her walking in the door. To be sure, she was out of breath from the effort and leaning heavily on a stick but she had made it to the clinic all by herself. It was an incalculably amazing feeling of accomplishment, tempered, of course, by the knowledge that she is still quite sick. But for a short time she has been moving in the right direction and I’ve silenced those negative voices in my head for now.

I'm happy; are you?

“That cost HOW much?”

It’s been somewhat quiet lately in Itipini and nothing major or new has risen up to challenge me, just variations on the zillion everyday challenges that never go away. As a result, I’ve shifted my gaze from the day-to-day a bit and am now looking eagerly at my break in August and September. This is natural, I think, and even healthy. I’ve been here for more than than 10 months now and the experience has been intense and overwhelming. There’s nothing wrong with anticipating a break.

But in addition to the anticipation, I’ve been developing at least two fears about this break I want to share with you. First, I have all the usual fears about the shock of going from a relatively poor and underdeveloped context to a relatively rich and (over?)developed one. In the span of about 15 hours in August, I’ll go from Mthatha - sub-Saharan provincial backwater - to downtown London - global financial and cultural capital. Should be great.

The other fear is perhaps less usual for returning missionaries to have: I’m afraid that when I visit with old friends, some part of me is going to end up judging them for the decisions they make. For if there is one thing that has most assuredly changed about me as a result of my time here, it is my perspective on issues related to money, needs and wants, and how one spends one’s time. I can just picture myself thinking as a friend orders, say, a coffee, “You’re spending how much on that? Don’t you know how far that money could go in Itipini?”

“Judge not lest ye be judged” right? Ha! Easier said than done.

Teaching the children a little hygiene

The Noble Pursuit

I don’t think I’ve ever confessed a deep-seated fear I’ve held onto in my time here. You may laugh when you read this but on some level, some significant part of me has always been worried that I’ll be forgotten in this distant corner of the world by the friends and supporters who sent me here. I am busy creating my own new and supportive environment here but I don’t want to lose touch with similar environments I’ve left behind. One reason I am so diligent with this blog and my monthly e-mails is that I want to keep people apprised of what is happening here in hopes that they do the same for me. I have frequently written that the best way to support me is to write me a “gossipy” e-mail and that’s so because it makes me feel connected with all of you whom I’ve left behind.

So far, so good. I don’t think I’m in immediate danger of being forgotten and I frequently feel overwhelmed by the number of e-mails and letters I am sent. (Thanks, by the way, to the many of you who write me real mail!) But all these communications raise another difficulty and it is that difficulty I want to explore here.

Sometimes when I read my correspondence, I am struck by the number of people who tell me (or strongly imply) what “great work” I am doing and how important it is and how great I am for choosing to be here. From conversations with other missionaries, I’ve learned I am not alone in receiving these sorts of messages. It seems as if just by taking on the title missionary, our correspondents think we are engaged in some noble pursuit. Please know first that I deeply appreciate these messages and the words of encouragement do matter tremendously. So don’t stop sending them just because of what I’m going to say next.

The trouble is that when I read these e-mails - from accomplished, talented people, who are engaged in important service work in their own lives, and whom I respect a great deal - I am struck by an incredible feeling that they’ve got the wrong guy. I want to check to make sure the e-mail is actually addressed to me. After all, my life here often seems decidedly ordinary. I wake up, eat breakfast, brush my teeth, get in the car, drive to work, and try to do something meaningful but some days I wish I was somewhere else besides Itipini. After work, I do some errands, drive back to my rondavel, eat dinner, read a book or write some e-mails, brush my teeth, and go to bed. Occasionally, this routine is spiced up by dinner out or a Bible study but it strikes me as a fairly ordinary sort of life, one not much different to the life I’ve lived anywhere else. It is unsettling to have this life described in such grand terms.

What’s more, as I have written time and again, I often feel very ineffectual and helpless here, that my contribution is so minimal as to be meaningless, and that I am having no discernible impact on anything of importance. Contrast this with the effective and transforming work I see being done by some of my correspondents and I wonder if it shouldn’t be me writing the “noble pursuit” e-mails.

If there is anything remotely noble about the missionary, it is his decision to live a normal, routine existence in situations that are completely different to those with which he is familiar. The significance of this shouldn’t be underestimated and it can be jarring at first and aggravating. But after a while the new context becomes familiar and some frustrations begin to fade away. That sense of excitement and adventure that accompanied the setting out on the mission gradually fades, along with any sense of nobility once associated with the pursuit. I consider myself and my work here perfectly “normal” and just like everyone else’s, with the exception that I am performing it in a different context than you are yours. This is where the importance of the idea of the Incarnation, which I wrote about in my recent monthly e-mail, comes to the fore. That idea helps soothe some of the pain and aggravation caused by the feelings of insignificance that naturally attend this line of work.

And, really, if everyone keeps telling me how great this all is, it’s all going to go to my head. We all know I don’t need any more of that!

Big Muddy

It has been raining for the last several days - torrential at times, scattered at others creating an all-pervasive gloom over Mthatha since Tuesday morning. This is not the first time this has happened here but I don’t think I’ve ever noted just how much that affects people in Itipini.

Our roof in the clinic leaks pretty dramatically (we’re getting it fixed) so that’s one problem. The cloudy skies make it so dark in the clinic it can be difficult to see until your eyes adjust. Several times this week I’ve thought, “Let’s just flip on the lights” until I remember we don’t have electricity. It’s also colder inside than it is outside, which means I just want to keep hunched over in a corner.

For people who live in Itipini, I imagine rain must just be about one of the least anticipated events (aside from sunset and winter). Everything in those shacks leaks - the roof, the walls, and I’m sure even water figures out how to get through the dirt floors. When I’ve been inside some shacks this week, there are pots and pans and anything else that can be used to catch rain all over the place. But there are always more holes than pots to catch it.

But the major issue created by the rain is the mud. It is everywhere and gets everywhere. The mile-long road into Itipini becomes one big mud puddle and several inches of water rush over the bridge you have to cross from town. The paths between shacks become several-inch -deep mud slip-n-slides. I’ve seen several people this week slide and fall in the mud. When I pick up a child, I find myself with a big muddy footprint on my shirt. We have to really thoroughly clean the clinic at the end of the day to get it all out. On the other hand, I’ve learned that fishtailing the car in a few inches of mud is as much fun as in a few inches of snow.

In this regard, I have at least two advantages over most people in Itipini. First off, I bought myself a pair of rubber boots (called gumboots here or “amagumbootsi!” by the eager pre-schooler who saw Jenny and I modeling ours this week) when I first showed up for precisely situations such as this. That compares to many people here who either walk around barefoot (dirty and cold!) or in sandals or something equally insufficient. Second, I have a car and can drive through that mile-long mud puddle and over the bridge and not get wet or dirty.

On Friday, I turned the weather into a bit of an evangelism opportunity and began leading mildly ironic prayers in Xhosa thanking God for the rain but asking politely for a little sun now. All that time in Xhosa services on Sunday has really improved my religious vocabulary. My prayers earned disinterested chuckles but each time I led one the clouds seemed to thin a bit and the sky to brighten before darkening again. Clearly we should have been following Paul’s admonition to “pray without ceasing.” Then maybe I could dry my laundry.

It’s worth noting that winter is traditionally the dry season around here but in the last several years there have been more and more storms like what we’ve had this week. My co-worker Dorothy has said several times this week, “Rain...in the winter!” in a shocked and confused voice.

“Lost”

Since getting my new computer a few weeks ago, I’ve been sorting through and organizing several years worth of pictures, including the nearly 6000 I’ve taken in Itipini. It’s been a fascinating experience to look back on pictures I took when I first arrived and realize that I now know the people in them. They are no longer the random faces they once were, illustrating what at the time was a brand-new experience, but characters (protagonist and antagonist) in my daily experience of Itipini.

In the process, the woman in these two pictures jumped out at me. In the first, I remember trying to take a picture of the child behind her when she raised her head just as I pressed the shutter and in that split second realized what was happening and managed to make a funny face. In the second, she is again making a funny face on the right, while the woman on the left looks on somewhat judgmentally. They were both taken at our pre-school graduation in December.

This woman’s name was Nolufefe (“mother of grace”), she was my age, and she died over the weekend. While she had HIV and her CD4 count was below 200, what likely killed her was a growth in her abdomen that was detected about two months ago as she began the process of getting on anti-retroviral drugs. In those two months, she lost an incredible amount of weight and became a shadow of who she is in these pictures. A few weeks back she was admitted to the hospital and was apparently in line for surgery but died before that could happen.

I mention this story because I was moved by how we heard the news. Unusually for Itipini, her father is a hard-working, sober, and exceedingly polite gentleman and her mother is the alcoholic, unpleasant drain on the family purse. I see her father frequently in town pushing his cart around but when his daughter got sick, he took her to all her appointments at the hospital.

The trouble is that once she got admitted, it was more difficult for him to visit her. A round trip to the hospital on the taxis is about $1.50, which is pretty steep if you’re not making much more than that during the workday. They might have cell phones but airtime is expensive and I doubt they spoke much beyond the usual rushed conversations everyone has around here. He had other family members to support (including Nolufefe’s five-year old son) and so went back to work in town. A few times a week, we gave him the taxi fare and he would go check on his daughter and reported back the news about where she was and her impending surgery. But those were only brief visits and I can only imagine how isolated Nolufefe felt in the ward. My car gives me the freedom to forget just how big Mthatha is and how difficult it can be for people to get much beyond the routes they tread daily.

On Tuesday, we gave Nolufefe’s father money for another trip and he came back to the clinic a few hours later. The usual expression on his face was gone and he looked thunderstruck. I asked him how his daughter was doing and all he could muster was one word, in English - “lost.” She had died on Sunday. I could only imagine what it was like for him to show up at the hospital expecting to see his daughter and instead find that she had died two days before and no one had been able to tell him.

Nolufefe’s son is one of my favourites in the pre-school. In this picture, he’s in the middle of the first row in blue pants.

“I’m a man of means, by no means…”

I’ve mentioned before how some men in Itipini earn their living by pushing their modified grocery carts into town in hopes of earning tips helping people cart loads around. Every morning on the drive into the clinic, I pass a veritable flotilla of such carts and men headed the opposite direction to work. Sometimes when I am driving in town, I’ll see them hard at work, their carts weighed down by huge loads, navigating the busy and chaotic streets that are downtown Mthatha.

I see the man in this picture virtually every day. I don’t know his name and he’s never been a patient in the clinic in my time but he’s a fixture in my daily routine at Itipini.

Before I came to Itipini, I had, of course, heard about the world’s poor who lived on less than a dollar or two a day. What I’ve realized while here is that the dollar doesn’t just appear out of nowhere. It can require a full day’s worth of difficult, physical labour. And all that earns the person is the right to bare subsistence.

Long Weekends

The number of “firsts” I’ve racked up while here is truly impressive and my list of new experiences keeps growing. Recently, I added something else to that list: for the first time in my life, I found myself NOT looking forward to a long weekend.

Monday was Youth Day, a public holiday commemorating the 1976 Soweto Uprising. In the weeks leading up to it, I found myself deeply wishing that I could just go to work in Itipini and not have a holiday. It’s not that I am particularly devoted to the people in Itipini and feel I can’t take a day off; nor is it that I want to squeeze in as many moments there as possible before my break in August; nor did I have any pressing projects or commitments that couldn’t be set back a day. Rather, the root of my desire was much simpler: I was feeling lonely and craved the social interaction of a day at work, rather than what was shaping up to be a quiet weekend. I can handle two days of a quiet weekend but three is pushing it.

In the past few weeks, I cast around for a plan to fill my time but nothing was generating much interest. There aren’t any other volunteers in town and a trip to the Wild Coast alone was unappealing. The price of gas is so high right now that driving to other towns to visit friends and fellow missionaries is not feasible. The bus schedule is such that it takes a lot of effort to get to those places for what would only have been a short visit. So I prepared myself for a long and quiet weekend.

Fortunately, fate intervened at almost the last minute and I was able to work out a very stress-free and cheap trip to Grahamstown to visit two friends. We did almost nothing of note, and almost nothing I wouldn’t have done had I stayed in Mthatha. But the fact that I was doing it with someone else made all the difference and made my holiday a rejuvenating experience rather than an isolating one.

I’ve written about loneliness before and called it the ever-present reality. That’s true but the degree and severity with which it is present, I’ve learned, varies substantially over time. Some (many) days I feel like Mthatha is a great place to be and wonder why I would ever want to be any place else. Other days I find myself counting down in earnest the days until I can go home for a while.

P.S. There’s another kind of people who don’t look forward to public holidays: the people in Itipini who earn their living by trying to find work in town every day. Some men in Itipini push modified grocery carts into town every day, hoping to make money helping people carry groceries and other loads around town. But when the shops are closed for a holiday, they’re out of luck and without savings to fall back on. Even had my quiet long weekend materialized, it still would have been better than how they spent their day off.

“So much depends on a…”

A few weeks back, we lost water for about five days at the hospital where I live. Not only did that put a crimp in the operating room schedule, it also made me appreciate just how dependent I am on running water, as I hauled buckets back and forth from my rondavel. Of course, people in Itipini haul gallons of water every day, as do hundreds of millions of other people (women) around the world and that puts my five days in perspective.

The water in Itipini comes from one of two taps. It is city water and is clean and good - I drink it - but sometimes the water pressure fails and the line of buckets at the tap lengthens while the women stand around and wait, sometimes for quite a long time.

I took this picture a few weeks back. It reminds me of the william carlos williams’ poem that begins, “So much depends on a red wheelbarrow.” I tried to write something similar for Itipini but my muse deserted me after “So much depends on a golden water tap.”

Recent Favourites

Inch by inch, row by row

Someone asked a while back in the comments what sort of gardening goes on in Itipini. Here, at last, is an answer.

Many people, though by no means all, garden around their homes.

A major component of the after-school program is their garden, which they plant and tend year-round. I’ve lost count but I think they are on their third crop this year. As you can see, their corn gets quite tall. They either keep the vegetables for themselves or sell them in town.

Siyigqibile!*

*Pronounced see-yee-click-bee-lay, it means “we have completed it,” as in “Charlie and the Chocolate Factory.”
And not a moment too soon!

Don’t forget, you can still submit your suggestions for the book we’ll read next.

Excuses, excuses

Sometimes Mthatha seems so normal and regular, like I’ve been here for ages. But then you hear or see something that reminds you where you are.

One day, a few weeks back, Dorothy couldn’t come to work. The reason? Her cows - she owns three - had run off and the man she pays to tend them was nowhere to be found. Cows are a sign of wealth and I understand that a full-grown one is worth about 5000 rand (about $650 US). Basically, Dorothy’s savings account had wandered off. She tracked them down that day and sorted everything out.

A while later, I was talking to the contractor who is building a new rondavel next door to mine. The place has been pretty well finished for the last few weeks but they haven’t put on the roof yet. When I asked him why, he said they’re waiting for the grass (for the thatch roof) to grow to the right height before cutting it. Probably not something you’d hear from a contractor in the U.S.

What the…?

Because my Internet time is limited, I have a pretty well-worn path I trod around the web, first to my e-mail, then to update this blog, then to a few news web sites, occasionally to check my bank account or the blogs of other missionaries, and before I know it my time is up and that’s that.

As a result, lots of important bits of information pass my radar screen entirely without notice. So when I come across something I’m not used to seeing regularly - and this is particularly true with news from the world of sports - the shock value of the news is much greater because I haven’t been following the story all along.

All of this is a way of saying I nearly fell out of my chair the other day at the Internet cafe when I happened to see the Celtics made the NBA finals. How in the world did that happen?

Suka ukulinda!

Lately, I’ve been finding myself encountering people who fail to take adequate command of their health. This is particularly evident in HIV-positive people who fail to have their blood drawn for regular CD4 counts, a crucial indicator of how much the virus is affecting them and the determinant for whether the person can qualify for free, life-prolonging, anti-retroviral treatment.

I noted in passing about Nosisi that when she came into the clinic, weak and thin, it had been 18-months since her last CD4 count. HIV patients are supposed to have a count every six months. While I don’t like to be uncharitable about the dead, I did find myself thinking while I was interacting with Nosisi about how the situation could have been different if she had had a CD4 count a year ago when she was due. For one thing, she likely would have been a lot stronger and better able to fend for herself so she wouldn’t have needed my help at all. She could have walked to the government clinic that does CD4 counts and had her blood drawn. Her count would have almost certainly been under 200 since it had been that low 18 months ago and she could have begun ARV treatment as a relatively healthy person. Instead, it wasn’t until she was near death’s door, with a CD4 count of 44, that she came to us and we could begin to help her. By then, as I have seen before, it was too little, too late.

Why do people do this? Why do people rationally make a decision that is entirely irrational? This is their health we are talking about, one of the most important factors in their life success, and yet that health is routinely and comprehensively neglected in a way that boggles my mind. I know people persist in other behaviours that harm their health, like smoking or alcohol consumption but those can be explained away by addiction. But what explains the situation here? Is it apathy? Denial about the state they are in? Ignorance of their options?

I don’t have the answers - though I think denial and ignorance play a huge role - but I raise the questions for a couple reasons.

First, it points to an important obstacle to addressing the HIV epidemic. Plainly, governments and aid organizations can roll out ARV programs and no matter how well-funded they are, the money alone will not solve the problem. There needs to be some sort of education component to go with it, which there is here but it is clearly not reaching everyone. What we need more of is relationships. More people will begin to take ARVs when their friends and role models are talking openly about the importance of taking them. That is something I can do - and that I do do - but it is also something all South Africans can be doing as well, particularly those who are successfully taking the pills.

Second, it again brings up the question of what the missionary’s role should be in all this. There are other people in Nosisi’s position in Itipini, who are overdue for CD4 counts and should get them now so they can monitor their health. I believe in empowerment and not “meddling” too much as a missionary. Is it my job to seek these people out, drag them to the clinic, and make them get a count? Wouldn’t that take energy from my other efforts, some of which are directed towards helping people like Nosisi who waited too long? And isn’t there something offensively paternalistic about the belief that I know better about their health than they do? Shouldn’t I just butt out and let them live their own lives? When they want help they know where to come.

For the record, I do not roam Itipini with a checklist and play CD4 count truant officer (I am too busy playing pre-school truant officer) but nor do I let people pass by unnoticed. In the clinic, when a HIV-positive patient comes in for another concern, we check to see when their last CD4 count was and encourage them to get one if the time is right. But that misses a big chunk of people (mainly men) who rarely darken the door of the clinic until they are as sick as Nosisi was. And we can’t force someone who doesn’t want a count to get one. I seem to hear a lot of “ngomso” (tomorrow) when I bring the subject up. My response is the title of this post - don’t wait!

HIV is life-changing. My impression right now is that not enough people adequately grasp just how they need to change their behaviour and attitude towards their own health as a result of their positive test. Part of me wants to say to these people, “Well, live and learn.” But, as I’ve written before, what happens when they don’t live?

Let me conclude with a happier story. The woman in this picture is named Nomanesi and she is holding the anti-retroviral “cocktail” she began to take last Thursday.
I was shocked when I looked at her medical records to see just how rapidly her life had changed. She tested positive for HIV on April 10. Her CD4 count results were returned on April 24. The count was 116 so she qualified for ARVs. She immediately began the process to qualify for those ARVs and a little more than a month later - June 5 - she was taking her first pills that she will take every day for the rest of her life. Our role at the clinic was minimal. We did the initial HIV test and gave her taxi money to get to the hospital for a required chest x-ray. Otherwise, she was acting completely of her own volition and the impetus during the entire process was her own.

What I want to know is how we can get more Nomanesis in this world and fewer Nosisis.

“They are not nurses… they are murderers.”

I’ve just finished a truly terrific book about the genocide in Rwanda - We wish to inform you that tomorrow we will be killed with our families by Philip Gourevitch. I mention it because one passage seemed particularly apt to describe something I deal with every day.

The generic massacre story speaks of “endemic” or “epidemic” violence and of places where people kill “each other,” and the ubiquity of the blight seems to cancel out any appeal to think about the single instance. These stories flash up from the void and, just as abruptly, return there. The anonymous dead...become their own context. The horror becomes absurd.

Gourevitch’s point is that he wanted not to see memorials to places where the mass murders happened but to talk to people individually and learn about the genocide that way.

Before I arrived in South Africa, the HIV epidemic was similarly “absurd” and abstract. I had no context other than reports of hundreds of thousands of people dying every year. Since I’ve been here, as I’ve already written, the HIV epidemic has been reduced/expanded to the stories and deaths of individuals - friends - and those stories have reached down into my very core and changed how I view HIV and, more generally, the world. I hope that in telling some of these stories to you, the epidemic has similarly begun to seem less abstract. It is thinking of the “single instance” - with the knowledge that there are so many other people suffering in the same way - that is so important.

All this is a long way of introducing Nosisi, whose funeral I attended last weekend. In the interests of making Nosisi not a statistic but a story, let me tell you about her, even though her story is similar to many I have told before.

Nosisi first came across my radar screen in mid-April when she came into the clinic, looking very weak and thin but still able to walk and take care of herself. We knew she was HIV-positive but she had not had a CD4 count in nearly 18 months when positive people should get one about every 6 months. At her last CD4 count, she was below 200 and so had qualified for ARVs a long time ago. To complicate matters, she had lost her government-issued ID, which would make it more difficult - if not impossible - for her to get treatment. We drew her blood for the test and sent her own the way to try to begin the process of getting on ARVs.

About two weeks later, I heard that she was still quite sick was 44 and was not making any progress on ARVs. It turns out that the government clinic up the hill would not do a CD4 test on her blood if she couldn’t provide proof of her identity and date of birth and without an ID she couldn’t. (This is not the first time that the absence of an ID has caused these sorts of problems for people. If it weren’t so tragic it would be ironic given the strong resistance during apartheid to the pass system, where blacks had to carry pass books with them. To me, the ID appears to play a similar role as the pass once did.) The woman who told me about Nosisi’s troubles then said, in perfect English, “They are not nurses...they are murderers. They are letting her die.”

Sometimes I’m able to sweet-talk the nurses at the government clinic into providing services to someone without an ID but I ran into a particularly obstinate one when I tried for Nosisi so we set off to the Department of Home Affairs (commonly called the Department of “Horror Affairs” for its bureaucratic ineptitude) to get a replacement ID for Nosisi. This was an experience in of itself, taking a weak and emaciated woman who could barely walk by herself first to the pharmacy to get the pictures and then to Home Affairs and the unbelievably long line. It never ceases to amaze me how people here can wait so patiently for so long. Fortunately, my friend Noxolo, who grew up with Nosisi, came with us and she sweet-talked the guard into letting Nosisi to the head of the line. Even then, it still took a good three hours to get Nosisi sorted because of various breaks for lunch, tea time, and the computer crashes.

By the time we got Nosisi’s CD4 count done (it was now 44), she was getting quite weak and she could no longer keep down any food. So when we started taking her to ARV appointments, they would put her on IV drips (eventually they went in her neck because her veins were so weak on her arms) and she would get referred to the hospital...and make no progress on getting on ARVs. Of course, the hospital is always dealing with a crush of similar such patients and she could easily get lost in the shuffle. It went on like this for at least two weeks - Nosisi couldn’t keep any food down and so got progressively weaker but the symptomatic pills for nausea and upset stomachs she was prescribed didn’t get to the root of her illness. Eventually, she could no longer walk and I started either wheeling her everywhere (at one point “borrowing” a wheelchair from one clinic and getting in deep trouble with the nurses - never steal anything if you are the only tall, white person in a given community) or carrying her, bride-crossing-the-threshold style.

What was so difficult to watch in this whole process was how Nosisi’s will to live just evapourated. I think people here sometimes have too much faith in just what nurses and doctors can do to make them better. Though she never expressed this to me in a language I could understand, I could sense that Nosisi would anticipate each visit to a clinic or the hospital, hoping that they might finally give her something that would make her feel better and make the food stay down. Each time she threw up after taking whatever new pills she had been given, I am sure she came closer and closer to despairing of ever making it through this alive. I wanted to give her a pep talk and tell her how she just needed to persevere a little longer and get ARVs and how they would eventually make her feel better but I lacked the vocabulary to do so. Even my intentionally upbeat attitude around her did nothing. It got to the point where she seemed to be crying all the time and with her long hair untended - no energy for that - and her sunken cheeks, she had this wild look to her I won’t easily forget and that was disturbing to be around.

Nosisi was eventually moved into our sick bay, where it is a little more comfortable than the shack she lived in. We kept going to all the appointments - each trip was a major undertaking and required her to expend a massive amount of energy - but she died on a Monday morning just before we showed up to open the clinic, about a week after going into the sick bay. The funeral home came that morning and took her away as some women of the community sang and prayed.And that is how I knew Nosisi, one of approximately 1000 South Africans who died that day from AIDS.

“Usazi isiXhosa!”

One of my favourite things to do at Itipini is to sit around with some of the dozen or so women we employ to cook food, distribute food, and clean. Often, during a slow moment, I’ll take a seat in the kitchen or the craft room or wherever the crowd is and try to join in the conversation.

I say “try” because, of course, the conversation is entirely in Xhosa and these moments are most valuable because it allows me a chance to work on my language skills. I’m thankful that my relationship with these women is such that I can feel free to mess up in front of them and know I’ll still be welcome. The few of them who do know a bit of English now will only talk to me in Xhosa because they want me to practice. At times when I pull off a complicated thought in gramatically-correct Xhosa or throw out an advanced vocabulary word, they’ll use the all-purpose expression of surprise around here - “yho!” - and exclaim, “usazi isiXhosa!” (“you know Xhosa!”). Hearing that is always like a little pat on the back for me and inspires me to continue my language struggle.

One thing these women cannot figure out is why I am not married. I always insist that I am too young for marriage but they just snort in derision at that. This is a frequent topic of conversation and has led to several new vocabulary words, notably “isishumane” (a bachelor but with the connotation that the man is afraid of women) and “ulewu” (a man with several girlfriends, a playboy). Debate raged for a few weeks (it has since died down, thankfully) about which one I was. On the one hand, there was the attention I attract from all the young women I see every day that seemed to indicate lewu status. But on the other hand, I don’t have an isithandwa (lover) so I must be a isishumane. I threw this picture from my 20th birthday into the mix one day and it created more turmoil.

I realize I have not yet written much about these women, who, because they are my co-workers, are a fundamental part of my daily life and some of my closest friends here. Their stories are some of the ones I know best and I am always amazed at the obstacles they overcome every single day just to survive. I’ll try to write more about them someday but in the meantime here are some pictures.

“The graves are not yet full”

I’m pretty sure I’ve noted this before but one thing that is remarkable about weekends here is that everybody goes to funerals. There are so many people dying, primarily from HIV but also trauma, that seemingly every Saturday there’s a funeral to go to. Dorothy, our Xhosa nurse in Itipini, once told me that sometimes she skips funerals on Saturday and sneaks around town doing her errands because “they are so many funerals there’s no time for my life.”

This past Saturday, I went for the first time to a funeral for someone from Itipini. I realize I’m putting the cart before the horse here because I still haven’t gotten around to posting about the woman who died and how she died. That’s a story I still mean to tell but for now you should know that her name was Nosisi, she was 23, and she had AIDS.

Nosisi was far from the first person I’ve known to have died in my time here but it was the first time I was invited to a funeral and it seemed in poor form to turn down the invitation, given that Nosisi had occupied so much of my attention in her last month alive and that I had no other plans for the day. Along with some people from Itipini, I set out for the funeral. (There were seven adults in my tiny little car, a memorable-enough experience in itself.)

I’m not going to say much about the funeral because it was not nearly the most notable part of the day. It started two hours late, while we waited for a critical mass of people to arrive. It was straightforward and full of singing and words I could only barely understand. They had a brief viewing time and somehow I ended up standing closest to the casket and thus was forced to see Nosisi one last time. She looked peaceful and I could see a hint of the beauty everyone with whom I’ve spoken has mentioned in reference to her. When I knew her, she was emaciated, weak, and pale, with no energy to walk or eat, let alone take care of her appearance.

What made the biggest impression on me was the burial at the grave. I barely know where to begin describing the experience so let me start at the beginning.

When you pull into the graveyard, the first thing that strikes you is all the fresh soil. I haven’t been to a graveside burial in a while and I realize in retrospect my views of such things were heavily influenced by movies, with their manicured green lawns stretching away endlessly around a mourning family in black. Not here. Here, there are so many burials every Saturday, that the soil is always being disturbed and turned. There’s no green, just a pale brown, interrupted by mounds covering fresh graves and big piles next to the empty graves.

The next thing that strikes you is that there’s a traffic jam at the graveyard. There are so many cars trying to get in and out - not just for your funeral (there were only three cars for Nosisi’s) but for the previous funeral(s), the concurrent funeral(s), and the impending funeral(s). It takes a minute to realize you actually have to pay attention to your driving in this graveyard and not just sort of doze off as you can when you’re driving at the half the speed limit, with your hazards flashing, in a funeral procession.

Once you get out of the car and get to the graveside, you realize you’re not at the side of a grave but at the side of graves, plural. For there are so many burials to take place on this particular day, that there are a half-dozen or so empty graves lined up, each about six feet deep, long enough to hold a coffin, and - and this is remarkable - no more than twelve inches apart and separated from the next row by about two feet. Immediately and unbidden, the Hutu Power phrase made infamous during the Rwandan genocide sprang to mind - “the graves are not yet full.” It’s a different context to be sure but the imagery seemed so similar to me.

Empty graves, waiting for coffins. Nosisi’s grave is out of the picture but immediately next to the green-draped one.

Our small crowd gathered round the next available grave. Think, first, of the difficulty of this. There’s a big pile of dirt on one side, a row of graves on the other, and just twelve inches to cram the fifteen or so of us around the grave. Meanwhile, just a few feet away, the previous funeral is just finishing up as a group of men hand-shovel the grave full. Right behind us, not four feet away, a funeral home employee is setting up a tent for the next funeral. About 100 feet away, another funeral, larger, is burying their body. They have a PA system and we can hear everything.

The men on the left in this picture are for Nosisi’s funeral. The men in the right are from the previous funeral.

In that context, you might understand if I say that the graveside service for Nosisi was rather perfunctory and somewhat lacking in the dignity generally accorded these sorts of events. Two men hopped down into the grave while the rest handed them the casket. Prayers were muttered, songs were sung, dirt was tossed, and we all went back to the cars while the men in the group hung back to hand-shovel the grave full. (If you’re wondering, it takes a group of men with two shovels about fifteen to twenty minutes to fill in a six-foot deep grave, roughly three times as long as we spent around the grave.) I was invited to remain for this part but I wasn’t quite ready to live into this part of Xhosa manhood. We left behind a freshly-full grave, with a stone marker with a number on it so the family can find the grave again when - if - they can afford a headstone.

Nosisi is lowered to her final resting place.

The final memory I’ll take away from this day (aside from the excellent food we ate after the burial) is a short interaction I had with Nosisi’s uncle (I think - relational terms are used differently around here than I am used to), who could not have been much older than me. As I was preparing to go, he came up to me and, in halting English, introduced himself. What he really wanted was copies of the pictures I had taken and I told him I’d be happy to give them to him as soon as they were developed. As I turned to go, he grabbed my arm and said, “I like what you…” and paused for a moment looking for the right word “…do today” and smiled at me. I thanked him and left but on the walk to the car I realized it was one of the nicest compliments I had been paid in a long time. His choice of verb was particularly apt after all the thinking I have been doing about the distinction between being and doing, which regular blog readers must be sick of hearing about by now. I had not done anything during the day, except show up at a place where I was not expected to be. I had not been anything special either, except for the same person I am every day. But somehow, by taking her death seriously and taking time to remember her, I had made an impression on this man and, though he doesn’t realize it, he on me.

From the paper

This cartoon was on the opinion pages of the newspaper a few weeks back.

The Winter of My Discontent

It is getting to be winter in the southern hemisphere and I’m about to write something I never thought I would, after moving from Alaska to South Africa: I’m cold! My indoor thermometer says it is 57˚F/14˚C in my rondavel right now. It puts in perspective the disagreements I’ve had with roommates past about whether to set the thermostat at 65 or 70. I have not yet seen anywhere in South Africa any sort of central heating system; everyone makes do with space heaters. I don’t use one of those because it takes so long to heat up my rondavel it is barely worth it and I shudder to think how much energy they must use.

The upshot is that here I am much more in tune with the weather and the rhythm of the day than I ever have been before, even in Alaska where weather determined whether we would get mail or groceries from the planes. When I wake up and forsake my pile of blankets, it is so cold and I skip across the floor and bundle up in lots of layers just to eat breakfast. But as the sun rises a bit higher (and it is almost always sunny now as we are into the dry season), it becomes warmer and during the work day it is quite comfortably warm. (After a summer’s worth of complaints about the heat, Jenny is now enduring a winter’s worth of complaints about the morning and evening cold.) But as the sun ducks behind the mountains, it quite quickly gets cold before getting quite chilly at night. Since the sun is up for less and less time each day (sunrise is about 7 o’clock and sunset around 5:45), that means less and less heat. Sometimes it seems like the only place I am truly warm during the day is in my bed when I wake up or in the shower - neither are places where great mission work is done.

The weather is affecting my daily lifestyle in myriad minor ways. To wit:

• I realized on Sunday I had to hurry home from church so I could get in some quality hammock time before it got too cool. Even then I was uncomfortably cold in shorts and bare feet and if you can’t lay in a hammock in shorts and bare feet, what’s the point? (The tough life of a missionary, I know…) And while we’re on it, what’s the point of cold without snow?
• I am changing my clothes all the time it seems, first into shorts for the work day than into pants for the evening and always seem to be putting on and taking off shirts to keep warm.
• I sleep with socks on all the time after never once sleeping with socks in Alaska. But I had 18-inch thick walls in Nome.
• The car takes forever to warm up when it is first started and sometimes even in the afternoon when I leave Itipini. I must be quite a sight when I am in a hurry and try to make the car move, only to have it shudder and stall and stall and stall again while I try to get it going.
  

Of course, as the hammock comment indicates, I am perhaps still finding it a bit warm. There have been several times when I’ve seen people walk past in scarves and gloves and realized I was only wearing shorts and a t-shirt. It is remarkable just how bundled up people get here. I never thought I’d see ruffs on hoods in South Africa. I associate those only with Alaska.
The other thing about the changing of the seasons is that it has dramatically affected what is available in the grocery store. I had grown accustomed to cheap watermelon on the shelves but that is now gone replaced by incredibly cheap oranges. I can buy a 7-kilogram bag of oranges for $1.50 and they are all perfect for juicing.

In all of this, I am trying to keep in mind just what it would be like to be experiencing this weather in Itipini, where the tin walls surely don’t keep much heat in and the wind and cold comes in through all the holes. Blankets have been in high demand lately. It rained today (so much for that dry season) and I amazed when I went in a shack just how many pots, pans, tubs, and assorted other devices they had had to muster to catch rain coming through all the holes, including over the bed where the sick patient I was seeing was resting.

Ultimately, I have to keep reminding myself, it is a gift to live for a while with less distance between me and nature. Most people all over the world do not have the benefit of the protective cocoon of furnaces, worldwide fruit and vegetable shipments, and so forth we’ve created for ourselves in the rich world. It’s giving me a new appreciation for the rhythm of Creation.