My parents are visiting for the next two weeks and I’m looking forward to the opportunity to show them around Mthatha and farther a field in South Africa. It’ll take my away from my computer and Internet access, though, so don’t look for any posts here until early April.
In the meantime, catch up on all those long, weighty posts you only skimmed the first time around!
I continue to meet twice a week with a group of seven high-school students for our interminable reading of “Charlie and the Chocolate Factory.” Their attendance has been pretty good, which means they must be finding something of worth in our meetings, but I still wonder just how much they actually understand. They don’t seem to show that much enthusiasm for the unfolding story, even as I try to build up to each new revelation, and I can only think it’s because the plot just isn’t clicking for them. For a while, some of them even thought the story was non-fiction.
In any event, these students never fail to brighten my week and I look forward to my meetings with them. Here’s some brief snapshots of who they are.
Lindiwe
Lindiwe was one of the first people in this group I really became aware of last year, mainly because of her son Kamvalethu (“our future”), who is about a year and a half old. Lindiwe is 17 or 19 (our health records say 19 but she says 17) and in grade-10. She’s lovely and friendly but just doesn’t seem to be all that curious about the world. She goes to school, does her work (I think), reads “Charlie” all right but never seems to get interested or excited about any of it. Her name means “the one we’ve waited for” and she is always late, a fact I frequently harp on by saying “silinda uLindiwe” – “we are waiting for the one we’re waiting for.” I think this is hilarious. No one else does.
Ayabonga
Ayabonga is 17 in grade-10 and has a 3-year old daughter who is cared for by Ayabonga’s mother. She and Lindiwe are best friends and when I was first getting to know Lindiwe, Ayabonga always intimidated me. She didn’t smile or talk a lot and was this strong, powerful presence next to the willowy Lindiwe. When I saw that Ayabonga was going to be in this group, I was a bit worried how it would work out because I was convinced she would be nothing but a disruptive presence.
Now that I’m actually getting to know her, I am happy to report I was completely wrong. In fact, Ayabonga is rapidly turning into one of my favourites. Her English is fairly poor but it’s good enough to make fun of me – she now frequently imitates my “silinda uLindiwe” in a way that is actually quite funny – and good enough to ask me for help on her homework, which she does more consistently than anyone else. I’m grateful she seems to be taking her education seriously and is quite regular in her attendance. But whenever I ask her a comprehension question about “Charlie” she just stares at me completely confused. She has a long way to go.
She also loves my iPod and I now make sure to bring it on Wednesdays just so she can listen. In fact, she gets on so well with me now she just walks in and rips the ear buds out of my ears so she can listen too.
Nonhlazo
Nonhlazo (“lucky”), who also goes by Victoria, breaks my heart. She’s 18, in grade-10, and has an energetic 2-year old who is an absolute bundle of joy. Her English is solid and she’s an all-around good person with a wonderful smile. But her attendance at school leaves a lot to be desired and I’ve caught her several times around Itipini during the school day. I try to reinforce for her the importance of school but some of it gets lost in translation and the rest of the message obviously doesn’t sink in. I realize she has some significant responsibilities and her mother isn’t as helpful in the raising of her son as other mothers are. But I see her son wandering around Itipini by himself sometimes and she’s nowhere to be found and not in school either. I see so much wonderful potential in her that is not being drawn out and built up the way it needs to be. I try to check in on her frequently but she can be tough to find.
Noncedo
Noncedo is the only student of this group in grade-12 so this is a big year for her as she’ll have to take a high-stakes exam in November that determines whether or not she gets a diploma. She was a bit late in coming to us asking for help with school fees but since then she has shown impressive dedication to school and really seems determined to pass that test. In fact, she’s blossomed into one of the most eager students. She always seems to show the most grasp of the story and is always asking if we can read another chapter. She lives with both parents, is 18, and doesn’t have any children. She seems so normal! She also pays more attention to her appearance than any other person I’ve ever met in Itipini and I’m quite frequently stunned at the kind and variety of outfits she pulls out.
Mthunsikazi
Mthunsikazi is another “normal” student. In fact, AMM doesn’t pay any of her school fees for her as her family has it all sorted out. She just hangs out with the other girls at school and came along one day and I was happy to welcome her. She’s only 15 and in grade-10 and also doesn’t have any children. She is very quiet and struggles the most with the English so it’s easy for her to fade into the background of the group. I’ve been trying to draw her out more lately but it’s tough because there’s a definite language barrier and I haven’t quite built up a rapport with her yet.
Luleka
Luleka has the capacity to be a brilliant student. Her English is good, her family background is strong, and she doesn’t have any children. But I think she’s content just to meet the standards of the school she’s in, which might not be all that high, rather than push herself. I try to push her with “Charlie” but she’ll shrink back and let other people answer questions I ask her. I’ve been trying to get her to open up a bit more lately but she can be incredibly withdrawn at times. Even though her attendance is good, she always seems like she wants to be somewhere else. We just don’t have enough vocabulary in common for me to draw her out and learn more about her.
That being said, as they were leaving on Wednesday, she turned to me, made sure to make eye contact, and said very softly but meaningfully, “Have a good Easter, Jesse.” It made me feel so good I almost forgot to wish her a happy Easter as well.
Nonzuzo
Nonzuzo is far and away the best English-speaker in this group. She will zoom through paragraph after paragraph of “Charlie” with amazing ease. Lately she’s been drifting away from the group, pleading sickness quite often, and I hope it’s not because she thinks the book is too easy for her or that she’s so far ahead of the other students she doesn’t need to come. I haven’t quite figured out how to make the group important for her.
Some other tidbits I’d rather not associate with a particular person but you might find interesting. One is an AIDS orphan. Another had an abortion last year. One has run away from home at least once. I am so different from all of them I wonder how I ever ended up here and why they even want anything to do with me.
After our pool party last month.
If you’re a particularly attentive student of the pictures on this blog, you’ll recognize these three from numerous previous posts. They are all sons of women who work in the kitchen. Because they’re too young for the pre-school, they are always around in the morning before the pre-school breaks for lunch and it is still quiet and calm around the Project area. I call these three “abahlobo bam bancinci” – “my little friends” – and it’s hard to tell who is more excited when we see each other, me or them.
Left to right: Talent, Bongamusa, and Simnikiwe. Not a great picture of Bongamusa but two out of three ain’t bad.
Later on, Simnikiwe was pretty happy. Must have been a pretty good lunch that day.
For several years before moving here, it was impossible for me to read about the HIV epidemic in sub-Saharan Africa and not say to myself, “I want to be there. I want to help.” Now I am and I am – more or less – helping. But not always in the way I thought.
For instance, a big part of my job that I have yet to write about is pill counting. All of the pills we hand out come to us in gigantic, industrial size containers of several thousand pills. We have the thankless task of counting them out into little pill bags, 8, 15, 28, 30, 60 at a time. There is absolutely nothing glamourous about this and it is hard to see the connection between this work and one’s desire to alleviate suffering.
I often have to remind myself that it is important. In this picture, I’m counting an antibiotic known here as cozole that is given to HIV/TB patients as a prophylactic. Because their bodies are so susceptible to disease, they take this drug to fight infections from the moment they begin, rather than when they begin to manifest in symptoms when it might be too late.
It’s not as rewarding as starting a library, it’s not as fun as playing the guitar, it’s not as nerve-wracking as testing someone for HIV, and it involves almost no interaction with the patients. (In fact, interaction is awful – it makes you lose track of your count!) But it’s important nonetheless.
My experience in Itipini certainly confirms the truth of this new report from Amnesty International.
I'd also like to echo the sentiments of this government minister.
When I first arrived in Itipini, I was quite clear about my frustration at not being able to do anything. I felt helpless and didn’t know how to contribute. But gradually that began to change. I figured out how to give pills to TB patients; I started bandaging a few wounds; I got better at finding patients’ medical records; I learned where the hospitals are so I could drive patients there; I learned what pills HIV patients need on a regular basis and started handing those out. Before I even realized it, I was actually doing quite a bit in the clinic.
This lesson hit home for me the other day when I realized I was helping five different patients simultaneously. There was one who wanted her TB pills; one looking for the nutritional supplement we give HIV patients; one whose ankle was on ice because of a recent fall; one who wanted to drop off her results from a recent blood test; and one who had just been discharged from the hospital following knee surgery and wanted to show me the record of his time there. Somehow all these balls stayed in the air at once and everyone got what they needed. I even impressed myself at the conversation I had – in Xhosa – with the knee-surgery patient about how his knee was feeling and when he needed to return for a review. My goal in coming here was to help people and slowly I am figuring out just how that is done here. An important lesson of my time here is that you can’t just show up and expect to be useful right away. It is immensely gratifying not only to want to help someone but also to know how to help them in their particular context.
The other day while I had stepped out of the clinic for a minute – dealing with yet another request – a patient I know well stopped by. She has a chronically sore wrist and grossly swollen feet. She’s often a little tipsy and she’s always loud, demanding, and cuts the other patients in line. When I returned, she was her usual aggressive self and pounced on me when I walked in the door. I immediately smelled the alcohol on her breath and started directing her towards the door as we don’t serve drunk patients. But she got right in my face and unleashed a torrent of Xhosa at the top of her lungs. I didn’t catch nearly all of it but I did catch a few key words “go,” “Mqanduli” (a town nearby), “tomorrow,” and “Brufen” (a pain pill we give out). She was also pointing to her wrist dramatically. I asked when she was coming back and she said she didn’t know and launched into her spiel about Brufen again. Realizing she wasn’t going anywhere without the pills, I calmly wiped her spittle off my face, got her the pills – better to treat a drunk patient in 30 seconds than spend 30 aggravating minutes trying to get her out of the clinic, I reasoned – and sent her on her merry way. The point of the story is that when I first arrived I wouldn’t have been able to do this. I wouldn’t have understood her, I wouldn’t have been familiar with her history to know about her wrist, and I wouldn’t have known where we keep the Brufen. Something that would have taken me at least five minutes and someone else’s help to figure out last August took me 30 seconds today. I even got a round of applause from the other patients when she left because they were happy to see her go as well.
There’s a flip side to this as well. The people in the community are now quite comfortable with me and aware that I can help them. In fact, they probably have an inflated sense of what I can do. Everywhere I turn, people need something and they expect me to provide it. In addition to all the things I’ve already mentioned, there are many more: a blanket for their baby; money for a million reasons; to be added to the list of people to whom we give food every day; more supplies for the pre-school; more colouring books for the library; for me to fill their gin bottle with medicine; for me to weigh them; a ride into town or to the hospital; and on and on and on. Two of my most well-worn phrases are “linda apha” – “wait here” – and “hayi ngoko” – “not now” – which I find myself using when I’ve got several requests coming my way all at once. When I leave Itipini, there’s only more neediness: everyone wants money for something, as I’ve written about before, and they’re not shy about coming up to me and asking for it.
It’s reached the point where I assume at the beginning of every conversation that there’s going to be a request for something during its course. I am always on the lookout for what it is so I can anticipate the request, decide if I can help, and get to work providing it so I’m ready for the next request that is surely just around the corner. I feel like the vast majority of people I encounter on a daily basis look at me instrumentally, i.e. they see me as a means to achieving their end. I don’t blame them and I’d probably do the same thing if I was in their position but it is incredibly exhausting. Some times it seems like no one cares about me for me; they care about me because of what I can do for them. It would also help if everyone were a bit more consistently grateful for the help. It doesn’t help my mood any to bend over backward to help someone, only to have them take the help for granted and walk out without saying thanks.
I guess this is a natural part of any service-oriented type job, at home or overseas. When you work in a community project that is dedicated in part to meeting needs, its no wonder that people expect you to, well, meet their needs. And it is gratifying to effectively meet a need and know you’ve made a small but positive difference. And there’s even relief occasionally: sometimes during the day, I’ll go hide out in the kitchen where I know the ladies who work there won’t overwhelm me with requests and will just let me sit and practice my Xhosa.
But wouldn’t it be nice if when someone asked me how I am, they really listened to the answer instead of blowing through my answer to their request?
This young woman was waiting for water at the tap next to the clinic on Friday.
When I arrived in Itipini, one of the first families I became aware of was the family whose shack is just up the hill behind the clinic. There were at least 5 children in the family, none older than about 8 or 9, at least one of whom has already tested positive for HIV. The husband and wife together ran a “spaza shop” or little store that sells a variety of small food items. In addition, attached to the shack is a shebeen, or bar, and we can often hear loud music pumped from the house, powered by an old car battery. It was in this shebeen that I was first offered (and declined) the homebrew they drink here that features battery acid as a major ingredient to give it an extra “kick.” (Some day I’m going to write a long post about alcohol in Itipini.)
The reason this family stood out to me was that the second-youngest child was easily one of the most photogenic in Itipini.
(Right, so maybe I didn’t catch her at the best of moments on that last one. All of them are totally candid, though.)
She’s also a budding prima donna – yes, they exist even in shantytowns – and spends most of her time completely ignoring me except when I sing “He’s Got the Whole World in His Hands” and replace “whole world” with her name. Then she does this little dance but keeps walking as soon as I stop.
I learned more about the family when I realized one of our TB patients was the father/husband. He also had HIV and was extremely weak. His wife, also HIV-positive and a past TB patient, had to come for his pills every day even though it’s only 30 feet from the clinic to their shack. His CD4 count was very low, low enough to qualify for anti-retrovirals but he refused to begin the treatment, citing some myths about the drugs and claiming they wouldn’t actually heal him. His story has a predictable ending and he died in late January. He was 32.
The mother in this family has always stood out for me. For one thing, her first name is “NoFirst” (kind of a paradoxical name, isn’t it?). I’m not sure where that came from but it certainly sticks out. For another thing, I’ve never once seen her laughing or joking with the other women who wait outside the clinic. In fact, I’ve rarely ever seen her smile.
She just works and works and works and works. One morning I was in Itipini early and watched as she made trip after trip from the tap to her shack with a 5-gallon bucket full of water on her head. NoFirst was also the patient who helped me with a breakthrough moment last year, when I realized I might have a chance of understanding Xhosa and might be making headway in my efforts to build relationships here.
Now she stands out even more. Apparently it is traditional for Xhosa widows to wear green so lately she has stood out from the ragged clothes most people wear here.
I also continue to be amazed at how hard she works in the wake of her husband’s death. She just has not let up. But then again, what other choice does she have? She’s got a lot of mouths to feed.
Last week, she tested positive for TB again and has begun another round of treatment. (Incidentally, I learned from her government ID then that her first name is “Xoliswa” – roughly “the peaceful one” – and I’ve been calling her that since. But she silences me and says, “NoFirst!” before breaking into a rare smile.) I want to think positive thoughts about this family but the TB diagnosis was a reminder of her mortality and generally poor health. She tested positive for HIV several years ago and a decline, though mild, is evident. I can’t help but think that at some point, perhaps in the not too distant future, she’ll join her husband and leave behind a lot of young children. I live in hope, though, and have been making sure she takes her medications. She’s not eligible for ARVs yet but when the time comes I hope she takes it more seriously than her husband did.
Great Canadian Stephen Lewis, the UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, opens his book “A Race Against Time” by writing that he has spent his last several years on the job “watching people die.” I once heard Lewis speak and found him inspirational and I think the work he has done is just fantastic. But I’d like to quibble with this for a moment. It’s true that he has traveled extensively in sub-Saharan Africa, often paying return visits to certain programs. I have no doubt he has seen people die on those visits and met people who were dead by the time he returned. But I think what is ultimately more heart-breaking is to become familiar with a family, to begin to understand some of the relationships that bind them together, to form memories relating to specific instances with those family members, and, over time, see some of those family members decline and ultimately die.
I'm sure you've heard about “AIDS orphans,” children who’ve lost their parents to HIV. But what do we call those young children who aren’t orphans yet but someday (soon) will be?
Here’s an example of the kind of unexpected frustrations and aggravations – and good memories – that crop up all the time in Itipini because of the language barrier.
After we cleaned up the clinic on Friday afternoon, I went into the kitchen to wish our kitchen staff a good weekend. This is usually a simple matter of a few short phrases thanking them for their work and concluding by saying, “sobanana ngomvulo” – “see you Monday.” But this time that last phrase set off a commotion. Of course, I couldn’t understand a word of it as the six or so women in the kitchen probably speak a dozen words of English among them. But I gathered after a bit that they thought Monday was a holiday and I should have said “sobanana ngwolesibini” – “see you Tuesday.” This was a bit of a problem – the women were clearly looking forward to a day off but we need them around to distribute and cook food on Monday.
A typically stilted and disjointed conversation ensued, involving as it always does two- or three-word phrases and lots of hand motions on my behalf and a steady steam of incomprehensible mush from the women. (I thought understanding one Xhosa speaker was tough but I learned on Friday that six women, all speaking simultaneously, and all animated by the belief that they were being robbed of a holiday is much, much harder.) The conversation certainly stretched the limits of my mainly medical vocabulary but I think I got my message through that the Easter holiday isn’t until the following Monday.
But I guess I’ll find out for sure on Monday.
I was preparing yet another tale of life in Itipini – yes, it involved HIV, TB, and suffering children, how’d you guess? – when I thought, “wait a second, how I have made it all this way without once telling the story of Mbongeni?”
Mbongeni is a South African success story. About a year and a half ago, he was weak and thin and dying. He’s HIV-positive and had been diagnosed with multi-drug resistant TB. He is the quintessential sub-Saharan African suffering patient.
But before I arrived in Itipini, he got his act together. He got on anti-retroviral drugs and his CD4 count is rising. He started going to his doctor’s appointments and consistently taking the drug cocktail that fights MDR. He’s been taking a big pile of pills every day for the last year at least and will for the rest of his life.
But the benefits are enormous. He is much stronger now, so strong in fact that every morning he takes his pushcart (a heavily modified grocery cart) into town and makes money by helping people with their groceries. In fact, he is so business-like that he only comes into the clinic once a week to get his MDR pills, as opposed to daily, because he wants to head into town before we open. One time I had forgot to prepare his drugs for him and as I rushed to do it I felt so guilty that I was making him miss valuable work time. Unusually for Itipini, he is married (well, I’m not sure if it’s actually marriage but he lives with only one woman) and the two of them are obviously in love. In a place where sexual violence and single mothers are too common, this is unspeakably touching. He is now helping her get on ARVs, no doubt buoyed by his own success.
All this would make for a good story all by itself. But what makes Mbongeni stand out for me is his unique and wonderful combination of character traits. First, he speaks not a word of English but when he makes his once-a-week trip to the clinic he is clear and direct about what he wants and does not waste any time. In addition to the pills, at various times throughout the month he’ll need the multi-vitamin cocktail we give to HIV patients, the prophylactic antibiotic we give to HIV patients with TB, an ointment for sore joints, and, for reasons that defy my explanation, mouthwash. He and I have developed over time a series of signals and shared vocabulary for what he needs. My favourite is the mouthwash. He just squeezes his eyes shut, puffs out his cheeks, and starts miming swishing. Some day I’ll figure out how to take a picture of it. I love it.
Second, in keeping with his business-like attitude towards his health, Mbongeni does not generally miss a doctor’s appointment. Often when he has one, he dresses up in his one suit coat and tie that, truth be told, is pretty ratty and limp. But he wears it with pride and heads off to each appointment with his head held high. On days when he’s not headed to the doctor, he wears this broad-brimmed straw hat that, I must admit, I find myself coveting some days.
On the way to the doctor with his wife – I call this one “Itipini Gothic”
I see more of Mbongeni around town than I do in Itipini. Sometimes he is pushing something around in his cart but more often he is sitting with other men, all of them looking for work. Whenever I see him, I shout his name and wave and he always gives me a gigantic smile and a huge thumbs-up that often involves his entire arm, which I can’t seem to capture on the camera. But I’ve got the memory of it and that’ll do for now.
Right. Now back to work on the other stories.
