First set of pictures up...
https://picasaweb.google.com/106419429553511755451/Tbilisi?authkey=Gv1sRgCJyhnr6rj9WzVg
https://picasaweb.google.com/106419429553511755451/Tbilisi?authkey=Gv1sRgCJyhnr6rj9WzVg
Tuesday, October 2, 2012
Reflections on Georgian Elections
Telavi
Georgian wine country.
Mountainous, green. After a windy mountain ride, up to almost 2000
meters and down again from Tbilisi, we find ourselves at Chateau Mere, an old
castle looking building, functioning vineyard, winery and hotel. The swimming
pool, flanked by stone walls with wide open windows, made to look like roman
ruins, looks down on the countryside below. I sip my deep red wine, from some
of the oldest grape vintages in the world, nibble on my khachapuri, and
ruminate about the past several days.
Georgian elections. I don’t even know where to begin, but I
feel lucky and honored to have been on the ground for this historical time for
Georgia, and to have had the privilege to speak to so many locals, from so many
different classes and viewpoints. Most of the reports you will read in the US
papers will not be as informed as they could be, as we have been, from taking
the time to ask people here what they think. Here is my understanding of the
situation.
Sakashvili, the current president. Western educated, has
created a political identity and life for the Georgian people distinct from
Russia. Has kept his distance from associating with Russia, is not open to
economic exchange (oil pipelines going through Georgia to Russia currently
closed off), even started the war with Russia in 2008. In many ways, life is
better for people here now than it was in the 1990s. This is now a modern
country. Reliable electricity, good roads, clean streets, reliable police. Very
safe, in that the level of corruption has been moved up to higher reaches of
government. No longer must you bribe the
local police officer. Locals and tourists
alike feel safe walking the streets late at night, even leaving their doors
unlocked. In some ways though, he has
hurt the economy with his refusal to associate more closely with Russia, who potentially
would be a great market for Georgian exports. People here are feeling the bite
of the world recession, of fewer jobs. Older people who used to rely on their
pensions during the Soviet era no longer have that safety net. Sakashvili has
proposed implementing income taxes, a new idea to many, that they do not
welcome. And lastly, there is the prison
scandal. Sakashivili came down very hard on crime, and even petty theft landed
people in jail. Seems that most people in the country know somebody who has
been in jail. And when a few months before the election, videos emerged of
extreme maltreatment of Georgian prisoners (think Abu Graib), there was mass
public outcry, especially among the youth. Some people claim these videos were
fabricated by the opposition to make Sakashvili look bad. We probably will never know.
Ivanashvili. Emerged from post-Soviet era as one of the top
billionaires in the world. Was previously
very reclusive, although funded many initiatives in this country. Also, interestingly, was a big supporter of actors and the arts, after
there was no longer a USSR to support them anymore. Would like to turn around
the economy and continue to push Georgia forward, which mostly means closer
economic ties with Russia. He has
created the “Georgian Dream Coalition” essentially a coalition of several
parliamentary parties, to come together to overpower the current party in
power. Has also gotten several of the actors he was supporting to become the
next round of politicians to run for office.
Wants to improve the economy, further eliminate corruption at the upper
levels of government. However, many fear his closer ties with Russia will mean
he will be under Putin’s control, even if not overtly. Our hostess this morning at our Tbilisi
guesthouse, a middle class female, who has been successful and hardworking in
business with her husband, said she is afraid that all the youth supporting
Ivanashvili do not remember how hard Georgians fought to get away from the control
and influence of Russia, and how life overall is better now than it was before.
Each side we have spoken with has been fair, well thought
out, and wanting the best. There are no good answers here.
While overall the elections seem to have been free and fair
at the polls, there seem to have been unfair techniques used beforehand, like
state television stations unwilling to broadcast views and material of opposition
parties, especially affecting access to information for those in the
countryside. Our taxi driver even told us yesterday that the buses were running
less frequently yesterday, to make it harder for people to make it to the
polls.
Yesterday evening, whether based on exit polls or just the
feeling of an overall free and fair election, Georgian Dream supporters were
dancing and celebrating in the streets. Honking horns, people cheering, music, rallies.
Think post-Super Bowl or World Series victories, nothing scary or threatening.
The police watched calmly. I have never seen Americans so excited about or involved with politics.
Enough election results came in today to show a solid
victory for the Georgian Dream Coalition, or solid enough for Sakashvili to
actually concede. I breathe a sigh of relief. Good for him, to let Georgia
actually continue to grow as a true democracy. Whether the outcome of the
peoples’ choice will truly benefit them is yet to be seen.
Sunday, September 30, 2012
Tbilisi
Tbilisi
Fabulous conglomeration of very old, sort of old, soviet old, new, and uber new, all in some combination that I've never experienced before. Open excavations of ancient streets below modern streets, next to 19th century two story buildings with Middle Eastern style grates, next to Soviet Block apartment buildings, next to wide tree lined majestic European boulevards, next to glass and steel modern architecture. Churches galore both old and new, a mosque, a synagogue. Influences of Mongols, Turks, Arabs, Persians, Russians, and something unique altogether. Georgia has their own alphabet, unlike any other I've seen.
The people are absolutely lovely. Friendly, talkative, wanting to get to know us in a positive, unpushy, not trying to sell you something kind of way. Every taxi driver has a tourist tip, and a political opinion. The women are beautiful and fashionable, well dressed enough to fit in with any of the great fashion cities of Europe. The men are good looking, although seem to enjoy their overly tight clothing.
Parliamentary elections are tomorrow. The two choices seem to be the lesser of two evils, and even that is giving them credit. The opposition party rally yesterday was the most peaceful gathering I have ever seen, a family day gathering, with people of all ages, classes, manner of dress, gathering with balloons, flags, music. Not a policeman to be seen. Hopefully it will stay that way after the elections as well.
As I stroll my way through town, up and down mountains, through plazas and narrow streets, over bridges and to rooftops, I sample tastes of Georgian cuisine - Khachapuri (cheesy bread), eggplant and walnut puree, cold spinach fritters, smoked cheeses, all garnished with pomegranate seeds, fresh juice galore, and lots of Turkish coffee.
A very cool city through and through.
Fabulous conglomeration of very old, sort of old, soviet old, new, and uber new, all in some combination that I've never experienced before. Open excavations of ancient streets below modern streets, next to 19th century two story buildings with Middle Eastern style grates, next to Soviet Block apartment buildings, next to wide tree lined majestic European boulevards, next to glass and steel modern architecture. Churches galore both old and new, a mosque, a synagogue. Influences of Mongols, Turks, Arabs, Persians, Russians, and something unique altogether. Georgia has their own alphabet, unlike any other I've seen.
The people are absolutely lovely. Friendly, talkative, wanting to get to know us in a positive, unpushy, not trying to sell you something kind of way. Every taxi driver has a tourist tip, and a political opinion. The women are beautiful and fashionable, well dressed enough to fit in with any of the great fashion cities of Europe. The men are good looking, although seem to enjoy their overly tight clothing.
Parliamentary elections are tomorrow. The two choices seem to be the lesser of two evils, and even that is giving them credit. The opposition party rally yesterday was the most peaceful gathering I have ever seen, a family day gathering, with people of all ages, classes, manner of dress, gathering with balloons, flags, music. Not a policeman to be seen. Hopefully it will stay that way after the elections as well.
As I stroll my way through town, up and down mountains, through plazas and narrow streets, over bridges and to rooftops, I sample tastes of Georgian cuisine - Khachapuri (cheesy bread), eggplant and walnut puree, cold spinach fritters, smoked cheeses, all garnished with pomegranate seeds, fresh juice galore, and lots of Turkish coffee.
A very cool city through and through.
Thursday, September 27, 2012
Well, it's been three years since my last post, on a weekend trip to Zimbabwe, and three years since I left Zambia. Now it's time to return to the great continent, this time to Rwanda. I figured I would start up the blog again too, since many of you had asked for updates.
First I'm headed for a little jaunt in Georgia, then Istanbul, and finally on to Kigali on October 8th.
Check back for more travel details and pictures as I can post them.
First I'm headed for a little jaunt in Georgia, then Istanbul, and finally on to Kigali on October 8th.
Check back for more travel details and pictures as I can post them.
Monday, May 4, 2009
Weekend in Zim
The Zimbabwe of the news world, when it’s covered at all, is a Zimbabwe ravaged by years of tyrannical rule. It’s a Zimbabwe of cholera outbreaks, of crumbling infrastructure, of supply shortages, of kidnapped journalists, of farms overrun and dilapidated, of a currency so inflated that the US dollar has now taken its place as the official currency. It may in fact be all of those things, but in my brief glance at it this weekend, I saw glimpses of the great country it must have been, and still is in some ways. In a brief couple of days, I understood the love of my white Zimbabwean friends for their lost homeland. I drove through breathtaking, great rolling, acacia and baobab tree covered hills, along well-maintained roads no less! I passed by massive (empty) silos, laying in wait for a time when Zim can return to being the great agricultural giant it once was. I stared in shock at the beautiful, CLEAN, tree-lined city streets of Harare, plots with large lawns, and appealing, shiny and modern buildings downtown. I danced at the Harare International Festival of the Arts in Harare Gardens, a massive park complex in the middle of the city. If I squinted a bit, I could almost have been in any big US city, tall hotels peaked from between the palms and deciduous trees that surrounded the music stage. I soaked up the culture- the music, the dance, and the artwork in the National Gallery. I enjoyed the festival together with well-dressed, well-spoken, well-educated Zimbabweans of all sorts, black and white.
What’s wrong with you Zambia?! You could learn a thing or two from your neighbors. You have so much potential! Even with Mugabe’s awful control, Zim seems so much more put together, at least in some ways. The roads, the city, the education, the culture. How does a suffering country keep its roads drivable, its people educated, its parks beautiful? Lusaka doesn’t even have parks!!! I could not get over how clean it was. In Lusaka, garbage on the streets is the norm, but in Harare, there was barely any. You have to look hard in Lusaka to find incredibly intelligent and driven Zambians, yet just in my brief few hours in Harare, I feel I observed several Zimbabweans like that. A week-long festival of the arts would never ever work in Zambia. There wouldn’t be a venue for it. And nobody to clean up after it. And the electronics for the stage would never work, at least not well, and not for the whole time. Just about the only obvious sign to me that all was not right in Harare, was having to drive through several gas stations with no gas, before we could find enough to get us back to Makuti, in northern Zimbabwe where we were staying.
There were multiple time over the weekend, as I sat on the second story deck of Rodney’s friends’ house in Makuti, overlooking nothing but breathtaking rolling hills, that I just wanted to scream out loud, or collapse in happiness, or hold my breath, from the loveliness of it all, of being able to see it and experience it and take it all in.
Of course it was only a weekend, at a vacation home in a quiet part of the country. I did not stay in Harare long term. I did not have to interact with clinic staff and ministry of health officials. My view of Zim was a vacation view. And of course it’s not all well and good there. Of course there are shortages of nearly everything, including food and medicine, and many people are suffering greatly.
This was Rodney’s first time being back for seven years. I asked him about it, and he said it was good to be back, but so much of the experience for him was intense memories. Every bend of the road, it seemed, he would glance around- Is that farm still there? Is that restaurant still open? I wonder if so and so still lives there? He even tried calling an old neighbor of his, but the phone lines weren’t working. At the festival, we saw children performing from the school where he used to teach. He recognized old students of his, now with children of their own. For him, I think, it was good to see that life was going on and people were making do, but it was also a reminder of a place he could never really go back to. Even if he did, he would never really be accepted, at least not by the government, as the Zimbabwean he once was. He would just be a white South African with a South African passport, just another ex pat wanting to move there.
When we decided to go to Zim for the weekend, I was curious how much of the obvious signs of suffering I would see, to get a sense for how bad things really are there. I could never have expected to see what I actually saw. But I’m glad that I did. I’m glad I got to know the good parts of life in Zim, all that it is now, and a flavor of what it once was. I feel now that I can better share in the hope that one day, when Mugabe has finally gone away, that it may return to that, or maybe even better, a true example to the countries around it, including Zambia.
After crossing the border, as we headed back to Lusaka, I noticed every pothole we had to avoid and every pile of burning garbage. Although the landscape of Southern Zambia is very similar to that of Northern Zimbabwe, and it is indeed beautiful, it somehow lacked the special feeling that I got in Zim when taking it all in.
Or perhaps I just had a Zim-biased weekend. I don’t mean to paint Zambia in a bad light. Lusaka is indeed a relatively developed and modern city, and I found more here than I ever expected to, but contrasting it with its southern neighbor, they’ve a long way to go on the road to development.
What’s wrong with you Zambia?! You could learn a thing or two from your neighbors. You have so much potential! Even with Mugabe’s awful control, Zim seems so much more put together, at least in some ways. The roads, the city, the education, the culture. How does a suffering country keep its roads drivable, its people educated, its parks beautiful? Lusaka doesn’t even have parks!!! I could not get over how clean it was. In Lusaka, garbage on the streets is the norm, but in Harare, there was barely any. You have to look hard in Lusaka to find incredibly intelligent and driven Zambians, yet just in my brief few hours in Harare, I feel I observed several Zimbabweans like that. A week-long festival of the arts would never ever work in Zambia. There wouldn’t be a venue for it. And nobody to clean up after it. And the electronics for the stage would never work, at least not well, and not for the whole time. Just about the only obvious sign to me that all was not right in Harare, was having to drive through several gas stations with no gas, before we could find enough to get us back to Makuti, in northern Zimbabwe where we were staying.
There were multiple time over the weekend, as I sat on the second story deck of Rodney’s friends’ house in Makuti, overlooking nothing but breathtaking rolling hills, that I just wanted to scream out loud, or collapse in happiness, or hold my breath, from the loveliness of it all, of being able to see it and experience it and take it all in.
Of course it was only a weekend, at a vacation home in a quiet part of the country. I did not stay in Harare long term. I did not have to interact with clinic staff and ministry of health officials. My view of Zim was a vacation view. And of course it’s not all well and good there. Of course there are shortages of nearly everything, including food and medicine, and many people are suffering greatly.
This was Rodney’s first time being back for seven years. I asked him about it, and he said it was good to be back, but so much of the experience for him was intense memories. Every bend of the road, it seemed, he would glance around- Is that farm still there? Is that restaurant still open? I wonder if so and so still lives there? He even tried calling an old neighbor of his, but the phone lines weren’t working. At the festival, we saw children performing from the school where he used to teach. He recognized old students of his, now with children of their own. For him, I think, it was good to see that life was going on and people were making do, but it was also a reminder of a place he could never really go back to. Even if he did, he would never really be accepted, at least not by the government, as the Zimbabwean he once was. He would just be a white South African with a South African passport, just another ex pat wanting to move there.
When we decided to go to Zim for the weekend, I was curious how much of the obvious signs of suffering I would see, to get a sense for how bad things really are there. I could never have expected to see what I actually saw. But I’m glad that I did. I’m glad I got to know the good parts of life in Zim, all that it is now, and a flavor of what it once was. I feel now that I can better share in the hope that one day, when Mugabe has finally gone away, that it may return to that, or maybe even better, a true example to the countries around it, including Zambia.
After crossing the border, as we headed back to Lusaka, I noticed every pothole we had to avoid and every pile of burning garbage. Although the landscape of Southern Zambia is very similar to that of Northern Zimbabwe, and it is indeed beautiful, it somehow lacked the special feeling that I got in Zim when taking it all in.
Or perhaps I just had a Zim-biased weekend. I don’t mean to paint Zambia in a bad light. Lusaka is indeed a relatively developed and modern city, and I found more here than I ever expected to, but contrasting it with its southern neighbor, they’ve a long way to go on the road to development.
Friday, February 27, 2009
More on Gender
Two unrelated stories to make me reflect further on gender in Zambia.
Story #1
This story also makes me reflect on myself, on how trusting I am, or how much I choose to see the good in people, because my reaction to a patient and reaction of Dr. Jack were very different.
I saw a patient on Wednesday. A man in his 40s, on ARVs for several years now. Has been doing fairly well, says he is adherent to his medications (but everyone always does). On this visit, we noted a largish drop in his CD4 count, not quite significant enough to consider assessing him for treatment failure, but it was a drop. But on exam he looked fine, he hadn’t had any recent illnesses or infections. I asked him if he was married, and then I asked if his wife has been tested, and here is the story he tells me.
Yes, she was tested in 2005 at UTH (University Teaching Hosptial) when she was pregnant, and the test was negative, but I don’t believe it. How could she be negative after all that time we were together?
So my initial thought about this statement was, he was worried about her. He really did feel she should recheck, that it could be a false negative, that since he’s infected it would be likely she is too. When I asked if he had suggested she test again, he said it wasn’t his place. Then he asked me this:
From 1991 until 2001, I was completely abstinent. Since that time, I have only had unprotected sex with my wife. Is it possible I could have been infected as long ago as 1991?
Again, my first thought about this statement was that he was really trying to figure out if his wife could really be positive and not getting treated. And I went into an explanation of the evolution of an HIV infection, and how it’s perfectly possible that he was infected back then, and he could have been healthy all this time as his CD4 count slowly went down.
So then Dr. Jack comes in, notes the large drop in CD4 count, immediately starts probing about how adherent to his medication the man really is. That’s Dr. Jack’s big thing, your CD4 drops, you’re having adherence issues. So he starts asking him about the situation at home, if there’s trouble with his wife, if he’s depressed. What Dr. Jack picks up on right away, and I did not at all, is that this man isn’t asking these questions because he’s worried about his wife, he’s asking because he’s blaming her. He thinks it’s her fault, that she really is positive and she infected him. It’s all about the blame game. Dr. Jack shares a story about another patient of his, a girl who got raped when she was 13, got a baby out of it, and then never had sex again (and he believes her). And 26 years later is when she was diagnosed with HIV because of multiple AIDS related infections. That is way above the upper limit of normal for how long it can take to develop AIDS, but it’s possible. For this man, 10 years is higher, but by no means uncommon.
The man started getting a bit uncomfortable and clearly didn’t want to be there anymore, kept looking at his phone, at his watch. He left as quickly as he could.
But there it is, I hear it all time, about men who refuse to get an HIV test, even when their wives come home from the pre-natal clinic found to be HIV+, even when their little newborns get diagnosed with HIV, these men blame their wives and do not think it could be themselves.
I’d like to acknowledge the fact that it could be his wife, maybe it was a false negative test and she did get HIV first. By no means am I saying it’s always the men. But if often is. And if they refuse to be equal partners in testing and prevention, if we can’t get beyond the figure pointing to the point of, well, we’re infected, what can we do about this now? we will never curb this HIV crisis.
Story #2
I went out to lunch yesterday with my supervisor Steph and Julian, one of the nurses who works with us at CIDRZ. We are the OPD-ART integration team, and we thought it would be nice to have a lunch together to acknowledge all the progress we’ve made over the last year. Over the course of the conversation, Steph asked Julian how she had met her husband, and she proceeded to tell us a wonderful story of serendipity.
Julian had been a nursing student at a hospital in the Copperbelt and her (future) husband had been a Ministry of Health official, visiting the hospital and met Julian because he stopped her in the hallway to ask for directions to an office. He had been enchanted with her, and later found her again to thank her. After that encounter, he wrote her a couple of letters, but she wasn’t really sure how to respond and she didn’t.
Two years later, she had graduated, and moved to hospital up in Northern Province. He had just taken a job there too, in the MoH office, although neither of them knew about the presence of the other. One day, he saw her name on a roster, and wondered if it was the same Julian. He asked that she be called in to the office to see him.
So there she is, working at the hospital and gets a message that she’s been summoned to the district health office to see the Director of such and such (but no name) and she has no idea why. She figures it’s because she’s getting fired. She said it was a long walk over to the office. Then when she told the secretary she had an appointment, the secretary asked why, and Julian said she didn’t know, and the secretary thought there must be some mistake, because why would such an (unimportant) woman be told to meet the Director of such and such if she didn’t even know why. But the appointment was confirmed and Julian was shown into his office, while he wasn’t there, to sit and contemplate her impending job loss.
Then he walked in, and smiled, and said, “Ahh, it’s you!”
She was definitely in shock at first, and didn’t know what to say, and felt bad for not returning his letters. But sounds like she got over it, because after 6 months of dating they got engaged.
I tell this story because it’s so cute, but the gender part relates to a statement Julian made after telling the story.
She said, “I really thank God for giving me such a truly good man. He loves me and he loves our children, and he supports us, and he helps take care of the children and the house, and I feel so lucky for such a good man.”
At first, hers statement made me a little sad, the fact that it meant so much to her implied to me that it’s not the norm here, and I’ve certainly observed that. Even some of the upper-middle class Zambian women I’ve met here tell me about how their husbands will come home from work, kick up their feet, read the paper, and expect their wives to do it all, they won’t lift a finger at home.
But then her statement also made me think about the way things are at home. Some of these things have become a given, at least in some parts of the country, men are expected to do these things-house cleaning, child care- and when they don’t, their wives get upset. Should they be so upset? Should they be more thankful, or at least, acknowledging of the help their husbands offer at home? Would more marriages be healthy and strong, from just those simple acknowledgments?
How different, really, are gender roles here and in the US?
Story #1
This story also makes me reflect on myself, on how trusting I am, or how much I choose to see the good in people, because my reaction to a patient and reaction of Dr. Jack were very different.
I saw a patient on Wednesday. A man in his 40s, on ARVs for several years now. Has been doing fairly well, says he is adherent to his medications (but everyone always does). On this visit, we noted a largish drop in his CD4 count, not quite significant enough to consider assessing him for treatment failure, but it was a drop. But on exam he looked fine, he hadn’t had any recent illnesses or infections. I asked him if he was married, and then I asked if his wife has been tested, and here is the story he tells me.
Yes, she was tested in 2005 at UTH (University Teaching Hosptial) when she was pregnant, and the test was negative, but I don’t believe it. How could she be negative after all that time we were together?
So my initial thought about this statement was, he was worried about her. He really did feel she should recheck, that it could be a false negative, that since he’s infected it would be likely she is too. When I asked if he had suggested she test again, he said it wasn’t his place. Then he asked me this:
From 1991 until 2001, I was completely abstinent. Since that time, I have only had unprotected sex with my wife. Is it possible I could have been infected as long ago as 1991?
Again, my first thought about this statement was that he was really trying to figure out if his wife could really be positive and not getting treated. And I went into an explanation of the evolution of an HIV infection, and how it’s perfectly possible that he was infected back then, and he could have been healthy all this time as his CD4 count slowly went down.
So then Dr. Jack comes in, notes the large drop in CD4 count, immediately starts probing about how adherent to his medication the man really is. That’s Dr. Jack’s big thing, your CD4 drops, you’re having adherence issues. So he starts asking him about the situation at home, if there’s trouble with his wife, if he’s depressed. What Dr. Jack picks up on right away, and I did not at all, is that this man isn’t asking these questions because he’s worried about his wife, he’s asking because he’s blaming her. He thinks it’s her fault, that she really is positive and she infected him. It’s all about the blame game. Dr. Jack shares a story about another patient of his, a girl who got raped when she was 13, got a baby out of it, and then never had sex again (and he believes her). And 26 years later is when she was diagnosed with HIV because of multiple AIDS related infections. That is way above the upper limit of normal for how long it can take to develop AIDS, but it’s possible. For this man, 10 years is higher, but by no means uncommon.
The man started getting a bit uncomfortable and clearly didn’t want to be there anymore, kept looking at his phone, at his watch. He left as quickly as he could.
But there it is, I hear it all time, about men who refuse to get an HIV test, even when their wives come home from the pre-natal clinic found to be HIV+, even when their little newborns get diagnosed with HIV, these men blame their wives and do not think it could be themselves.
I’d like to acknowledge the fact that it could be his wife, maybe it was a false negative test and she did get HIV first. By no means am I saying it’s always the men. But if often is. And if they refuse to be equal partners in testing and prevention, if we can’t get beyond the figure pointing to the point of, well, we’re infected, what can we do about this now? we will never curb this HIV crisis.
Story #2
I went out to lunch yesterday with my supervisor Steph and Julian, one of the nurses who works with us at CIDRZ. We are the OPD-ART integration team, and we thought it would be nice to have a lunch together to acknowledge all the progress we’ve made over the last year. Over the course of the conversation, Steph asked Julian how she had met her husband, and she proceeded to tell us a wonderful story of serendipity.
Julian had been a nursing student at a hospital in the Copperbelt and her (future) husband had been a Ministry of Health official, visiting the hospital and met Julian because he stopped her in the hallway to ask for directions to an office. He had been enchanted with her, and later found her again to thank her. After that encounter, he wrote her a couple of letters, but she wasn’t really sure how to respond and she didn’t.
Two years later, she had graduated, and moved to hospital up in Northern Province. He had just taken a job there too, in the MoH office, although neither of them knew about the presence of the other. One day, he saw her name on a roster, and wondered if it was the same Julian. He asked that she be called in to the office to see him.
So there she is, working at the hospital and gets a message that she’s been summoned to the district health office to see the Director of such and such (but no name) and she has no idea why. She figures it’s because she’s getting fired. She said it was a long walk over to the office. Then when she told the secretary she had an appointment, the secretary asked why, and Julian said she didn’t know, and the secretary thought there must be some mistake, because why would such an (unimportant) woman be told to meet the Director of such and such if she didn’t even know why. But the appointment was confirmed and Julian was shown into his office, while he wasn’t there, to sit and contemplate her impending job loss.
Then he walked in, and smiled, and said, “Ahh, it’s you!”
She was definitely in shock at first, and didn’t know what to say, and felt bad for not returning his letters. But sounds like she got over it, because after 6 months of dating they got engaged.
I tell this story because it’s so cute, but the gender part relates to a statement Julian made after telling the story.
She said, “I really thank God for giving me such a truly good man. He loves me and he loves our children, and he supports us, and he helps take care of the children and the house, and I feel so lucky for such a good man.”
At first, hers statement made me a little sad, the fact that it meant so much to her implied to me that it’s not the norm here, and I’ve certainly observed that. Even some of the upper-middle class Zambian women I’ve met here tell me about how their husbands will come home from work, kick up their feet, read the paper, and expect their wives to do it all, they won’t lift a finger at home.
But then her statement also made me think about the way things are at home. Some of these things have become a given, at least in some parts of the country, men are expected to do these things-house cleaning, child care- and when they don’t, their wives get upset. Should they be so upset? Should they be more thankful, or at least, acknowledging of the help their husbands offer at home? Would more marriages be healthy and strong, from just those simple acknowledgments?
How different, really, are gender roles here and in the US?
Friday, February 13, 2009
Weeks'-End-Update and a Word about Food
It already feels like ages since that last uplifting entry and yet the weeks have flown by lightning fast, I can’t believe it’s already Friday again. But it’s all been rushing forward towards big things.
Next week is big, for both of my projects.
Monday is ART-OPD integration at clinic number 3, in a neighborhood called Chazanga. It's hard to believe it all happened so quickly. When I first got here in July, they had spent 9 months preparing to integrate the first clinic, Ng’ombe. Chazanga we planned from start to finish in less than 3 months. Something that makes this clinic unique is that they don’t yet have an ART program. ART will be starting next week as well. So not only are they initiating ART, but it is beginning as a fully integrated clinic, with ART just part of the outpatient department. It will be nice because we don't have to rework any of the established systems in the clinic, but it will be more challenging for the staff I think because they will just be learning how to work in an ART clinic. It's nice for the patients, because until now, they haven't had ART in their neighborhood clinic, and they've had to travel to other health centers to get their ARVs. Now it'll be close to home, and I think we're going to have a lot more people testing for HIV, since we've made (opt out) testing a standard part of any clinic visit.
My peer educator program evaluation moved along nicely as well. The interviews are complete. Let me tell you, it was a royal pain in the butt coordinating availability of my staff, who were conducting the interviews, with availability of the clinic staff to be interviewed, with availability of transport to get them there. But somehow (with a few extra visits to the clinics, why did we have to choose the furthest away clinics for our program) we managed to interview everyone we intended to.
Next week we're hosting officials from the local Ministry of Health, doing a site visit with them so they can see what the peer educators are doing, and then presenting them with the data we've collected. Overall there's been a very positive response to the program, from staff and from patients. And the concern that the people who volunteer at TB corner would be resentful of our peers getting paid to work at TB corner was somewhat founded, but doesn't seem to be too harmful overall. Everyone here is always looking for "motivation," incentives, snacks, transport allowances. I think the only thing holding us back from expanding this peer program will be available funding. I think our CDC funding is much tighter this year. Looks like if the MoH says yes, we will be able to continue the current peers at least for the coming year, but expanding it to other clinics looks uncertain. I’ll know on Wednesday if I can call this project a success.
Wednesdays have become my clinic days, and it's been really awesome. I've been going long enough now that I'm even getting to see some patients who return for follow ups. Yesterday I saw the little 8 year old girl who I first saw a month ago for her initial history and physical. If you look back to my January entries, you can read all about what a bad condition she was in at the time.
Right after I saw her in January, she was initiated on anti TB therapy and given various antibiotics and antifungals for her opportunistic infections. She definitely looked better yesterday than the last time I saw her! For kids we do CD4%age instead of absolute CD4 count. Her %age was, get this, 0.4%! Anything under 25% is considered getting low. Her CD4 count was essentially nothing. We initiated her on ARVs yesterday, it was really interesting for me to see how we go about doing that, choosing which drugs and which doses, based on her co-infections and other medications. Concurrent ARVS and TB treatment can be tricky. Of course just this morning I read an article about IRIS, immune reconstitution inflammatory syndrome, a serious condition patients can get after initiating ARVs while already on TB treatment. Now I keep thinking of her and hope I don’t see her in a few weeks time with that too. It's hard to see kids like that, but I really enjoy the overall experience too, the medicine, the interaction, the support, the learning.
I have to say though, working in an HIV clinic makes is not helping me remember my non-infectious disease stuff. I saw another patient a few weeks back, a friend of someone at the clinic who just needed to be seen for malaria like symptoms, HIV negative. Long story short, I totally wanted to work her up for SLE (lupus) after talking to her for a long time. But sadly, a simple ANA is hard to get and very expensive too. And it wouldn't have been worth it for her, she's not doing all that badly. And then who would manage it? Maybe for me it would just have been the thrill of making that kind of diagnosis, in a place where usually people never know they have those types of conditions.
It’s going to be another busy weekend as usual. 8 mile run. The return of Stitch n’ Bitch Lusaka, first one for 2009. Birthday party for one of our friends, with Thai lady catering. Sadly, the boat shipment did not come in, and there will be no Pad Thai due to the lack of noodles.
Curious what food items are available and not available, and when. I shouldn’t complain. Before I got here, I expected no availability whatsoever. I pictured myself eating onions, tomatoes, eggplant and carrots all year. But once I’ve been given the opportunity to buy an item here, it makes me sad when I can’t.
Cilantro
Red chili paste
Couscous
Balsamic vinegar
Granola
Chickpeas
Celery
Canned diced tomatoes
Tahini
Sweet corn
Usually when they’re out of a particular item, they’re really out of it. Like a totally empty shelf, you reach all the way up to see if maybe one is left all the way at the back and come back with a dirty hand, and no more in for weeks. I don’t think I’ve ever made a grocery trip without not being able to find at least two of the items on my list, items that are usually there. We like to come home saying, “Gosh, there’s a run on lentils and popcorn this week!” This week I really wanted parsnips, and they actually almost always have them. But they tried to be sneaky, they put Chinese turnips on the shelf instead, long and white and root looking yes, but not really the same thing at all. Celery is just luck of the draw. Zambians don’t really do celery. But they know mzungus like it. Sometimes they only have little milk cartons instead of big ones, or small trays of eggs instead of large ones, or only instant coffee, or no instant coffee. Good thing there hasn’t been a run on toilet paper yet.
Next week is big, for both of my projects.
Monday is ART-OPD integration at clinic number 3, in a neighborhood called Chazanga. It's hard to believe it all happened so quickly. When I first got here in July, they had spent 9 months preparing to integrate the first clinic, Ng’ombe. Chazanga we planned from start to finish in less than 3 months. Something that makes this clinic unique is that they don’t yet have an ART program. ART will be starting next week as well. So not only are they initiating ART, but it is beginning as a fully integrated clinic, with ART just part of the outpatient department. It will be nice because we don't have to rework any of the established systems in the clinic, but it will be more challenging for the staff I think because they will just be learning how to work in an ART clinic. It's nice for the patients, because until now, they haven't had ART in their neighborhood clinic, and they've had to travel to other health centers to get their ARVs. Now it'll be close to home, and I think we're going to have a lot more people testing for HIV, since we've made (opt out) testing a standard part of any clinic visit.
My peer educator program evaluation moved along nicely as well. The interviews are complete. Let me tell you, it was a royal pain in the butt coordinating availability of my staff, who were conducting the interviews, with availability of the clinic staff to be interviewed, with availability of transport to get them there. But somehow (with a few extra visits to the clinics, why did we have to choose the furthest away clinics for our program) we managed to interview everyone we intended to.
Next week we're hosting officials from the local Ministry of Health, doing a site visit with them so they can see what the peer educators are doing, and then presenting them with the data we've collected. Overall there's been a very positive response to the program, from staff and from patients. And the concern that the people who volunteer at TB corner would be resentful of our peers getting paid to work at TB corner was somewhat founded, but doesn't seem to be too harmful overall. Everyone here is always looking for "motivation," incentives, snacks, transport allowances. I think the only thing holding us back from expanding this peer program will be available funding. I think our CDC funding is much tighter this year. Looks like if the MoH says yes, we will be able to continue the current peers at least for the coming year, but expanding it to other clinics looks uncertain. I’ll know on Wednesday if I can call this project a success.
Wednesdays have become my clinic days, and it's been really awesome. I've been going long enough now that I'm even getting to see some patients who return for follow ups. Yesterday I saw the little 8 year old girl who I first saw a month ago for her initial history and physical. If you look back to my January entries, you can read all about what a bad condition she was in at the time.
Right after I saw her in January, she was initiated on anti TB therapy and given various antibiotics and antifungals for her opportunistic infections. She definitely looked better yesterday than the last time I saw her! For kids we do CD4%age instead of absolute CD4 count. Her %age was, get this, 0.4%! Anything under 25% is considered getting low. Her CD4 count was essentially nothing. We initiated her on ARVs yesterday, it was really interesting for me to see how we go about doing that, choosing which drugs and which doses, based on her co-infections and other medications. Concurrent ARVS and TB treatment can be tricky. Of course just this morning I read an article about IRIS, immune reconstitution inflammatory syndrome, a serious condition patients can get after initiating ARVs while already on TB treatment. Now I keep thinking of her and hope I don’t see her in a few weeks time with that too. It's hard to see kids like that, but I really enjoy the overall experience too, the medicine, the interaction, the support, the learning.
I have to say though, working in an HIV clinic makes is not helping me remember my non-infectious disease stuff. I saw another patient a few weeks back, a friend of someone at the clinic who just needed to be seen for malaria like symptoms, HIV negative. Long story short, I totally wanted to work her up for SLE (lupus) after talking to her for a long time. But sadly, a simple ANA is hard to get and very expensive too. And it wouldn't have been worth it for her, she's not doing all that badly. And then who would manage it? Maybe for me it would just have been the thrill of making that kind of diagnosis, in a place where usually people never know they have those types of conditions.
It’s going to be another busy weekend as usual. 8 mile run. The return of Stitch n’ Bitch Lusaka, first one for 2009. Birthday party for one of our friends, with Thai lady catering. Sadly, the boat shipment did not come in, and there will be no Pad Thai due to the lack of noodles.
Curious what food items are available and not available, and when. I shouldn’t complain. Before I got here, I expected no availability whatsoever. I pictured myself eating onions, tomatoes, eggplant and carrots all year. But once I’ve been given the opportunity to buy an item here, it makes me sad when I can’t.
Cilantro
Red chili paste
Couscous
Balsamic vinegar
Granola
Chickpeas
Celery
Canned diced tomatoes
Tahini
Sweet corn
Usually when they’re out of a particular item, they’re really out of it. Like a totally empty shelf, you reach all the way up to see if maybe one is left all the way at the back and come back with a dirty hand, and no more in for weeks. I don’t think I’ve ever made a grocery trip without not being able to find at least two of the items on my list, items that are usually there. We like to come home saying, “Gosh, there’s a run on lentils and popcorn this week!” This week I really wanted parsnips, and they actually almost always have them. But they tried to be sneaky, they put Chinese turnips on the shelf instead, long and white and root looking yes, but not really the same thing at all. Celery is just luck of the draw. Zambians don’t really do celery. But they know mzungus like it. Sometimes they only have little milk cartons instead of big ones, or small trays of eggs instead of large ones, or only instant coffee, or no instant coffee. Good thing there hasn’t been a run on toilet paper yet.
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