we've now moved from training on aids to training on nutrition, and then next week we'll go out with our local counterpart and conduct 5 hour trainings....
i had finally a moment of scepticism this past week. we were listening to a visiting speaker who works with Pathways providing palliative care and home health and hospice services. he spoke so passionately about the care they deliver i was actually moved to tears, as was another of my classmates who'd lost an aunt to aids a couple of years ago. he looked at us very compassionately and gravely and said something like, 'and sometimes, the patient will die'- all of the sudden i felt like i was back in the gw hospital he reminded me of one of the doctors. anyways it is amazing the level of in home care he descibed= training family and community members how to care for the patient so they can be cared for at home- providing 32 day trainings to them on all aspects, plus sending in supervisors to make sure all's well; counselors to help them handle the grief, having a contact person assigned to them at the hospital so they can access expert care immidiately at any time- i was thinking gee whiz we should have been living in africa.... but then at the very end when asked what are the challenges they face it began to seem like all of that is the ideal of what happens, far removed from what happens in practice.
the next day we were visited by nuns who run an amazing counseling service- counseling and encouraging people to get hiv testing, and also caring for and trying to raise money for schooling for the outrageously ballooning number of orphans due to hiv here- i read in one of my papers orphans due to aids in africa account for 80 percent of orphans worldwide- can that be true? in anycase it's a huge problem that the tanzania govt. is not yet talking much about let alone dealing with and these nuns are doing an amazing service- also helping provide food to a lot of communities who've been hit by aids and are going hungry. they spoke for the first 45 minutes on how they counsel people. only listen, never be shocked by what the client tells you, never judge, never advise, offer empathy not sympathy and so forth. i was truly inspired. then a question of condoms came up- and we heard, ' they shouldn't use them because in that case the person is walking away from the light. the women who use them lead to prostitution. they are unreliable anyway because they come at such a range of prices so they probably don't all really work. " someone asked about the situation we have been discussing this week that affects a huge number of women in africa. what about the woman who is married with children, and her husband works far from home. she's quite sure he has girlfriends and likely doesn't use condoms. She has zero leverage to negotiate with her husband to use condoms with her, because there is the attitude that if a woman shows interest in condoms she's a prostitute. actually a woman i know here is in this situation. she's never been tested. i was encouraging her to get a test. she said she couldn't because if she was positive, her husband would likely leave her, even though it would have come from him. he would probably be in denial and not get tested himself. even if she tested negative she would have to keep putting herself at risk with her husband because it is impossible for her to discuss sex with her husband, and even the mention of a condom can lead the husband to accuse the wife of having affairs, and possibly kick her out. it's a very common situation. and a huge disincentive for a wife to get tested. it is ironically a disease mostly affecting women in africa, and yet the women are in such a compromised position to do anything about it. another factor we learned is that women are generally much more vulnerable to stds. and a woman with an std the involves any sort of skin sores is 4 times more at risk for aids. So this has all been a pretty heavy topic this week. we heard from a massai woman who has a women's organization for the massai who was very interesting also. there are so many factors to reckon with when attempting to diseminate info. for one there are age sets here- the massai but also many other tribes here have the boys go through puberty rituals with all the other boys their age, they are an 'age-set' and there are leaders among them. if you go to a community and try to hold a general info. session you may get nowhere. first you get invited, then the age set leaders decide who you should talk to, and so forth. but back to the nun, that wasn't the question someone asked her. rather a classmate who is also a catholic, from mozambique asked what about the situation of a husband who know's he's hiv + and he wants to protect his wife and family, but continue in the marraige- what about condom use for him?- she asked because she said another rule for catholics is to protect your family above all else. the question's answer wandered off into any topic except the actual question. we didn't push it too much- the nun was a saint with the work she is doing, and yet the condom thing...
the bio-intensive farming has certainly been the most hopeful segment of our work thus far- another interesting point the massai woman brought up was that if presenters go into the massai communities with a package talk, they'll listen politely but dismiss it as something to do with the outside world and not them- if they are to take any of it seriously they have to be a part of the conversation from the very begining- it can't just be a delivered lecture- it has to be a conversation which they can own as their own.
next week we're going out to do our nutrition etc. trainings in the villages and we've been instructed to bring soda, white bread and peanut butter to offer a lunch! i couldn't believe it! but the trainings are a bit of a give and take i guess- some incentive along with the info-