The Front Line of the Ebola Disaster

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EBOLA

October 2014.

I am in the lunchroom in my Cambridge office reading the NY Times front page article from last week, A Hospital From Hell, in a City Swamped by Ebola Ebola in Liberia, Sierra Leone, Guinea. The Facebook updates, this BBC video, emails from Liberian friends, NPR’s coverage, UNICEF, Oxfam and MSF’s outreach, they all pull me back. They make me remember some of the worst days of the AIDS epidemic. I see the photos of hospitals and the faces of those on the front line of the Ebola fight and I’m pulled back to another hospital from hell.

While there are critical differences between AIDS and Ebola, such as the number of infections, the incubation period, and the time from infection to death; It is the similarities—the lack of adequate treatment, weak and failed African health systems, infections among health workers, the horror and the destruction of an infectious epidemic—they pull me back.

It’s the mid 1990’s.

I’m 23, a Peace Corps volunteer working in Nkhotokota District Hospital in Malawi, Africa. AIDS surrounds me. Death surrounds me. No one knows how many people are infected. I can not breath. My heart stops. My chest is heavy. I know what death smells like. There is death in my office, in the wards, on all sides of my office, around my house, at the schools, in the post office, at the bars.

I try to hold a meeting and I hear people wailing as their beloved takes their final breath. I tremble. I can’t breath. Another coworker–the Chief Medical Officer–has tested positive. Our Head Nurse has tested positive. I walk the halls of the AIDS ward. The skeletal bodies. These are human beings. I am shocked. There is no cure. There are no drugs here. My neighbor is infected. No Mr. Matengere, not you too. Later I sit at his bedside. The life has drained. It will be hours now. His twin baby boys, I hear them laugh. It isn’t clear yet whether they are infected as well.

I am counseling patients. I practice saying the words:

It is hard to tell you this, but your test came back positive. You have HIV. I am sorry. There is no cure.

Something heavy sits on my chest. I am surrounded by men with TB coughing and children made still and motionless by malnutrition, and the opportunistic infections that disgust me. I can not look at that woman. It is harrowing. The world doesn’t care. In the US, people are eating donuts and  bowling. A child has died in my arms. A baby. A dead baby child is in my arms. I’m trembling and I can not breath. My blood test came back positive. I have to get out of here. I have to survive. It’s a mistake. But I experience–for moments–what the death sentence feels like.

Each day, they come to my office. They come to my home. They come to me in the street. I look into their eyes. I hold their pain:

Can you help me?      My parents have died.       My child is sick.      My husband…

I can not hold their pain. It is too heavy. It crushes me. I can not breath and I am trembling. Each morning the medical officers describe the condition of the sick. There is nothing for these patients. We wait for each of them to die. I am dying as I listen, at least it feels that way. One morning, there are two patients who have bled out. Ebola? No, we don’t have Ebola here. We have HIV. Ebola would be worse than AIDS. I close my eyes tight. If I didn’t hear it, it doesn’t have to be true. I wait. No more patients bleeding out. Alcoholism and other diseases cause hemorrhagic death too. No Ebola here. We are somehow lucky. I want to survive. I want my coworkers to survive. I want the patients to survive. Death is winning. I am not sick. Still, this feels like death. Death pulls me.


 

Back to 2014.

I fold the NY Times. This is Ebola, not AIDS. In the past 20 years, we’ve made gigantic strides in treating and caring for people living with HIV because finally, the people who could make a difference, started to give a damn.

The Ebola virus causes an illness which is often fatal if untreated. The current outbreak in west Africa is the largest and most complex Ebola outbreak since the virus was discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has spread from Guinea across land borders to Sierra Leone and Liberia… World Health Organization

The outbreak of Ebola in West Africa has become a major regional threat. Approximately 3,865 people have died since March. UNICEF estimates that 8.5 million children and young people live in affected areas.  UNICEF

You can help. I can help.

Stand by those on the front Lines. Please donate today.

Stop the Spread of Ebola in West Africa

These organizations need our support to make more beds available, to conduct house-to-house educational programs, to purchase chlorine, gloves, raincoats, plastic mats, blankets, tarpaulins, and syringes for those on the front line.

Please Donate:

UNICEF: https://www.unicefusa.org/donate/stop-spread-ebola-west-africa-your-gift-matched/18771 If you donate to UNICEF, your gift will be MATCHED $1-for-$1 by the Paul G. Allen Family Foundation.

THIS IS SIMPLE: Text Ebola to 864233 (UNICEF) for a $10 donation

Oxfam: http://www.oxfamamerica.org/explore/stories/as-the-ebola-outbreak-spreads-heres-how-you-can-make-a-difference/

Medicine Sans Frontiers https://donate.doctorswithoutborders.org/onetime.cfm


 

Learn more Centers for Disease Control   West-Africa-outbreak-infographic

If I die on Monday

As I ran today I thought about what I would want for Saturday, if I had been killed by a drunk driver on Monday morning, as Meg Menzies was on Monday, January 13, 2014. (See http://wtvr.com/2014/01/14/meg-menzies-run-megsmiles/)

If I die on Monday, and you sign up to “finish my run” this Saturday, as you run, please think about how you can help me finish my work of nurturing my family.

If I die on a Monday, I’d want someone to make sure my kids laughed this week. Make them smile, make sure they are silly, especially if my husband can’t smile. If people around town, or the state, or the country, or the world, are moved by my death, ask them to write to my kids and tell them jokes, send them funny pictures, give them funny ideas. Make them laugh. Be really, really silly. They can’t resist that. If the laughs turn to tears, hold them for a while; then bark or moo at them. Become a rooster or a chicken. Take pictures.

If I die on a Monday, will someone read to the kids? They’ll need a load of books from the library or a book store. Spare no expense for good books. Keep them reading. It will give them comfort and a break from the sadness. They can’t resist new markers and paper too. And art is good for the soul.

If I die on a Monday, will someone tell them that I am in their hearts and their minds, in the stars and the snowflakes, in their achievements and their failures, in each other, and in the kids they may have one day? Tell them I am in the music they play and the songs they sing. So keep playing and keep singing. Someone has to continue to remind them that I’ll never leave them. I’ll be in the moon and ocean and every time there’s a mess, I’ll be in their heads saying “put away your socks, put the toilet seat down, bunch of swines” When someone does something in the house that no one will own up to, they should say, “oh Mom did it, what a rascal.”

If I die on a Monday, will someone remind them to forgive the driver that hit me? Not right away, but over time, take them to people who have forgiven and found peace and happiness. Travel the Internet and the globe if you have to, but make sure they see examples of people who have forgiven others. I don’t want them to live a life weighed down by anger. If they resist, insist they use the anger for good. Any good they can think of.

If I die on a Monday, will you tidy my house a bit? By Saturday it can get nasty. My upstairs bathroom trash can needs emptying. Meant to do that before I left. Please hire my family a regular, trustworthy cleaner. I want them to live in a clean and healthy home. Pay the person well. I want everyone who steps through my door to feel appreciated.

If I die on a Monday, will you keep an eye on the bills? The bills are paid through early February, but remind my husband to keep on top of it because I always do all the bills. He may open mail, but there will just be piles of trash and probably some important bills. Please sort. For months to come, remind him.

If I die on a Monday, will you find a superb grief counselor to help everyone through this? They aren’t prepared. They might need to be gently urged to go. They might need a ride. Better yet, can you find a counselor to come to our house? He’ll need time, but encourage my husband to date and marry. He’s the best human being I have ever met. He’s a wonderful husband. I recommend him without any reservations.

If I die on a Monday, will you take down the Christmas tree on Saturday,  if the kids agree? Sorry I left it up, they wouldn’t let me do it last weekend. Please take it down and put away the ornaments. Make sure it comes back out the day after Thanksgiving. Take pictures of the kids in front of it when it goes up! Send holiday cards too please. We love to recieve cards.

If I die on a Monday, will you remind the kids to brush their teeth? My death is no excuse for bad dental hygiene.

If I die on a Monday, will you encourage my daughter to play the piano and my son to play the drums? Homes should have music. Tell them I’ll be listening.

If I die on a Monday, will you do weird and funny things to keep the kids imagination alive? Set out cool stuff where they can see it, like a animal picture in the National Geographic, or a volcano photo from the newspaper. Scotch tape, magnifying glasses, yoyos, screwdrivers, boxes, recipes… Just set them on the kitchen table and the kids will do something.  You won’t have to say anything, they’ll find it and be interested. Laugh at what they do and take pictures.

If I die on a Monday, my life insurance policy should at least take most financial worries away, but help my husband access the policies. Help him change all the accounts. He hates making phone calls and he’s not much of a fighter.

If I die on a Monday, will you listen to my kids talk about me? Will you look at our photo books with them? Let them sleep in my bed. Let them play in every drawer. Oh they would have such a good laugh in my underwear drawer. There are a few pairs I really should have gotten rid of before it came to this.

If I die on a Monday, will you make sure they still eat mostly nutritious food? They’ll fight you on this but they need to remember that my expectation is that they will be healthy active kids. I made them from scratch and I built them to be healthy. Tell them to make good decisions for their bodies. I don’t know if it will work, but I always say that. So don’t just make a dinner, stay and make sure they eat a bite or two.

If I die on a Monday, will you make sure the kids and my husband keep going to everything, even if they can’t stay long? Soccer games, swimming and gymnastics, birthday parties and piano recitals, and nights out with the guys. See movies, ice skate, ski, ride their bikes and run. Don’t forget to run. I’ll be out there. They could go to church. I’ll be there too.

If I die on a Monday, will you hire someone to be at the house during dinner and evenings so the cooking or heating food continues, lunches are made, the kids are reasonably clean, get their stories and get to bed on time. My husband can do all of this, but he’ll be broken and overwhelmed. He’ll need you to keep things going. He may need to exercise a lot. That’s how we deal with the good and bad. We get active and find motion.

For perhaps a year–maybe more–I’ll need people who will commit to keeping my family going hour by hour, day by day, week by week, until they are on their feet again. As you help me finish my run, will you please, please help me finish my work?

Traveling with Grandparents

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Through the night with Anna Babin

Coming back from the DRC, our route was Kamembe Rwanda, Kigali Rwanda, Entebbe Uganda, Amsterdam, and home to Boston. On the hop from Kigali to Entebbe I boarded the flight. There was an older woman sitting in my seat. She appeared to be traveling alone. I told her I had the aisle. She threatened me with a sad story of an overactive bladder. I had intended to sleep as much as possible on this overnight flight anyway so I didn’t mind not having the aisle. I sure didn’t want to get up every 20 minutes. Plus I am cut from the cloth that when an old person traveling alone wants a seat, they get it. I gave in to this tough old threatening bird and settled into the window spot. (Though she only went to the bathroom twice and we were on the plane for 10 or 12 hours!)

I looked this lady over and saw a twinkle in her eye. I asked if she was on her own and she said ‘Yes’. She had a rubber band around her wrist. I said:

‘It takes a lot of moxy to travel through Africa on your own.

She smiled and her eyes twinkled even more. The woman was 76 years old and for the next hour she told me about her trip. She went to three countries, was face-to-face with gorillas and told me about gorilla language. See here for where she went. Also, look here (CNN report) for how recent gorillas are in the path of rebel fighters.

She said:

You better do everything you want to. My one son, a physician, doesn’t want me to travel. Eh, I was widowed 17 years ago. I have to do this for me. Next trip will be the Galapagos Islands, and then maybe Morocco! I can only tell me son one trip at a time though… I’ll have to wait a month or two to tell him about the next one. He’s 50 you know. You’d think he’d want me to live. Ha, I will anyway.

This lady made me laugh, entertained me with stories of her husband, a urologist, told me about volunteering at Lake Sunapee to help wounded veterans and disabled and autistic kids ski with abandon. She told me about having a twisted bowel and emergency surgery in Buenas Aires. Her son had a fit! She said it was the nicest hospital in the world. They even wash the ceilings!

In Uganda, she opens her bag. There is this Teletubby episode where Tinky Winky has a bag and can fit much more in the bag than the size of the bag. This woman had a magical bag too. As we waited on the plane for passengers to board, she gives smuggled bottles of water to this nice French guy, bananas to Erin, licorice to me and then she just keeps pulling  more things out of the bag….making me laugh all the while.

Now this woman bore a striking resemblance to my beautiful grandmother, Anna Babin who passed away when I was in college.

Memere and Pepere Babin

My grandparents were foster parents who loved children deeply and wanted a better life for the kids that crossed their path. While I loved talking to the woman on the plane, what I loved most was as I slept from Uganda to Amsterdam, I’d wake up every now and then. My eyes would flutter and I would see my grandmother. I sleepily saw her glasses, her silver white hair, her hands, that tissue in her sleeve (no kidding). Through the night, as we flew over Chad, the Sudan, Libya, the Mediterranean and so forth, I slept as though I was with my grandmother, like an angel flying through the night with me.

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Border Crossing, Airplanes, and Kenny Rogers

So we tried to cross the border from DRC into Rwanda…short drive then we board the plane. We get our passports stamped in the DRC (while watching the immigration folks accept a bunch of bribes.) We get to Rwanda…wait, wait, wait, wait, then get stamps. We have to pay $30 to drive across the border. We had $80 (4 $20 bills). No problem. Except, they won’t take our money. One bill has a 2 millimeter tear. One bill has a pink marker mark. One bill was from 1996 (too old). The final bill? (not sure).

Anyway, we can’t cross. Slight panic as the plane leaves in an hour. Actually, we are quiet. We are thinking of what to do. I am staring at Forex trying to figure out how to get money. But Erin realizes the vehicle can’t cross but we can. So we drag our suitcases across the rocky parking lot, through the gate, and get a taxi. We get in.

The issue here is that I try painstakingly to make sure that I always know my driver in complex countries where the rule of law is compromised, where police forces are weak or not trusted. The border between the DRC and Rwanda is an interesting spot at best. Currently the DRC is accusing Rwanda of training soldiers. Foreign Policy and The Guardian reports that the US is burying a report on this. We are two extremely pale white women. Kidnapping, sexual assault and other crimes are not that rare in these parts. Our team had told us that people are killed for $5.

That said, we buckle up…We want to go home. Our driver (who has no money and can’t help us cross the border) takes the number of the taxi driver. However, our driver couldn’t help us if we needed help because he doesn’t have the money to cross the border after us! I don’t know what police he’d call if he were suspicious. Maybe there are some? Really, no one could help us if we had problems. Our taxi driver starts the engine.

To my delight, Kenny Rogers is blaring from his tape deck. I know we are perfectly fine.

Erin must think I am completely insane. I rolled down the window and with the wind in my hair, in tune with the tape deck, I belted out “You picked a fine time to leave me Lucille….”

Then, it was “Through the Years” and I could say the shimmer of Lake Kivu, but I closed my eyes and I could see my late grandfather, Raymond Morin

Memere and Pepere Morin

and grandmother, Edna Morin dancing at their 60th wedding anniversary.

I can’t remember when you weren’t there
When I didn’t care for anyone but you
I swear we’ve been through everything there is
Can’t imagine anything we’ve missed
Can’t imagine anything the two of us can’t do

Through the years, you’ve never let me down
You turned my life around, the sweetest days I’ve found
I’ve found with you … Through the years
I’ve never been afraid, I’ve loved the life we’ve made
And I’m so glad I’ve stayed, right here with you
Through the years…

Through the years, when everything went wrong
Together we were strong, I know that I belong
Right here with you … Through the years

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DRC fieldwork complete

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I won’t say much yet. Emmanuel and Zione are still in the process of sending data collected in North and South Kivu. We conducted quantitative and qualitative interviews with women, focus group discussions with community members and key informant interviews with health workers, business owners and others.

We have all learned so much with this study.

Traveling to Goma

Shimmering Lake Kivu

The DRC is beautiful, complex, and riddled with corruption and poverty. Our team went to places where women couldn’t be interviewed because the neighboring village had been attacked by rebels. They avoided places that were insecure and ‘owned’ by rebels. They traveled days into the field where they were cutoff from surrounding areas because of insecurity. The team worked intensely and despite major challenges.

Zione and Emmanuel are powerful, determined, impressive leaders.

Zione Themba and Emmanuel Kambalame

I am humbled by their work. For all of the our team in Goma and Bukavu, I tip my hat, I bow, I thank you. As I receive the data, it becomes my honor, my responsibility, my quest to tell the stories of the women you have so carefully worked to understand.

Here’s our photo diary. Check back as we’ll be adding more photos!

And now, until we begin in Nigeria, perhaps I can sleep, rather than  waking up every 20 minutes through the night. Despite the fact that these two are far tougher than me, I’ve been like a Mama Bear worried about my Cubs!

“She’s right, this is the DRC, you can be killed.”

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We conducted two focus group discussions with some Congolese, aged 22-40. The details of who was involved in the discussion will be shadowy, given the content of the discussions. Still, I wanted to share some of the respondents’ thoughts on life in the DRC, including the challenges they face and foreigners in the DRC. They talked about corruption, the burning desire for money, unemployment, the Interahamwe. For background on the Interahamwe, check here.

What is the best part of life for people your age in the DRC?

Businesses, trying to make businesses.”

“Dancing! My friends we dance, we go to the club, yes!”

“ We look for money; We look for a job.”

“My studies.”

“Many people of our age prefer gold …. The objective is to be rich”

What are some of the challenges of life for people your age in the DRC?

“It’s simple. We are poor. We are looking for money.”

“Many of us have fake degrees from useless universities. Then, there are no jobs when school is done. If you have no relatives, you have no job. For the first born, the parents can send them to the university. But he graduates and he can’t get a job. Then the parent will not send the next one.”

“We have killing people and stealing. They can kidnap and kill. For just $5 or $10, they kill.”

“The young men, they have no jobs, so they are joining rebel groups for money. The rebels tell them, ‘Join us! You will get a big house…..lots of money.’ They are poor, what can they do?”

“We have churches everywhere, on every corner. They collect money. Everyone wants his own church so he can earn some money. They just want to collect money for themselves.”

“I should not talk, we can be killed here.”

“She’s right, this is the DRC, you can be killed.

What else? Are there any other problems?

The problem is our government. There is nepotism throughout.”

“Yes, but the government needs to get rid of the Interahamwe for us. They should get them out of the forest for us. Because the tribal war. See the Hutus came (following the Rwanda genocide). We gave them a place to live. The Tutsis came to look for those Hutus and the Hutus went into the forest and that’s a big problem of us. The main problem is this in the DRC. The rich part of the DRC is in the East. Our Congolese population want to do farm occupation, but they can’t because their land was taken by those militia. They were killed or chased from their land or it is just not safe any more. The international community has the power to take the Interhamwe out of our forest and return them to their country. But no, Why? (Why don’t they?) I don’t know why. Our president has no power. If the president doesn’t agree with the international community, they’ll push him out.”

“You should not speak!”

“Another problem is that we Congolese, we never like each other. We are corrupt. We have to change.”

“Yes but the corruption is because we are very, very poor! …. a big problem is the government”

“We do like the corruption. We need to be rich. Instead of working, we are waiting for help.”

“(in response) But we shouldn’t wait, see your relatives over there…they’ll die. There will be orphans.”

“When you have nothing. When your children are at home, not at school. You have nothing. What can you do? You are the friend of so and so and you get a job, you take it. If no job, you want to know how to get in his house.”

“In 1987 we had 4% jobless; nowadays we have 94% jobless. Where we are going, we can’t keep going like this. From 1996 to today, I am victim of this situation (jobless)

Who are the people who come to the DRC? Where do outsiders come from?

You know we are neighbors with Rwanda. So Congolese and Rwandese are like the same so…”

“No we are not the same! THEY killed my father. We are not the same!”

“Well foreigners come from Burundi, Uganda, Kenya, some are working for international organizations.”

“A lot of Chinese are around. Indians are around.”

“There are so many whites. We don’t know what they are….” (Congolese seem to call Indians and Chinese White)

“People are coming and stealing our money. When they are around they are stealing money. Everyone knows they come to steal our money. Even the children know.”

“Ah, we shouldn’t speak. Will you tell our leaders what we tell you?”

“How long will you be here?

There will be no names. This is confidential. I can show what she is writing…

“It (the FGD) is confidential, but this is the Congo. We kill each other! You might say it is confidential but we kill each other.”

“They come for business. They do business here. They pay to the government (taxes) to be able to do business.”

“Those Chinese come here. They say they will make roads. I don’t’ know why they come here. There are no roads.”

“Some white persons give to us some food. All of them are not that bad. Sometimes they help us.”

“But, they (UN Military and Peacekeepers) come and they infect our people with HIV. They tell they will help them. We didn’t use to know HIV but now we know HIV. They give money to infect our women.  When they have money they marry/take our girls. They sleep with them (with their money) and now we know HIV.”

“They are here to destroy our country.”

“They just want [sex for a] $100 without condom. $1 with a condom. Why do you say they are good for us?”

“Everywhere we receive people like you. Every year. But nothing is changed.”

“People give them (girls) money. Many girls have to go with them and prostitute themselves. We Congolese, we never keep our girls. Parents never think of their girls and what they do. Their moms. They don’t take care.  They will let their girls go look for money anywhere… anywhere.”

Is the problem that mothers don’t know how to raise their children? Or people coming from abroad?

“But those people coming from the UN. They came with money. They infect our girls. People think they came here to increase HIV. People say UN men pay much more for a woman without a condom. Many families are poor. They just go for the money.

Should government shut the doors?

Government should control the situation. … all the people that we get in our country. People come and go with no controls.”

“I think that our government must be protect the population. It isn’t bad for those business men to come in. We must compare what we gain by having them here.”

“I think our government, well people must explain what they are coming to do here. IF they respect our rules and respect all the people, the education of our children our daughters, that’s okay.”

“Our government should help the locals. I know a local firm that wanted to start a concrete business. The villager can’t pay the tax but the foreign business can so the villager cannot succeed.”

“It is because there is war. If there is no war, they will go to their own countries. You know they contract with the rebels.”

“The Rwandese come to get our minerals. The white bring the HIV (UN).

 

I have not included every statement. I have not edited their words or opinions. I only share them here.

 

 

What to do when your hungry kids want food

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"There's a man who is my brother, I just don't know his name. 
But I know his home and family because I know we feel the same. 
And it hurts me when he's hungry and when his children cry. 
I too am a father, and that little one is mine." John Denver

We ask people all over the world about food security and hunger. Are there children getting enough food? What do they do to get food? If they don’t have enough what do they do. Parents and grandparents from India to Liberia, the DRC to Mozambique tell us their strategies about dealing with hungry children. Here are a few of their strategies, which include avoidance, beatings, begging, and so on. In their own words:

One mother in the Democratic Republic of Congo avoids her children:

When I don’t have enough food I avoid the children. That way they can’t ask me for food. I just pray to God that they don’t steal. To this time, I don’t think they have.

Female: Household size: 8 children

In Liberia, a woman goes hungry so her children can eat:

Because of the hard time, many Saturdays we don’t have food to eat. For Sundays, most times neighbors feels sorry for us when they cook they extend their hands to us.

My main concern is for my children. I allow them to eat the food while I remain empty. Most of the time, I go around to neighbors to eat and they give some of their food to eat…I really don’t care if they are giving it to me willingly or not. My major thinking is to survive. I have to eat and so I don’t look for attitude of giver when I am hungry.”

Female, Age 43, Household size=5

In India, a woman beats her child so he won’t ask for food:

I try to keep them quiet by beating them and tell them that I have no money… He gets scared because of the beatings… They get scared to look at me.

Female, Household size: 4

Finally, a grandmother from Mozambique tells us how she tries to get the boy to withstand the hunger, but he envies others. She wonders whether he understands the situation:

The challenges that I have encountered, they are many. The suffering of my grandson…Even when he wants to eat… you see now its morning, until now, he hasn’t eaten anything.

He will drink a cup of tea and a piece of cassava and he will go to school. When he comes back is when he will eat something…later on. The manner of eating, of dressing, it is very difficult.

When he gets home he asks for it. When you say that you don’t have, it is as if you are refusing, but he is able to see the granny does not have, because granny does not work. The grandfather works, but he is only able to buy a bag of rice for us to be able to survive.

He does not eat what he wants, so he envies. Sometimes he goes to school without having a snack. He says “Granny can I have 1metical to buy a snack?” I do not have, so sometimes I tell him to take cassava, put it in a plastic bag and take it to school. It looks like I refuse to give him things here in the house. He is suffering, even me as the grandmother, I am suffering, because I think about having things to give him but I don’t have.

Female: Household size: 3

I  think a lot about children and families being hungry but not how caregivers interact with their children who are hungry. These quotes above provide a tiny window into the relationships between parents and children and the struggles they face. Children are persistent little people who want to eat when they are hungry. Parents must cope with the pain of their hunger (and hunger is painful) as well as figure out how to manage the feelings and behavior of their hungry children. This can often yield parent-child interactions that are damaging to the child and the parent.

In a worst case scenario, I will never forget Maraweed, mother of Julius (see here for Julius’ story). She fought like hell to save her child. She walked miles in the hot sun, with her boy on her back, to get to Nkhotakota District Hospital for regular feedings. When, despite Maraweed’s efforts–Julius died–she sprung back to life like a plant that had been pruned. Once the burden of caring for her sickly, malnourished child ended, she could eat more, stop walking miles to the hospital and focus on the rest of her family.

While child mortality is high in so many countries (Click here for Child Survival Global Call for Action and here for the Roadmap to ending preventable child deaths), most children will survive. As the children get older, the risk is that they will be forced to work (such as burning coal in Liberia), to marry at a young age (which happens every everywhere), to prostitute or steal or other activities to earn money so they can buy food.

Let’s be clear. It does not need to be this way. There are policy changes and affordable strategies that together could end hunger. Food insecurity in these countries is a matter of apathy, war and conflict, inequality, lack of access to land, misinformed policies (such as Western agricultural subsidies).

For the poorest households, I have seen the evidence, helped collect the data to show that social protection programs work. The Roadmap calls for better measurement of programs and interventions to “educate girls, empower women, and delivering inclusive economic growth.” In my work, I have seen how Social Cash Transfers can empower families, get children in school, improve agricultural production, jump-start businesses, and end food insecurity. Of course, there are many important details in the program’s design and implementation and serious monitoring and evaluation of programs is essential. And these are just the beginning. But for mothers and grandmothers with young children, chronically ill people, the elderly, families that have suffered other shocks and need a lifeline, these programs work.

At the end of the day I AM A MOTHER. I want my children, all children, to eat when they are hungry.

See here for Social Protection for Africa

Social Protection Floor Initiative: See here for Implementation, national examples, affordability

See for example: Miller, C., Tsoka, M. and Reichart, K., 2011. The impact of the Social Cash Transfer Scheme on food security in Malawi. Food Policy, 36, 230-238. Many important articles are cited in this article.

Funny photos, refugees, and peace

 How can we move forward if there is no peace?

Initiative for Peace Building

Emmanuel, Erin, Zione and I were all eager to get closer to the beautiful lake that we can only see in the distance. After the day’s work we set off down the hill. I am planning to fall on my backside because the steep, unpaved streets are filled with ruts and dips and rocks. As usual, kids take notice and are excited to see us. As we descend we see so many interesting houses under construction.

We see houses with scaffolding made of thin trees. The three story houses set on hills often have these treacherous stairways that weave and wind. We see rooftop gardens with cabbage. In the distance we see an impressive house on a beautiful green compound that juts out into to the lake. Once owned by Mobutu Sese Seko, it is now inhabited by the Initiative for Peace Building.

Emmanuel, Erin and Candace

Zione takes this photo and we all double over laughing. With Erin and I in the background and Emmanuel in the foreground, Erin and I look like small children and Emmanuel like a tall statue!

We continue on…

As we descend further we see the UNHCR repatriation camp.

From UNHCR site

This a refugee camp filled with Rwandans in transit from the DRC back to Rwanda. They fled from Rwanda during the war. They tire of living in the forests and are returning to Rwanda as they are able to.

“Living conditions in the forest are very difficult. My life was miserable, being hunted like an animal. But I have a new life behind those hills and my children need to go back to school”, said Marie, pointing towards Rwanda. Marie’s journey to Bukavu was a long one. She came from Mangere, in the North Kivu region of Masisi, where she and her children had been living in the forest.

As we approach the gate, a truck full of people arrive. We can hear the sounds of crowds, talking and commotion in these long makeshift buildings. We are told they are filled with women and children.  (A few nights later I hear the sounds of men yelling and screaming for hours into the night. Terrible screams. Disturbing, haunting screams. It sounds like a men going mad or men in prison yelling through the night. At the time, I wonder about how these women and children sleep with this noise. Later I learn this yelling is common. You can imagine the limited assistance for people with mental health problems as well as the prevalence of PTSD given the years of war.)

As we walk, Erin strikes up a conversation with a Congolese man walking with his young daughter. She tells him we are walking to get a better view of the lake. He invites us to follow him as he lives right on the lake. We join him and his young daughter, who drops some candy as she walks. Zione picks up the candy and gives it to her. The little girl smiles.

Talking about peace

At his house, we marvel at the beautiful lake. It is a lovely view. He asks us, as we do our work here in the DRC, as we return to our countries….

Please advocate for us. We need peace. We need peace. We don’t really need aid. We need peace.

He tells us that women are respected here in the DRC. The woman is revered as she gives life. I tell him that is not easy to do and he agrees. So he says,

Why do we have to hear about women always being raped, children being killed, people being abducted?

He tells us the security situation is the problem in the DRC.

We can’t develop without peace. People are hard-working. There is a strong work ethic here. People are entrepreneurial. But how can we move forward if there is no peace?

Our Congolese team, Fashion, and the Desperate Housewives of Wysteria Lane

We have a team of 16 people. Eight are from Goma and eight from Bukavu. They are university students who have studied economics, development, law, statistics, linguistics, and computer science. Of course our women look very smart with a mix of African styled dresses, Western fashions and even some jeans. One woman has a beautiful peach pantsuit that would leave Hilary extremely jealous. We do have a few men on the team as well, but we must look to the women for exciting fashion. Similar to their peers around the globe (but not in IH745 where I outlaw it!), our team of young people are very busy texting…

I am sitting beside one of our Research Assistants at lunch time. She takes out her laptop (yes her laptop). She puts on “Desperate Housewives” and a few others gather around. (It’s an older episode, Susan is on dialysis, before she gets her kidney from Paul’s wife, who later killed herself. Remember? Gabby reconsiders cheating on Carlos with the young gardener guy. Tom and Lynette are still together.) I am so confused. I’m also glued to the episode because it is so weird to see the Housewives here in the DRC. Where am I again? Other popular shows among our team include CSI, Criminal Minds, Dr. House, White Collar (?)

We must work hard to train our Congolese team. Their first language is Swahili or one of the other 243 local languages spoken here. French is the national language.  I love French. Anyway, a prerequisite for our Congolese team was that they be English speaking. We convey our study in English, the materials are translated into French, and then the surveys are conducted in Swahili. This is complicated but possible because this team is so talented and we will check, check and recheck to ensure they understand our survey tools.

We discuss occupations with our Congolese team. We ask if there is any manufacturing here in the DRC. What is ‘made’ here? They tell us nothing is made in the DRC. Agricultural products are grown, resources are mined, livestock raised, fish are caught, but nothing is made here. Goods are all imported. Water is bottled in Rwanda or Uganda, but not here.

Next, we discuss historical events (so they can help our survey respondents (Women for Women participants) remember ages and birth dates). The team can only think of wars, elections, and natural disasters. They can think of no good events that people would be familiar with such as celebrations or sports events. I give them time to think. I wait and take a drink of water. Two drinks. Nope, no good events have happened here. They tell us that if there are concerts, exciting events, or famous visitors, they go to Kinshasa, never to the Eastern DRC.

I’ve been trying to read more about the situation of women and recent reports on rape and violence but the articles on gender based violence in the DRC are blocked. I receive a message that I am violating my internet agreement by trying to access them.

(I glance up and Bree is talking to her pastor and I think Rex’s mother (remember he was her first husband and the crazy pharmacist guy poisoned him? Not sure which season this is.)

One thing for sure, I am enjoying the French! Au Revior!  Je me sens bien.

Bonjour from the Eastern DRC!

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Coming into the DRC, I had no idea what to expect. The week before traveling I bounced between a fear-induced paralysis and Zen-like confidence. I saw stories like the ones below from the Voice of America, Reuters, BBC, and so on. I clung to the Zen feeling and breathed deeply, promising myself I would abort mission if necessary. My team of Zione Themba, Emmanuel Kambalame and Erin Morehouse were eager to go. Women for Women International assured me the situation was secure, and we set off for the Kivus.

My nose was pressed to the airplane window in awe of the stunning views from the airplane.

View from the plane

Rwanda, from Kigali to Cyangugu, is spectacular. Lake Kivu is beautiful.  The domestic flight and immediate luggage pickup means we depart Cyangugu immediately for the border. Bukavu (elevation 5000ft.) is on the Southern end of Lake Kivu. As we leave Rwanda, the sidewalk construction and the tarmac ends and the road into town is dirt. We enter the DRC. Later, the tarmac begins again in Bukavu city. Only the main road is paved.

Lake Kivu

It is hilly, green in places and densely developed with houses and shops. Brick buildings fill in all open space up and down the many hills. This is definitely not a planned city but a growing town where, since 1994, Congolese have come, fleeing from rural, unstable conflict zones.

In Bukavu, the traffic is thick and the streets are lined with people. It is very hard to walk down the street because the sidewalks are broken and rocky and we can’t help to look up at the houses, down to the lake, across at the vendors and businesses. We walk though, trying to avoid the pedestrian, motorcycle and vehicular traffic . This is very compelling people watching.

According to the World Bank, per capita GDP is US$199.  The CIA Factbook  ranks DRC 226 out of 226 countries in the world in GDP per capita, behind Sudan, Sierra Leone, Eritrea, Somalia, Zimbabwe, Burundi and Liberia. I think Burundi and the DRC are competing for last place though.

Nevertheless, houses or villas near the lake indicate there are some very wealthy folks here. The three story Victorian houses are surprising.Houses I am also surprised by so much new-house construction. The American, oops, I mean the “Congolese dream” is to have a house –a patch of land and a structure where a family can be safe and live together—and so they are building in all open spaces, unrestrained by permits, zoning laws or building standards. It is safe here.

The DRC, rich in minerals and natural resources and home to a long line of corrupt leaders, hosted the “African World War” and a series of conflicts, is rife with perpetual instability and insecurity. And yet, the buildings of Bukavu do not tell the story of Congo’s First and Second wars. In Liberia, where war ended in 2003, at least a third of buildings wear the scars of machine guns and bullet holes. Even in Bosnia, from the airport to Sarajevo and en route to Zeneca, you see the remnants of grenades and mortars and sniper attacks from the war that ended 20 years ago. You also see the endless graves that took over the parks and other open spaces. But here in Bukavu, I do not readily see destruction or the aftermath of protracted war. It is not until you talk to people that you begin to understand the long term impacts of the DRC’s wars and insecurity. There was violent fighting as recently as 2008 and even attacks last week (May 2012 see below (Except for you Mom!) “Blind violence” in the eastern DRC. U.N. military officials report “brutal massacres”). While an estimated 5.3 million people have died since 1998, millions of these deaths were among women and children who died of starvation and disease because they were forced from their villages by rebels and soldiers. They were cut off from food and healthcare or protection from rape, hunger, weather, and natural disasters. Of course there were guns, but machetes, spears and knives were also common weapons of war. These leave horrible scars on humans, but do not mark the architecture and landscape.

We will not conduct our study in all of the nearby sites where Women for Women works because of ongoing insecurity. There are some places you cannot travel through at dawn, dusk, or night because of ambushes. Young thugs (not rebels or soldiers) without jobs but with guns left over from the war opportunistically attack vehicles. Of course this can happen on the streets of Philly late at night or other large American cities too, but we avoid these areas in our own country and move on with our lives.

Stories that freak me out:

Voice of America: Nick Long, May 30, 2012

 UN Condemns Upsurge in ‘Blind Violence’ in Eastern Congo

KINSHASA, Democratic Republic of Congo – The United Nations has condemned an upsurge of what it calls “blind violence” in the eastern Democratic Republic of Congo. U.N. military officials say some of the most brutal massacres in recent memory have been committed by Congolese ethnic militias and Rwandan rebels.

The U.N. Stabilization Mission in the Congo, known as MONUSCO, says it has collected reports of 98 civilians killed and six wounded in 11 villages of North Kivu province between May 9 and May 25.

The mission says the killings were carried out by two Congolese militias – the so-called Mai Mai Rahiya Mutomboki, working with members of the Congolese Defense Force – and by the Rwandan rebel group FDLR.

It says most of the victims, including women and children, were killed with machetes, spears and knives.

 Red Cross reports deteriorating humanitarian situation in eastern DRC

GENEVA, May 25 (Xinhua) — The International Committee of the Red Cross (ICRC) on Friday reported a rising number of civilian victims, as violence continues in the Kivu region in eastern Democratic Republic of the Congo (DRC).

The Red Cross has observed continuing clashes near the border in the eastern part of North Kivu, as well as escalating fighting in the Walungu, Shabunda and Kalehe territories of South Kivu, and more recently in the Walikale and Masisi territories of North Kivu, which have caused many casualties and displacement.

For more on the conflict in the Eastern DRC: http://www.bbc.co.uk/news/world-africa-11108589

Why does a mom of two awesome children work all over the world?

Why do I travel? What makes me go from Eastern Europe to South East Asia to Africa? Why am I en route to Rwanda to cross the border into the Democratic Republic of the Congo? Why is that while I travel for this trip, I must plan for my return to Liberia to present results to the government and then to launch the field work for the evaluation of the national US Govt funded OVC response in Ethiopia?

Liberians hoping to be selected to receive the $10 cash transfer

After the DRC, the Ethiopian project is is my next big field work, a mixed-methods partnership with with the Addis Ababa University School of Social Work and a team of 60 data collectors.  We’ll get support from Pact Ethiopia and the National Statistics Agency. The summer months are before me, my garden is growing, but data needs collecting, we must overcome the logistical barriers and launch the study.

I pass the time on the flight making revisions to our Mozambique report, reading qualitative transcripts from women in Bosnia and children in India.

Nap time in Mozambique

I am somewhere over Africa as I write this, Libya I think. Not always, but more often than not, if I am idle, it hurts too much. I have physical pain from missing my children. Last night’s over night flight to Amsterdam wasn’t great for sleeping so I am tired. Not the fatigued-to-the-bone exhausted that comes later in the trip. Just tired, emotional, unsure. I watched some of a rather silly movie about a mom who travels for work. Stupid movie. The woman had an adorable daughter and a 2 year old son. Hits too close to home and makes me cry. I wonder how often stewards and stewardesses see people cry. So again, why do I do it?

Malawian children

These projects I take on and fall in love with, that drive me stark-raving mad and make me angry as a wasp, and that become part of me–these projects that take me all over the world–I do not do them because of ambition or success. My ambition bled out following a few failed grant proposals, poor treatment by some leaders in this field, when my organization let me down, and then some close collaborators, well, betrayed me. I was ambitious at one time, but no more. These major disappointments knocked the wind out of me and forced me to look inward.

Botswanan child

Career “success” is too fleeting. It is too dependent on others approval. I am too old and too young to be jerked around or need others’ affirmations to feel satisfied. Either I am satisfied or I am not, and it is based on my relationship with my work.

Children in Mozambique

Interview in Bosnia

Thus, the drive or the motivation that I muster to engage in global projects is not linked to ambition or career success or some early-career or female ‘need to please’. Neither do I think I will single-handedly “change the world.”  I do not board the plane thinking I’ll write the report of the journal article that will save lives.

I want to very much of course, but life, development, change, improvements, progress, these are all complicated.

Children murdered in the Bosnian war

Children in Karnataka India

When I fly across the globe to some of the less glamorous regions where war, disease and poverty live, it is about my duty as a human being. My life is bigger than me. Bigger than my words, bigger than my needs and desires. It is about connections and linkages. I am linked to boys and girls in Liberia and Botswana, children and elderly persons in Malawian, Bosnian woman and children, Indian families affected by HIV, Zambians riding bicycles, Zimbabweans struggling for employment, South Africans trying to adhere to their ARVs, Ethiopian families and organizations, Congolese families trying to survive war.   I don’t know what it all means yet.

Boys in Botswana

Maybe my linkages are important steps in a bigger picture. Maybe I’ll say just the right thing to someone on an airplane, or a student, or policymaker. I’ll influence the right person at the right time….maybe during a presentation, in the classroom, or in a meeting, or maybe at the park or a birthday party. And that person will make the decision that changes the world for the better. Maybe I’ll teach the person who influences another.

My girls

Maybe I’ll finally piece together some small part of a larger puzzle and I’ll share these results with someone who knows someone who can change something. I don’t know what how it all plays out. I am not certain my academic contributions are the thing that matter, just that this is the way I am supposed to learn and teach and contribute to the world. I have no illusions of grandiosity.  Yes, still, somehow it all matters. I don’t how, but it matters and my contributions are part of the solution.

So my question to you: What are you doing for humanity? Maybe there’s no proof it will matter, but what are you doing? What do you want to do? What would you do if you were not afraid?

Oh yeah!

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