Mozy on Down

Veronica and I spent the day hanging out in Pretoria with friends. All were preparing to head off on one adventure or another for the Holidays, a time when South Africa shuts down. We took care of last minute banking, since we would be out of the country for more than two weeks. After that we just chilled before the journey’s start. We took the Gautrain to the “Luxury “Bus Terminal – which must be a reference to the busses because the terminal is no great shakes – adjacent Bozeman Train Station at about 7:30 to catch out Intecape overnight to Maputo, Mozambique at 8:20. Bags securely loaded in the trailer towed behind the double decker bus, we found seats on the lower level, avoiding the swaying of the upper deck. “V” took the window seat, her seat, on the right side of the bus. I took the aisle for more leg room on the overnight trip. Off we went. She slept most of the way, clearing the residue of over exuberant nights at COS Conference. I watched her and the night pass, dozing as I could, plagued by the bus’s faulty air conditioning which emitted a blizzard gale or nothing at all, turning the already close cabin into an airless sweatbox. We passed through Nelspruit in the early hours of the morning, the last stop in South Africa. We arrived at the South Africa – Mozambique border with the rising sun, glad for the opportunity to stretch our legs and get some fresh air.

The transit was uneventful. We had both secured our visas in the month before to avoid any hassle at the border. When we arrived at the bus stop in Maputo, – no terminal, just a spot on the street near the Intecape office – a dozen or so taxi drivers were already there waiting. They all knew Fatima’s, the backpacker at which we had booked beds for the night. We negotiated a good price with one driver but lost him to others while we waited for out bags to emerge from the trailer, the down side of being one of the first aboard the bus. We found another, but could not get the better price and settling for the per person standard fare, we had to share the petite car with another traveller. I didn’t think we would get our bags in but did- mercilessly jammed into the trunk and piled on top of us.

Maputo is an African city, and the fact that it is in one of the poorest countries in the world shows. There few street signs and there is no traffic control to speak of. In places the streets barely exist at all, offering off-roading opportunities through wind rows of trash to the taxi drivers and their rat trap cabs held together with tape and wire. Unlike the mostly dry heat of Limpopo, the harbour city of Maputo is just sweaty, moisture pouring in from the warm Indian Ocean. Hawkers are ubiquitous, and at every turn you are offered the opportunity to purchase “original” art work and crafts claimed to be of the seller’s own hand that somehow look Identical to that sold on the streets and in the craft markets of Pretoria and almost any Southern Africa town. Despite its distress, Maputo has a certain charm and lacks the aura of racial tension that pervades the streets of most places in South Africa. That change was most welcome. Caution is still the watch word, but the feeling of the place is just more relaxed.

Veronica and I settled quickly into our dorm and soon found several South Africa Peace Corps volunteers from the class that followed ours already in residence. We headed into the city together, looking to change money, get copies of passports and get some food. We found the food at the fish market by the harbour. In the heat and having already walked for more than an hour on our other missions, we opted for taxis to get us there, though in theory it was a walkable distance. The fish market is just what the name implies, a place where fin fish, shell fish and squid are sold in open stalls without refrigeration. The fish is very fresh – literally right off the boats. You can buy your fish at a stall and take it to the restaurant to be cooked for a fee or you can trust the eye of the waiter at one of the restaurants to pick the fish for you. Either way, the cost is the cost at the stall plus a cooking fee. We trusted the waiter’s eye and the result was delicious. The good Mozambiquian beer is extra, and welcome.

V and I had only booked one night, this was a transition point not a destination, and we were up at 3 to catch the 4:30 Intercape bus to Vilankulos, some 700k north of Maputo along the coast. As far as Vilankulos, the road is fairly good, though it is mostly two lanes (one in each direction) and a little rough in places but paved the whole way. We heard later that once you get to Beira north of Vilankulos, there is little in the way of paved roads and a 4X4 a must. Though long, the trip is an interesting one, passing through village after village each with its share of aggressive hawkers selling mangos, cashews and good crusty Mozambiquian bread. The crush of the venders is sometimes so strong that it is impossible to buy anything even if you want to. Along the way the trees are hung with bags of cashews for sale, but the bus doesn’t stop so you can buy them. The bus company served a bag breakfast as we rolled along. It makes only a couple of stops, none long enough to get out and look around.

There is no formal bus stop for Vilankulos. The bus just stops at the side of the main road near the lesser road that leads to the sea. We were lucky enough to see a police officer (of the paramilitary type typical of many places in Africa carrying his automatic weapon) who directed us to a chapa, the Mozambiquian equivalent to the taxis in South Africa. In Moz, chapas can be mini buses or just a mini pickup truck with a cage on the back made of re-bar welded or wired together and covered with a tarp. Benches in the bed of the truck afford seating for ten to twelve people and then at least as many are crammed in standing. Being claustrophobic, I was lucky to get a seat at the end of the bench nearest the open back, though the “conductor” and two or three others rode on the back bumper blocking some of my light and air. Veronica was less fortunate, mashed between me and a drunken man and face to face, really nose to nose, with a baby held by his or her mother who was standing in the bed of the truck. I wish I had my camera but it was too cramped to dig it out. V laughed and didn’t seem to mind the baby, but the drunk got on her nerves. The little pickup raced down the narrow road, swerving and bouncing in a thrilling near death dance. It stopped every 5k or so to drop off or pick up passengers. The conductor states the fare and collects it at each stop. Some people argued. The exciting 25k trip couldn’t end soon enough nor last long enough, another contradiction of a PCV’s life in Africa.

When we got to Vilankulos, we were met by the owner of the backpacker at which we were to stay. Marcel is a Swiss national in his late thirties, I would say, who came to Mozambique to do cultural research but couldn’t leave. He and his wife Isabelle found some land and some financing and developed a very comfortable backpacker with its own beach, bar and restaurant (what more could you ask for). Marimba’s Secret Garden bills itself as a short distance outside of Vilankulos. “Short” is about 25K north along the coast on a sand track negotiable only by a 4×4 and even with low range engaged, sometimes with difficulty. The remote location is part of the charm and the feel of the place, the splendid isolation, it’s wonderful. The closest neighbours are solitary African homesteads where the locals grow mangoes, peanuts and cassava root which, with fish from the ocean, are the staples of their diet. As there is no way to get to town, eating at Marimba’s restaurant and drinking at its bar are a must, though you can avoid some of the cost by packing in some food for the lesser meals. The food is very good and reasonably priced, with dinners consisting of some form of local catch (native villagers fish the waters off the beach and spear crabs in the shallows). We had the splendid luck to be there before the season really started, there were only 4 guests , the two of us, a Swiss tattoo artist and a German Chef who volunteered to cook dinner a couple of times. The bar is well stocked and the company sociable.

Marimba’s has access to an old Dhow, the local fishing boat, and has its own crew to take guests out to the barrier island, Basaruto, about 10 to 12k off the coast. The islands are large dunes cast up by the sea over old reefs. It is hard to find words to adequately describe the beauty, so I will let the pictures speak. The sand itself speaks as you walk on it, the “skritch skrunch” of finely powdered decomposed shell and coral. The trip takes the day and starts with a trip past the islands to a long living reef about 3k farther out. This was Veronica’s first snorkelling experience and it was hard for her to put her face in the water and breathe through a tube. I remembered getting my boys started and convinced the crew to let he wear a life vest and that worked to let her relax and concentrate on the wonders below rather than not drowning. After that, I had a hard time keeping up with her and almost lost contact altogether when I dove to the bottom to retrieve a lost snorkel which turned out to have been lost a few days earlier by another of Marimba’s guests

The tides are substantial in the shallow sea and the ocean uncovers and covers the “land,” really just sand bars, very quickly. Near the end of the day we found ourselves walking on one such sand bar enjoying the sea and the sights but when we turned around found that the land we had just traversed had disappeared into the sea. We high tailed it back toward the island through the still shallow water, but the current was noticeable and increasing in strength with each step. The trip back was entirely under sail, the cool breeze and the warm sun and the rolling of the sea urging sleep. Sunburn is mandatory no matter how you try to avoid the tropical sun. . A sun shade, beer, water, soft drinks and lunch are provided in the price of the trip. It was well worth every Meticais, the local currency.

On our third day there we got a ride into Vilankulos. The trip takes about an hour if your ride does not get bogged down in the sand. On this trip we had to wait a while for a local to change a tire. You don’t want to try to drive off the established track. We went to town to visit with to other PCV’s who had driven up from South Africa and were staying in the village at a well-known backpackers there. Vilankulos is a real village and less of a tourist destination than many other spots along the beautiful Mozambique coast. It is more famous as a scuba diving mecca than as a beach locale, though the beach is spectacular. At low tide it is so wide that the walk to the water’s edge can be a good hike, as much as two or three kilometres of pure white sand. At those times, dhows can be seen sitting on their bottoms on dry land. They will be afloat again in a few hours.

For the trip to our next stop we opted to travel by chapa. The Isabelle delivered us to the right vehicle and even negotiated the proper price for us, much to the cab driver’s dismay. This was to be a 6 or 7 hour trip to Tofo, one of the better known beach towns along the coast. We were fortunate to both get seats, though the padding of the seat was wanting and by the end my butt was wanting out. Others were not so lucky. The conductor just kept stuffing people and chickens into the minivan, the goats and our packs had to travel in the trailer towed behind. The chapa was an older Toyota “Siyaya” which in South Africa would have been certified to carry 14 to 15 passengers. This one had about 20 or 21 crammed in, the conductor literally hanging out the open sliding door as it raced along the road. It stopped at several towns and villages along the way at each of which throngs a hawkers converged on the van in a largely vain attempt to sell their fruit, nuts and wares in the few moments the chapa stood still. Additional people were crammed in but the protests of the passengers prevented one young lad from getting into the cramped chapa with a dead antelope.

We jumped off the chapa at Maxixe (pronounced Ma –she-she), the small city just inland from the beach at Tofo which is located on a peninsula. We opted for the ferry to Inhambane, the town on the harbour side of the peninsula, which was 10 Metz – thankfully Isabelle had warned us against the aggressive hawkers selling rides across the harbour who charge 10 to 15 times that for a ride in an unstable and overloaded small boat. We did have to pay an additional 10 Metz each due to the size of our packs and they had to ride on deck while we sat in the cabin. We had been told that the ride from the pier to Tofo should cost us no more than 20 Metz, and V would have it no other way. We could not get the cabbie down to that price, but stumbled upon the local bus that made the trip for 10, or so we thought. When the conductor on the bus came to collect our fare, we learned again that the size of our packs garnered a 10 Metz surcharge. The bus dropped us within 200 metres of our backpacker.

Though Tofo has some very comfortable backpackers and nicer guest houses and small hotels, ours was “basic” and “self-catering” which means no blankets or towels and no restaurant and no bar. It really couldn’t be called clean and the kitchen was hardly functional. Veronica had her tent and opted to “camp” in the small courtyard. The place did have the benefit of location near the center of the village and the craft and liquor stalls and the eating places frequented by the locals that had reasonable prices. It also had several hammocks in shady spots, perfect for periodic regeneration after all too busy days and nights. The beach was at the front door and a walk down the beach brought us to the nicer restaurants and the clubs where the live bands played and the parties were supposed to be happening. As it was still a little before the season, the happening wasn’t really, but it was fun anyway. We discovered the local gin and the local rum which could be had for a song and somehow didn’t leave either of us hung over no matter how hard we tried. It came in half litre plastic bottles that you could drink the rum straight out of, though the gin was a bit harsh for that. We ended up packing quite a bit to Swaziland to serve duty as Christmas cheer.

Tofo has a wealth of craft stalls selling fabrics, bags, shell, bead and stone jewellery, paintings and all manner of sundries. The prices are reasonable for a resort area but you have to negotiate to get them and really work at it. My father would have loved every minute. I found myself restrained by a pack that was already too heavy and a long way to go yet, but I was able to get my Christmas shopping done. The water and beach at Tofo are lovely and there is enough surf to make a day in the water interesting. A lot of scuba diving and snorkelling tours leave off the beach, but we were content to be satisfied with our boat trip at Vilankulos.

After the chapa experiences we had already had, we opted for a small shuttle bus from the Tofo Fatima’s back to Maputo where we had another transit night booked at Fatima’s. The bus seemed to work on the same philosophy as the chapas and was soon packed to its roof with passengers and all the bags and packs were piled in the aisle so late comers had to climb over to reach open seats, very large middle age African women not exempted. The seats were better though, and the bus made one pit stop- just in time for me – and delivered us to the door at Fatima’s. We were up early the next morning to get a taxi to the long distance chapa rank for our trip to Swaziland and our Christmas rendezvous with Kristina, Charlie and Roy.

The Beginning of the End

Having made it to the 6th of November with continued healing of the spider bite surgery wound, it was back to Pretoria for knee surgery. The plan was for me to go in the morning of the 7th and be discharged the next day with a repaired meniscus. While the meniscus surgery went just as planned, upon looking around the joint, the surgeon found a defect in the cartilage on the tibial condyle and had to do some additional work to stimulate regrowth of cartilage in the affected area (I spare you the details). While this did not prolong my hospital stay – I walked out the next morning – it did result in my staying in Pretoria a few extra days for follow up. It is really nice to have a doctor who knows his or her stuff and I was effectively pain free without meds during my recovery. I did have some swelling, but that was controlled by anti-inflammatory meds. Right away, I was walking a few kilometers a day (and sometimes more – Shhhh!) with no problems. This was very heartening for me as I was committed to a 3 week vacation of hiking and other activities less than a month after my discharge from the doctor.

As I had to stay in Pretoria, I occupied myself with updating the materials for my HIV workshop, getting drafts of required Peace Corps reports done (one of which had to be completely redone as Peace Corps changed the format as of December 1), writing some letters of recommendation for a friend, reading. cooking and just hanging out, regenerating my energies for what was to be a hectic 3 weeks back at site before the Close Of Service conference on December 8.

To get the ball rolling on my workshop during my prolonged absence, I asked one of my coworkers to make the initial contacts and set up the dates for the planning meetings and event with the facilitators from the Department of Health and the Department of Social Development whom she was to enlist. I saw this as a great opportunity for “capacity building” so that the organization would be better able to organize additional workshops in other villages after I leave. Capacity building is one of the most important goals of Peace Corps work, but also one of the most difficult. Unfortunately, true to form, no progress was made in my absence, not even an initial contact. As almost all of South Africa shuts down for a month of Holidays after the first week of December, there was no way to get a project like mine organized before the effective end of the year, which had been the plan, and the entire effort had to be put on hold until my return in January from my vacation trip.

In the interim, there was plenty of work to do at the organization just keeping up with the normal work flow, fixing the messes created while I was gone and trying to meet the ever-changing demands of the Department of Health. More enjoyably, the Thanksgiving Holiday arrived. The Peace Corps Volunteers in Limpopo (and also those in KZN) make it a point to celebrate the last great non-commercial American Holiday with other expats in their respective areas. As we did last year, forty or so of us gathered at the Polokwane Game Reserve for a weekend of camaraderie and over eating. Since Thanksgiving is not a South African Holiday, work schedules required that we hold the event starting Friday evening for those who could make it by then, with the feast on Saturday. My schedule kept me in my village until Saturday morning when I boarded the first taxi out to Mokopane and then the first taxi from there to Polokwane. The Mokopane to Polokwane link is usually about an hour to an hour and a half, if the taxi fills promptly. It did that day and we were off in a brand new (still had the new car smell) 21 passenger van, for about 10 minutes. It took that long for smoke to start pouring out from under the hood. The driver babied it back to the taxi rank in Mokopane and we all filed off waiting to be placed on the next taxi out with space. Luckily there was another 21 passenger van about half full and a 15 passenger taxi ready to fill when we got there. The rank marshals made everyone get out of the larger van and into the smaller one so that our group could leave without further delay. This actually worked best for both groups as the group we replaced now only had to wait for a couple of seats to fill before they were off to Polokwane too. It would not be a bad thing to see a similar system in America, though our emphasis on timeliness would probably preclude it. You get there when you get there and making a schedule in not much use.

I got to Polokwane at a little after 10 and walked from the main rank there to the game reserve, with a stop at the store and the bank, in a little over an hour. Food preparation was underway, and I was pressed into duty in charge of butterflying and seasoning the leg of lamb and putting it on the grill. As before, the food, all self-prepared pot luck, was delicious and abundant and the occasional shower did nothing to dampen the enjoyment of the day. I was off again the next morning well satisfied and very thankful for such good friends and good food.

As I was back at site for less than two weeks after Thanksgiving before COS conference and still had to finalize the details of my post COS conference sojourn to Mozambique, Swaziland and the Drakensberg Mountains of KwaZulu-Natal and Lesotho, I spent most of the time in front of one computer or another. Thankfully my traveling companions did almost all of the trip planning, and a fine job it was as well. There were still enough individual details to fill my evenings.

Even though the travel time is only about 6 hours, transportation schedules and safety require that to get to Pretoria at the time scheduled for the start of the COS conference I have to leave site a whole day early and spend the night at a backpackers in Pretoria. If Peace Corps let us drive cars this would not be necessary, but “Them’s the rules.” As this situation obtains for most of the PCVs, it makes for a great opportunity for serious discussion about our mission and sharing of ideas for new projects. If you believe that, you would only be half wrong, but the main focus of such “travel days” is getting out together and socializing after being cooped up in rural villages for months. The timing was propitious as we had one of our number turning 80 and another getting to 25 at the beginning of December (my turning 62 was kind of ho hum in context). The spread is typical of Peace Corps with more and more people at the high end joining. It makes for a great synergy of experience and energy mixed with a great deal of tolerance and respect by all. Sounds like the classic formula for organizations which create great long term success.

Close Of Service conference, as the name suggests, is the springboard for the groups exit from Peace Corps service. We learn of all the reports and forms that must be completed before we go, all the right and wrong ways to leave our organizations and the people of the communities we have spent two years integrating into, the local friends we have made the groups we have formed as part of our service. It is also a chance to have al last great party, to say goodbye to comrades in a struggle against a formidable foes, HIV and sometimes PC. We may say we will all meet up again, but even if we do make that effort, it won’t be all of us, and those absent will be sorely missed. So COS conference had for many a mist of sadness, just enough to dampen the cheek from time to time, but not spoil the day. Peace Corps South Africa was kind enough to give us a nice setting for our final gathering as can be seen from the photos.

I will leave to my next post an account of my Holiday journey. I departed on the evening that COS conference ended on the overnight bus to Mozambique with my good friend and wonderful traveling companion, Veronica.

THERE AND BACK AGAIN

My apologies to JJRT for the title but it just seemed so right. I did in fact make it back to my site in early October after being away for almost a month. Not all was well when I got back. Seems the “machine” (used to describe any mechanical device except a vehicle) aka municipal water pump broke down about a week after I left resulting in 3 weeks of no water at my home. Despite valiant efforts by my host family, they were not able to save everything in my garden. My beautiful tomato patch, which had perhaps as many as 150 nicely growing fruit when I left, was decimated, the onions looked pretty bad but the cabbage and the chard survived. I was able to save a small tomato patch that was in the low end of the garden and so got the benefit of the leach from the little water put on the chard and cabbage. I have since dug up and expanded the area that failed to survive worked in the bulk of the compost pile and have planted beets, peppers and basil. Unfortunately, I learned today that the “machine” has broken down again and we are using what little water is available to keep the newly seeded are from baking hard. We are hoping for rain or that the pump will be back on line within a day or two. There is certainly no guarantee of either.

As with my garden I met with distress when I got into the office. Despite all my efforts and constant beggaring of the staff that they sit down with me and learn how to do the things I have been able to do to improve the functioning of the organization (which they never would), I found that they were back doing things pretty much the way they were when I arrived a year and a half ago. It is very sad and disappointing for me. On the bright side, at least one of the staff has also recognized the difference and has now come forward willing to be taught, at least as long as it does not interfere with tea. As they say, you can lead a horse to water but you can’t make it drink, which is an apt explanation of why South Africa, and most of Africa as a whole, remains in the “third world.” Everyone wants what the West and Asia have, but they are not really motivated to do what is done there to get it.

Someone explained it to me recently that the cultural philosophy of most of Africa is that if I survive today I am satisfied. I won’t worry about yesterday, that is past, and I will deal with tomorrow as best I can when it gets here. This is not a philosophy for nation building or economic development of any kind. I find this to be a true observation of the Black African rural culture as I have experienced it. It may help to explain why socialism and dictatorial rule are so accepted here as both can provide survival for the day as long as there are enough economic engines or resources to exploit. South Africa, of course has both a developed economy and vast resources, though both are under stress and likely to be more taxed in the near future. There is real tension here between the creators of wealth and the consumers of that wealth. It is economic inequality if you want to spin it that way, but making the rich poorer is not going to make the poor richer if the poor won’t do what is needed to generate wealth, or even sustenance, for themselves. Likewise, appropriating the mineral resources isn’t going to better the lot of the poor if you can’t get the wealth out of the ground. If you can’t keep a water pump on which several thousand people depend working how are you going to run a mine.

In addition to trying to get things at the office back on track and to integrate the 34 new carers transferred to BHCBC by the Department of Health (without prior consultation with our Board of Directors nor money to meet the additional administrative and infrastructure demands of course) I have had some involvement in some local community events. The Bakenberg Pensioners Association hosted the Limpopo Provincial Pensioners’ Association annual meeting – quite an honor. To feed the 600 odd attendants, two cows were slaughtered along with about 40 chickens. As the Pensioners Association shares the old primary school complex with us, the slaughtering was done outside my office door. As I have a sharp knife, I was asked to help in the men’s work of killing and cutting up the cows, and did. Chicken killing and plucking is generally considered women’s work and was done at the same time at another location at the old school.

“Blood and sand” perhaps best describes the process, though the hide being left on the ground as a work surface keeps the sand pretty well out of the meat. There is still plenty of hard stuff to crack a tooth on, however, as the bone cutting is done with a dull axe rather than a bone saw and leaves plenty of small shards for the diner to work around. After the carcass is dismembered, the large pieces are hung by pieces of wire in a tree. A smoky fire up wind and a splashing of vinegar served (not very well) to keep the flies in check. After tea and the butcher’s treat of pieces of tenderloin and liver cooked by throwing them in the embers of the fire after rubbing with salt, all the men stand under the tree and cut the meat into 2 to 3 inch chunks which are thrown into bins to be stored unrefrigerated overnight until they can be boiled in large black pots the next day. I prefer the ash and salt to the boiled meat, but I could do much better than either.

The whole butchering project took most of the day, and the women were up at 4:30 the next morning to start the cooking down at the tribal Authority hall where the event was held. Some of the men were there as well to set up the venue. I did not join in as we were up against a deadline for reports to be filed and had to man the computer while women from three different organizations demanded that I do 5 things at once despite my fervent pleas of “one thing at a time” (my normal working conditions). As the day wore down, the President of the local pensioners association, who is also a BHCBC board member ran into the office out of breath and asked if I had my camera. Luckily, I had stuck it in my bag the day before and still had some charge left in the battery. Seems that of 600 pensioners in attendance exactly 0 had a camera. As a result there was no one to take a picture of the newly elected board. I was given the command “let’s go now and hurry” and thankfully was driven to the hall. The reports were not done and I would have to walk back, but half a measure is better than none even if it was the downhill direction. As things happen in Africa, upon my hasty arrival I learned that the new board was still in the process of being elected, so I sat down and waited about an hour and a half to take the photos. There was some compensation in it as after the large group shot, three of the new board members asked that II take a photo of them sitting with the oldest member in attendance, a youngster of 110 years. He walked to the place I was taking pictures on his own power though guided as he is nearly blind. Quite the fellow!

I rushed back to the office to finish up the reports but the next day I learned that the local group wanted me to stick around to take a group picture or them in their matching T shirts. We arranged to do that the next Monday at their regular meeting.

While we haven’t had much rain yet we are in the stormy season which produces gorgeous sunsets and startlingly violent lightning. It is a wonderful show, though hail on a tin roof is almost more than a body can stand. I can provide the pictures but have not yet figured out how to upload the sound. (Some would argue, with great justification, that I ain’t so hot with the pictures either)

When I was last in Pretoria, just before I left, I had a meeting with the orthopedic surgeon and the general surgeon who took care of the spider bite. It was agreed that I would be fit for surgery on the knee and that has been scheduled for November 7. So it is back to Pretoria to pick up where I left off at the beginning of September. I should be there for a week or ten days for the surgery and rehab. I will be back at my site for about two weeks during which I hope to get another GET THE MESSAGE workshop done and then on December 8 it is back to Pretoria for my Close of service conference which will mark three months roughly to go. I can’t believe it has been that long. Right after that conference, I am leaving on my annual vacation with some Peace Corps friends – four countries in 3 weeks. More on that next time.

ALONG CAME A SPIDER

This will be a brief post as I have not been very active for the last month. At the end of August, after being at my site for three months straight, I took a long weekend off and relaxed at a lovely bed & breakfast in Polokwane, “Olivia’s Place.” Gorgeous surroundings and wonderful people sum it up. While there, I got word from PC Medical that I should come on down to Pretoria to meet with the orthopedic surgeon to talk about options for my knee. It had not noticeably improved despite 8 weeks of good effort at Physiotherapy at home, so I added a couple more days away from my site to talk at length with the surgeon and the PC doctors about having arthroscopic surgery to repair/trim my torn meniscus. The surgery was approved and a date set the following week on the 12th of September. I went back to rural Limpopo to finish up some work at the office, pack for an anticipated 2 week stay in Pretoria while my knee would be healing and rehabbed and to say good bye to all the folks there.

Sometime during that trip back I got bitten by a spider. It was one of the kinds of spiders with necrotizing venom that I have learned are fairly common here. Best I can figure, it was hiding in a chair or couch in the crease between the seat and the back when I sat on it. Even though I started antibiotics while still at my site, the bite was well abscessed by the time I got to Pretoria for my pre-op visits on the 11th. The Orthopedic surgeon took one look at it and informed me, quite rightly, that there was no way he would operate until the abscess was completely healed. He also said that the ulceration looked particularly bad to him and he marched me down stairs to a general surgeon. He agreed and scheduled me for surgery to “clean out the abscess” for the next morning. I ended up having surgery at the same time on the same day and in the same hospital as planned, but a bit up river from my knee.

To remove the abscess, the surgeon had to take a chunk out of my seat a bit bigger around than a US nickel and almost an inch deep. The wound cannot be sutured or the abscess is likely to return and there would be a very noticeable scar even if it didn’t. The wound has to be left open and cared for with special dressings and kept immaculately clean so that it heals slowly from the inside out (if I said bottom up that would also be accurate but confusing.) I have the unfortunate experience of being well trained in wound care as a result of Linda’s failed cancer surgeries, so the day to day dressing changes was left to me. Thank goodness for all the years on the farm backing trailers into tight places as otherwise the mirror views necessary to the task might have made it impossible. What was not possible was for me to return to my site and my work there. Not only would that have made my biweekly doctor appointments for wound checks impractical, but the lack of clean running water and a shower would just make avoiding reinfection a miracle. So here I sit at my usual Pretoria backpackers (though in a single in suite room rather than a dorm) waiting for my clearance to go back to work.

I have been able to get almost all of my quarterly PC reporting done and have updated the GET THE MESSAGE materials to incorporate some new information of ART as an aid to prevention that gained general acceptance at the World AIDS conference in July, on Medical Male Circumcision (MMC) which is being pushed hard in SA right now and to address some of the observations that came out of the last session. However, as I enter my third week here, sitting is getting a little boring. I have offered to help out at the PC office, but as yet nothing has been found that needs doing. If I had any pain or disability, the inaction would be more palatable. I think that I am not alone among volunteers in having embraced an active life style, physically and mentally. It is addictive and I miss it. Good news is that the medicos think I should be ready for a return to third world Africa by the first of the month. I’m certainly ready in my own mind.

As for the knee, I anticipate that the complete healing process for the spider bite will take a little longer before that surgery is an option. I want to try to get one more GTM workshop done and then will see if I can reschedule the work on the knee for the end of this year or the first of next. I will just hobble on ‘til then keeping a weather eye out for our little eight legged friends.

GET THE MESSAGE 2

Since my last post I have been focused on PT for my knee, and long hours trying to manage help manage a 50 person organization with no funding. In the last 3 weeks we have also been very busy trying to satisfy the Provincial DOH’s ever changing demands for reports and documentation in support of the effort to get Home Based Care funding back on track. Literally, they have presented us with four different contracts to sign (without prior review, right to comment, or negotiation) only to have them withdrawn within a day or so of our frantic efforts to get the necessary signatures and deliver the contracts at great expense to the Department. At no time has the Department completed the portions of the documents that detail its obligations, principally the amount of money to be provided and when the payments are to be made. We have since received three different “Budget Breakdowns” from the DOH, but they have not said that any of them will apply and no actual money has changed hands. The last payment we received was in mid-March. The staff and Community Health Workers have been working since then without compensation. We are so low on office supplies that we are printing forms needed to comply with DOH demands for reports reduced to half sheet size and printed on both sides of paper with the residue of old toner cartridges that can be freed up by banging and shaking. We ran out of staples a few days ago. Hope lingers on but frankly this has been the most disorganized, biased, inefficient and wasteful exercise of bureaucratic overbearing and incompetence I have ever seen. My experiences are shared by others working in this and other provinces.

What really galls me, as an American citizen and taxpayer, is the announcement made by Secretary of State Clinton on her recent trip here that the United States is going to turn the hundreds of millions of dollars of PEPFAR funding we give to South Africa every year over to the South African Government to administer. I have read the Partnership Framework for that shift and it expressly recognizes anticipated involvement at the Provincial and District levels. What are our leaders smoking? They certainly could not have consulted with Americans living and working here in relevant areas (not in offices in the capitals)to access the wisdom of the move. The only saving graces are that the transition is mapped out to take 5 years and the agreement is expressly not a binding contract. Let’s hope we put some knowledgeable people on the ground here in the countryside to monitor the effectiveness of this move and not just rely on reports generated by local bureaucrats and passed on through the National Government. Enough ranting.

Since my last post,I also attended another wedding, this one in a remote village near the base of some mountains that I see daily in the background from home, and was able to get the second incarnation of my GET THE MESSAGE HIV workshop done. Rather than wear my fingers to the bone reporting on the workshop, I share below the “Post Mortem” evaluation that I do as a regular part of my projects as a guide for considering improvements. I apologize for the length but I hope you find it interesting as a bit of real world evidence of my life here.

GET THE MESSAGE

EVALUATION REPORT

GET THE MESSAGE WORKSHOP
Leubaneng Primary School
Marulaneng Village
Bakenberg, Limpopo
0611
21 August 2012

ATTENDANCE
Total: 69
Male: +-20
With Prior Health Care Experience: +-19 (Nurses, carers, counselors, DSD etc.)
Lay Community Members Expected: +-100
Lay Community Members Achieved: +-50

ORAL PRE-TEST
At the commencement of the workshop the participants were given an oral pretest consisting of the six (6) True/False questions asked of 15 to 24 year olds in the South African National HIV Prevalence, Incidence, Behavior and Communication Survey, 2008:
- There is a cure for AIDS. F.
- To prevent sexually transmitted HIV infection, a condom must be
used for every round of sex. T.
- AIDS is caused by witchcraft. F.
- A person can reduce the risk of HIV by having fewer sexual partners. T.
- AIDS is cured by having sex with a virgin. F.
- HIV causes AIDS. T.
These questions were all answered correctly by all participants who voiced an answer. Most of the questions garnered full or almost full participation. The results of the 2008 survey showed that more than 70% of 15 to 24 year olds could not answer all the questions correctly. The audience members were congratulated on their success, but admonished that they needed to do a better job seeing that children and youth got the message, which was why they were at this workshop.

EXIT EXAMINATION:
The table below summarizes the results of the participants’ responses to the questions in the Exit Examination. The questions were presented in written English and read to the participants in Sepedi by ***********, Manager PHC for the Bakenberg Area and Assistant Manager of Bakenberg Clinic. Written Sepedi examinations were planned but could not be produced due to lack of time and resources. Future workshops will have Sepedi and English questions on the examination paper.

Question/Correct Answer Number Responding Number Correct Number Incorrect Percent Correct
1. Saliva is one of the primary HIV transports./ F 50 44 6 88%
2. A person who has never had sex is certain to be HIV Negative./F 52 26 26 50%
3. A female condom can be worn for up to 8 hours before having sex./T 52 50 2 96%
`4. A child can be infected with HIV while still in the mother’s womb./T 52 50 2 96%
5. A person who is treated with ART is less likely to infect other people with HIV./T 51 29 22 57%
6.People should get regular HIV tests because HIV can have no symptoms for many years./T 51 49 2 96%
7. Omitted
8. People who default their ART put themselves and others at risk of new and stronger kinds of HIV./T 52 50 2 96%
9. Parents should know the facts about HIV and talk to their children often, honestly and respectfully about HIV./T 52 52 0 100%
10. Children learn best from parents and caregivers who yell at them and pay no attention to what they have to say./F 52 40 12 77%
11. Please rate the helpfulness of this workshop. Scale of 1 to 10 with 1 as Not Helpful at All and 10 as Very Helpful. 34 Avg. rating: 8.3
Range: 4 to 10
Mean: 10

ANALYSIS OF ATTENDANCE
While I am happy to have reached 50 lay community members, the failure to achieve substantially more than half of the expected and intended lay community participation, with the resulting increased per person cost of the event, almost double that budgeted for, is discouraging and indicates an area in need of improvement and new strategies. One obvious remedy, if we choose to work through the Indunas again – which I think we should – is to request that they invite more people in the first instance. Alternatively, or in addition, the Indunas could be asked to put great stress on the importance of the event. I note that at this event they did not hesitate to fine us for failing to include time for them to make speeches in the preprinted agenda. Perhaps they might insure a better turn out by making invitees aware that failure to participate is a finable offense.
I think having the Indunas directly involved with the event is a very good idea, and it proved very helpful here in arranging for the venue and securing the cooperation and participation of the school personnel. I believe, however that best results would be achieved by involving the Carers in the invitation effort more directly, in addition to working through the Indunas. I suggest that the Carers use their knowledge of the community health situation to identify and invite lay members of the community who would benefit greatly from the workshop. This represents a more targeted approach than the blanket invitations delivered to all the households in the target communities for the November 2011 GET THE MESSAGE workshop. That event saw about the same turn out as this but from more than twice as many invitations which were hand delivered to all the households in the target village areas. I also think that it would be beneficial to post invitations in the clinic for the target village and/or in other public areas especially if there is no clinic. Reliance on local knowledge of appropriate locations will be necessary as each village is different.
ANALYSIS OF EXIT EXAMINATION RESULTS
Accomplishments:
I am extremely happy with the results for questions 1, 3, 4, 6, 8 and 9, though I don’t think anyone should have given an incorrect answer to Question 1 since the information is covered specifically at page 4 and again at page 5 of the Course Outline and is part of the very important foundational information about transports and doorways upon which this course is carefully structured. The need to follow the designed structure and in particular the transports and doorways concept was covered at the 15 August presenters meeting. I did note that, despite our 1 hour late start, people continued to straggle in and it may have been these people who missed the crucial information about HIV transport fluids.

The almost perfect score on Question 3 is reflective of the outstanding and entertaining presentation and demonstration by **********(local nurse) about the female condom. It was of particular interest to me that the males in the audience seemed to closely follow the information. Even if we are unsuccessful in increasing their use of male condoms, there is hope that they will embrace the use of female condoms by their partners and pass that acceptance on to the children and others in their households. I also saw great interest by the women who may now be willing to give female condoms a try and take better charge of their own health. As a general observation from my day to day interaction with the community, there seems to be a lack of familiarity with female condoms and, therefore, hesitance to try the unfamiliar. If we have changed that, we have done our job.

The similar near perfect score in response to Question 4 concerning in utero infection is heartening and indicates a success in one of the central goals of the event, to reduce stigma by educating people that HIV is a disease that infects the innocent, without sexual activity, and is not just a marker for people who are guilty of socially, religiously or culturally condemned conduct. Again the course tag line as stated on page 2 of the Course Outline is: “NO ONE IS IMMUNE AND SEX IS NOT REQUIRED.”What is difficult to understand is the totally incongruous result with respect to Question 2, which is analyzed later.

Again, with respect to Question 6, which concerns the need for regular HIV tests, it is clear that the message is getting through about the danger of HIV as a hidden disease that can be guarded against only by conscious personal effort. I have been told that some of the participants at the workshop took advantage of the testing that was made available by the clinic at the workshop site. That is a wonderful development. We should make provision for at-site testing at all future GET THE MESSAGE workshops and discuss it as a regular part of the program.

The high percentage of correct responses to Question 8 about the consequences of defaulting ART is important. It is one thing for people to recite the oft repeated mantra “Don’t Default” but quite another for them to demonstrate an understanding of the central reasons why ART default is of such concern. People who understand the nature of the bad consequences of conduct, especially those that affect others as well as themselves, are more likely to conform to good conduct and to insist that others do the same. Such knowledge also reinforces their ability to argue for the beneficial conduct when seeking to influence others. Here, in particular, their children and other family members.

Not much can be added to the perfect score on Question 9. Parents’ responsibility to teach their children about HIV was an oft repeated theme from my introduction at the beginning, by***************(nurse)and the demonstrations during the medical section and was clearly and effectively reinforced by*************( social worker) speaking as the voice of Social Development.

Areas of Concern:
The results with respect to Questions 2, 5, and 10 are matters of concern.

There is a rational disconnect between the near perfect score on Question 4, acknowledging that a child can be born HIV positive, and half the respondents’ failure to acknowledge that a person who has never had sex might be HIV positive. Do they believe that the fetus is having sex while still in the mother? Is the perceived stigmatizing mind set relating HIV infection with sexuality so strong that half of the respondents were blinded to the fact that they had acknowledged in their other answer that sex is not a requirement of HIV infection and that virgins are not certain to be HIV Negative? I don’t think so. I must find that the result here is the product of a bad question (though it is perfectly clear to a native English speaker) or to not understanding the question as written or as translated. Even so, we should make sure that this important point gets more emphasis in the future.
Question number 5 is an indisputably true statement. A person treated with ART is less likely to infect others. The following recent authorities, based in part on a large study conducted in South Africa, make this abundantly clear:
“In addition to improving quality of life and reducing AIDS-related deaths,
antiretroviral treatment is now recognized as preventing HIV transmission
by reducing viral load and hence reducing the potential for transmission.” UNAIDS 2011 REPORT
“ART lowers the concentration of HIV (also known as viral load) in the bloodstream and in genital secretions. Since viral load is the single greatest risk factor for all modes of HIV transmission, ART use decreases the risk that HIV will be transmitted from one person to another.” WHO REPORT 2012
“Every year, more than a million more people in low- and middle-income countries start taking antiretroviral drugs,” said Dr Margaret Chan, Director-General, WHO. “But for every person who starts treatment, another two are newly infected. Further scale-up and strategic use of the medicines could radically change this. We now have evidence that the same medicines we use to save lives and keep people healthy can also stop people from transmitting the virus and reduce the chance they will pass it to another person.” 18 JULY 2012 WORLD AIDS CONFERENCE PRESS RELEASE
“Antiretrovirals reduce transmission of HIV In 2011, a large multi-country study by the HIV Prevention Trials Network showed that antiretrovirals (ARVs) cut transmission of HIV by 96% within couples where one partner is HIV-positive and the other is not infected. A later study in South Africa reinforced these findings.
“When people take antiretrovirals, the amount of HIV in their body is decreased, making them much less likely to pass the virus to others,” says Dr Gottfried Hirnschall, Director of the HIV Department at WHO. “If we can get, and keep, more people on treatment, and reduce their virus levels, we can reduce the number of new people who are infected.” 18 JULY 2012 WORLD AIDS CONFERENCE PRESS RELEASE

A clear understanding of the role ART as a HIV prevention tool is crucial to the success of the current war against HIV in South Africa. It is one of the central themes of the current National HIV initiative, and a major driver for the continued flow of foreign monetary assistance to the country for procurement of the supplies of ARV’s that will be necessary to stem the pandemic. HIV testing is a component of the strategy. We test so that we can identify people who need treatment. We treat them to improve and prolong their lives but also to reduce the chances that they will infect others. The fewer people infected the fewer who will become infected in the future. Along with more traditional prevention strategies- abstinence, delayed sexual debut, condoms and fewer sexual partners-it is believed that that HIV can be conquered in a matter of a few years.

This information is not just important to medical professionals but to the community as well. It is the kind of information that is likely to give hope and motivate someone to get tested. Testing is the trigger. It identifies the people who, when treated, will be less likely to keep the epidemic going and who, if untreated, will likely cause the initiative to fail. This information is highlighted at the top of page 8 of the Course Outline and was specifically discussed for inclusion and special emphasis by me at the 15 August Presenter’s planning meeting.

A comment was made to me after the exams were completed that there might be grounds for dispute as to the correct answer to this question. It was felt that a person on ART might be more inclined to hide his or her HIV Positive status and thus engage in or invite more risky sex practices. Even though the observation is relevant to the degree to which ART might lessen the risk of transmission, it does not change the fact that the person receiving treatment is less likely (up to 96% less likely) to infect someone else. Even if the risk of transmission is reduced by only 20% as a result status nondisclosure, it is none-the-less reduced and the answer to this question is still: “True”.

It is clear that additional emphasis needs to be put on this fact in future presentations. I anticipate an additional segment of the Course Outline to address the matter in greater detail and with more emphasis on the Test-Treat-Prevent connections.

With respect to Question 10, it is difficult to tell whether some people were just joking or their conviction that learning is best achieved by loud dogmatic rhetoric was unshaken by the presentation. Clearly the message intended by the materials in the Course Outline is the opposite. It should be noted that all respondents, including those who answered this question “True”, correctly answered Question 9 which expresses the rational view. I will seek out ************’ s (local social worker) input on this item to see what she sees as the root cause of the incorrect responses and if there is anything more that can be done to correct the situation if she believes the incorrect responses are truly indicative of the beliefs of the participants.

A CULTURAL NOTE ON FORM

I am often asked about how we would do things in the United States of America differently than they are done here. I can say that this program would be very different at home. I have attended many hundreds of similar programs as student or as presenter. We would start the event at 8:30 or 9:00 in the morning. The presentation would start on time. The presentation would not be delayed more than 15 minutes or so even if one of the presenters was late. That person’s part in the program would simply be slotted in later if there was time and deleted if there was not. The program would not be delayed because an expected guest was late, as was the case here, even if the guest was an important one. The late arrival’s entrance would merit only a short acknowledgement at best. A late presenter would briefly apologize to all present as soon as given the chance. The value of all participants’ time would be respected

The event would proceed with far fewer formalities. The presenters would be introduced, or more likely introduce themselves, very briefly and give a short account of their qualification to speak with authority. The program would start immediately with its substantive content after a short introduction similar to the “Purpose of the Day” segment here. There would be no opening Prayer, no opening songs, and no formal welcoming. Participants would be expected to find the toilets and where to get water themselves, and for those for whom those items were particularly important, they would arrive early to identify the location of the needed facilities. Registration or the “Roll Call” would be taken care of before the event, starting at about 7:30 or 8:00 and usually outside the door of the event so that late comers do not disturb the presentation.

An event such as this would be treated as a serious undertaking and there would none of the entertainment that is common to such events in South Africa and which consumes a large portion of the time spent at the workshop. While the dance and choir performances and the hymns and songs and dancing by the audience are wonderful to experience, they would find no place if this program was presented in America. While those activities do keep the audience awake, the same purpose would be served in America by a brief “stretcher” activity or by a short refreshment break of 10 to 15 minutes midway through the program after which the substantive part of the program would resume whether or not all the participants had returned (most usually would have). More time would be spent teaching about and discussing HIV and parent-child communication.

A three to four hour workshop in the United States would probably not include a meal, though coffee and tea and light snacks might be put out at the back of the room or outside the door before the start of the substantive presentation and left available throughout the event, possibly being renewed if a refreshment break was taken. If the workshop lasted all day (8:30 to 4:30 or later) a midday meal might be provided, but not usually. For a full day event there would be a lunch break so people could refresh themselves and get something to eat if they wanted. The substantive portion of the program would start promptly after the end of the announced break time.

For an educational workshop in America, the room would be arranged differently. The dais, if one was used, would be occupied only by the presenters. Often times the presenters are seated in the front row of the hall and mount the stage or come to the podium only when it is time for them to present. Special guests might be afforded seats in the front row of the hall, but it would be unusual to put them on stage at fancy tables with flowers and snacks. Where the workshop involves demonstration of small objects, like the condom demonstrations in the GET THE MESSAGE workshop, aisles would be provided to allow the presenter to walk through the audience with the demonstration so that all can see, not just the people up front. Alternatively, the workshop might be conducted in the round, again so that all can see. At this workshop the hall was set up with aisles just for that purpose at my request. In true South African fashion, however, as soon as people started arriving they started moving the chairs to suit their personal needs or desires and the aisles disappeared. Fortunately, the group was smaller than expected, ************ (principal nurse presenter)had the audience move up front and the area where the demonstrations were done was raised so that good sight lines were available. At the GET THE MESSAGE workshop held in MMotong in November 2011 we were able to maintain the aisle and used it effectively for the demonstrations and to display STI photographs (a portion of the program that has been dropped in the interest of time). My preference is to have the aisle. It is a better facility for getting audience participation in the condom demonstrations. Getting someone to come to the stage at the front of a hall to do that is not possible.

Once the substantive presentation is over, so is the workshop. In America there would not be closing songs, hymns or dancing, and certainly no prayers and speeches by the guests. If there is a moderator for the event, he or she might take a minute or two to thank the panel of presenters and wish everyone a safe trip home, but little else. In all likelihood the event would end at or within a half hour of its planned closing time. In America there is great respect for the personal time and commitments of the people in the audience.

CONCLUSION

Overall, I think the GET THE MESSAGE workshop in Marulaneng was a great success and reached many people with the right message. One has to remember that this is a “train the trainers” program and that the beneficiaries are not just the 50 lay community members who attended, but their children and wards and family members to whom they pass the word. Everyone also took at least one of the handouts, either Sepedi or English, and those useful materials will now be available in 50 households in the village and can be referred to when questions arise. In a community assessment I did when I arrived in Bakenberg more than a year and a half ago, I determined that the average household here consists of about 5 people. Therefore, we have probably reached a least 250 people with accurate HIV information, and that is a very good thing.

I thank all from the Department of Health Bakenberg Local Area Clinics, the Department of Social Development Bakenberg Sub-Office, Bakenberg Home Community Based Care, Kgatha Ya Morago Home Based Care, Humana – People to People, Leubaneng Primary School and the Indunas and people of Marulaneng for their support, great effort and participation in this event and look forward to working with many of you for the next presentation of the GET THE MESSAGE workshop.

Seth W. Whitaker
[gallery orderby=”post_date”

THRASHING ABOUT

I started the month of June in Pretoria for a Safety and Security Workshop. You see, I am a Peace Corps Warden. Though I am not fond of the title, and it is a matter of some internal discussion, wardens form an integral part of the Peace Corps serious commitment to the health, safety and security of Peace Corps Volunteers. We have two primary roles. First, we receive and record (but do not report) whereabouts information for volunteers away from their sites overnight(s) so that each can always be reached should an emergency arise or some need for immediate communication present. Second, we assist in the execution of the Emergency Action Plan (EAP), should there be a need (e.g. natural disaster, civil unrest etc.), assisting with the notification of volunteers and staffing the consolidation centers which are safe(r) rallying points and a preliminary step to possible evacuation. Each Province hosting PCVs in South Africa has two wardens. At the workshop we worked closely with all staff, from the Country Director to the people who drive the vans, and were included in meaty discussion aimed at making the safety and security system more effective. The solicitation of our “boots on the ground” observations and ideas was most gratifying and I was very impressed at the serious focus that brought to bear on this important issue by the post’s new leadership.

The week in Pretoria also afforded an opportunity for me to see an orthopedist about my left knee that has been giving me trouble since last July. Unfortunately, the MRI showed a “significant” tear in the medial meniscus. While I am a candidate for arthroscopic surgery, we are trying a course of Physiotherapy – lower body exercises- to see if the knife can be avoided. I have been at is now for three weeks. It takes me about an hour to run through the routine which I have to do twice a day. I have not dropped my usual exercise routine, which takes a little over half an hour a day and is mainly upper body focused, and still try to walk two or three days a week for at least 5 or 6 kilometers. It would not be a stretch to say that I am getting somewhat muscly in my old age. I feel good and sleep better too, so I am not complaining. So far the knee has not gotten noticeably better, but I will give it time.

Last weekend I attended a graduation ceremony for one of the community health workers with whom I work. She and her daughter were graduating from a 3 month commercial (i.e. not government sponsored) computer training course with about 150 other people who attended the courses in three villages in the area. The event was held at the local Tribal Authority hall and turned out to be a full dress cap and gown affair with several speeches and awards. Though the event started an hour late in true African fashion, the audience was boisterous and demonstratively energetic, dancing, singing, parading and ululating throughout the 5 hours it took to complete. You wonder what the fuss was all about, but when you think of this course in the contest of rural South Africa and rural education here, you see that this is probably the most important and practically useful education that these 150 people have ever had. It gives them a distinct advantage over their peers both in pursuing further education and in the job market. The greatest challenge these enterprising souls will face in the short term is finding computers to use so that they don’t loose whatever knowledge they acquired. Now if only they could learn to start events on time!

We are in the middle of the dry winter season here and the world is now mostly brown and dusty. Days are cooler and damn cold if the sun is not shining, and the nights are mostly around freezing. Remember, the buildings have no heat and no insulation and all I and most people have over head is a tin roof, so don’t tell me about your below freezing temperatures unless you live with those temperatures inside you home as well as outside. With three blankets, socks and a wool watch cap I sleep in reasonable comfort, though getting out onto the cement floor is a little tough each morning. I actually start my physiotherapy exercises under the covers until I have a little internal heat going.

About three weeks ago I was pleasantly surprised to find that the municipality has partially remedied the water supply problem. There is no more pressure than before, but we have started getting water as many as 4 days a week. We still don’t know what days it will be, so we just leave a tap open over a 75 liter wash tub and remain flexible. The change has greatly benefited my garden. All we have right now is chard, but that is 100% more green leafy vegetables that the family had before. I have some tomatoes coming as well as some peppers and basil. Not much else will grow until the spring.

At about the time the water came, one of the major South African supermarket chains opened a mini version of its stores about 3 kilometers from my house. By no means is this a full service store, but they do sell some things that I used to have to make the 55 kilometer trip to town to buy – lettuce, carrots, green peppers, cheese, fresh milk products, butter, fresh eggs and some spices etc. I still have to make the longer trip to get good meat, most spices and adult refreshments, but I won’t have to break my back carrying my groceries home every two weeks. I just work a pass by the store into one of my regular walks once a week. Ahh! The modern life! I don’t know why it has taken so long. The round trip to town now costs 60 Rand and consumes more than 2 hours of a day. There are more than 30,000 people living within 15 kilometers of this store. It is mobbed from the time it opens until it closes very day. It’s just good business.

GET THE MESSAGE?

The last half of April and the month of May have been have been busy for me. I reported last time that I had received approval for a grant for repeats of the “GET THE MESSAGE” HIV education workshop for parents and adult caregivers that I developed and put on last year. I have since managed to have the course outline (Facilitators’ Handbook) and the course handout translated into Sepedi, which was one of the conditions of the grant award. Unfortunately I have been slowed by a death in the family of one of my principle local resources and lining up facilitators and a venue for the next workshop will have to wait until after the first of June. Sadly, this is not an unusual reason for delay here in South Africa.

In early May the volunteers held a weekend conference in Polokwane that was attended by a little over half of the 53 volunteers stationed in Limpopo Province. This was not a Peace Corps sponsored conference though it was sanctioned and some assistance was provided vis-à-vis the cost of the venue. The conference was held to address common issues from the local perspective and collaterally afforded a good chance to socialize. We rallied at the Polokwane Game Reserve, a favorite venue, which afforded good facilities and the opportunity to go on game walks. It was great to see Rhinos, Zebra, Giraffe, Kudus, Impala and Nyala, the last a large antelope. It is more exciting to see these animals on foot than in the relative safety of a safari wagon. Everything looks so much bigger and faster, especially the Rhinos. At the conference, I facilitated 3 sessions – Writing VAST grant applications, gardening in Limpopo’s semi-arid regions and one on volunteer safety issues. I also managed to get food poisoning, so was miserable for the last night there and had a harrowing 4 hours of taxi rides back to my site. I made it to work Monday, but was at half speed for a couple of days.

My Ngo continues to struggle with its government financing. The funding for the last quarter of 2011-2012 was received, but on the last business day of the financial year. As might be expected, it largely went for incurred but unpaid expenses. Though in October 2011 we submitted a proposal for funding for the current financial year which started April 1, we have not received a response. In mid-May our Manager was called in to the district DOH office for a meeting. We were informed that they were still reviewing the proposals and could not tell us when they might be able to respond. Worse, we were told that the Department’s expectation was that the payment that was received at the end of March would be used to fund operations through the end of June. In effect they were extending the financial year by 3 months, but giving notice not before the end of the financial year so that some plans could be developed (though I don’t know what since the money had long since been committed), but a month and a half afterwards when there was little left to plan with. As is so often the case, the big guys are balancing the budget (and mitigating their own mismanagement and incompetence) on the backs of the poorest and least able to mount an effective response. It amazes me that the Community Health Workers just keep on seeing their patients in the face of such ill treatment – Another cultural difference.

Despite the difficulties, the organization was able to hold a successful Annual General Meeting, and with the considerable efforts and skill of the carers, to feed almost a hundred people on about $85. I was asked to give a report on my first year with the NGO. Though I am not yet able to give such a long and complex presentation in Sepedi, I talked for a considerable time and from the several follow up questions that were asked it was clear that some of the message got through. Just as I can understand more Sepedi than I am comfortable speaking, the audience’s comprehension evidently exceeds their verbal skills.

Before I close, I want to say a few words about the HIV pandemic here in South Africa. After all, it is the reason I am here. There has been great controversy here about a painting (The Spear) displayed in a well-known gallery that depicts the President posed like Lenin in a typical Russian propaganda poster of the early 20th century with hand outstretched leading the masses to the promised glories of communism, but with a penis and testicles prominently displayed at the crotch. The President, of course, married his sixth wife a couple of months ago and now has four concurrent wives. He was prosecuted for rape a couple of years ago and acquitted, I understand, on an argument of consensual sex, based in part on the message communicated by the manner in which the alleged victim was dressed. It is rumored that he has a great number of children, not all with his current or former wives. The political statement carried by the Lenin reference is at least plausible in light of the partnership of the majority party with the Communist Party and the largest federation of Trade Unions and the direction some elements seem to be, or want to be, heading.
At about the time that this controversy arose, the National Department of Health here was reported to be heartened by the progress being made against HIV as indicated by the fact that they were reaching 80% of eligible HIV positive people with ART. (Though prevalence in the country has not gone down to any significant degree.) Digging deeper into the statement, however, the person speaking for the Health Department noted:
“Mbengashe says it is of great concern that there are fewer men who access treatment.
“Women come forward and they do respond to all our messages. But our biggest challenge is men. And one of the things, moving forward, is to find ways of finding men and actually bringing them forward so that they can actually get help.”
It is now generally accepted that one of the greatest cultural inhibitors to making real progress against the HIV pandemic in South Africa is the practice of having multiple concurrent sex partners. This problem is exacerbated by the effect of part of the HIV prevention slogan that has been around for years here “ABC” – “Abstinence, Being Faithful, and Condom use.” It is often believed by women that if they are faithful in marriage they are protected from HIV infection, and don’t have to insist on condom use, when in fact it is necessary that both partners begin the relationship HIV negative and stay that way throughout before the “being faithful” element has any real effect. That men are refusing to be tested for HIV infection further conceals the need for condom use and also reduces the effectiveness of the National ART push as a way of mitigating the rate of infection. (Recent studies have shown that a person on ART is less likely to spread the virus to others. Though not prevention, it would help significantly reduce incidence if you could identify and treat a large enough portion of HIV positive people.) Obviously, it is knowledge not existence of HIV positive status that triggers ART.

The debate as to whether The Spear is a violation of a right to privacy or a permissible political and social satirical expression will be played out in the Courts and in the Press here for quite some time. From the stand point of people who are concerned about the HIV pandemic, we can hope that the debate motivates both discussion and action on the role men in South Africa and elsewhere must play in the war against this horrible disease. From what the Department of Health is saying, it seems that thus far, in the main, women have been carrying the spear in that battle and that it is high time for men to join them.