Saturday, November 17, 2012

Troubled Township

I'm sorry to have disappeared in the middle of my Namibian adventure tales!  There are lots of small excuses - a house to clean, a job to do, a trip to California to enjoy (photos to come!).  But I'm hoping you'll continue with me as I finish my memories of the journey.
It was the dawn of what felt like the longest day of our trip.  The U.S. Embassy in Windhoek had packed our time there full of wonderful opportunities, but on this day I felt more pressure than enjoyment because I had somehow picked this action-packed day to be Group Leader.  The leader of the day was tasked with collecting appropriate gifts for each meeting we had (everyone in my group came with gifts that symbolized and shared their home state - an eclectic, amazing collection!), introducing our group and the purpose of ACYPL to each person we met and working with the Embassy staff to be sure things stayed on schedule.  When the alarm went off at 5 a.m. I was kicking myself for selecting this long day to volunteer for the increased level of responsibility, but there was a reason I'd picked it: I couldn't wait to meet Esme Kisting.
Esme joined my list of Most Amazing Women Ever as soon as I started reading about her work.  She runs King's Daughters, a non-profit in Windhoek that helps prostitutes find other ways to make a living.  That's a noble thing to do no matter what the circumstance, but in Namibia prostitution is a plague.  It's an all-too-easy career choice that is often passed down through generations (tired mothers send their teenage girls out in their place when they're "old enough"), promoted through tourism (it breaks my heart that there are still people on earth who would consider that an appreciation of Namibia's culture), and connected to the HIV/AIDS problem that is still an overwhelming problem in the country. 
Esme, like a modern-day angel, accidentally found her calling after her young husband died.  She went to work for the Council of Churches, a Christian organization in Namibia.  She enjoyed the work but said her interaction with the women who came for help stirred the desire to do more.  "These people needed more than 'hallelujah' and 'amen,'" Esme says.  So she got support to slowly build King's Daughters into what it is now: an active support system for women who are trying to change their lives and give their daughters a new path.
I think Esme deserved a palace for her organization but instead we met in the bicycle shop, a metal-walled enclosure in the middle of a dusty lot near her offices.  The shop provides an income-generating arm of King's Daughters, and I'm proud to say U.S. funding helped Esme get part of the materials needed for her to hire transforming prostitutes and local men to fix up old bicycles and resell them.  When our funding ran out, Esme talked a company into donating another metal trailer for the organization to use.  I can't even say I was surprised, since as soon as I met her I knew it would be hard for anyone to tell this beautiful, kind and enthusiastic woman "no" regardless of what she asked.

I'll admit that I cried through most of our meeting.  I cried because of the heartbreaking tales, like the woman whose determination to get help had inspired the creation of King's Daughters, and who continued to help with the organization even after her baby died of AIDS.  I cried because of success stories, like the women who had successfully found full-time employment off the streets and  Esme's award from the State Department for her work to end human trafficking.  And I cried out of admiration for someone who has clearly found what she is supposed to be in life, and who is willing to dedicate every moment to become that sign of hope for others who truly need it. 
The only thing that could have made me willingly leave our conversation with Esme a few minutes early was the chance to see more of the Katutura Township.  As you can tell if you've seen the many pictures I took every time we drove by a township located near a highway, I really wanted to learn more about how people lived in the "second economy" of these African nations we were visiting. 
"Katutura" means "the place where we do not want to live" in Otjiherero, the Herero language.  The township has a history similar to others like it - it became the living place of Windhoek's black population in 1965, when those Namibian residents were forced out of their homes under apartheid. Their former homes were demolished so whites could build fancier ones in their place, and though the world has altered - apartheid is ended and Namibia is now an independent nation - the displaced Namibian families continue to live here. 
The fact that this abuse of humanity could happen at all is horrific; that they continue to have to live in this area without basic necessities is hard to comprehend.  And yet we saw many of the urban scenes you'd see on streets in any other part of the walking to and from school, women gossiping in the streets or carrying children and packages, teenagers flirting in the shade of buildings.  This was a hub of entrepreneurship and the signs of a willingness to work were everywhere, in a rather confusing way.  I lost count of how many car washes we saw - there was a car wash at about every third house.  Confusing, since Katutura is a place with lots of dirt, little water and absolutely no disposable income, but most of them were busy.
Check out this interview with the owner of one of the carwashes  we saw- it's impressive and informative!  Keep in mind that one U.S. dollar equals about eight Namibian dollars - so when he says they charge $30-40 for a car wash, it's in Namibian cash.

Each metal shack held a variety of businesses...a small variety.  They fell into the categories of salon, car wash, convenience store, and bar.  Lots and lots of bars in metal shacks, referred to as "shabeens."

I suspected that any time spent in the townships would change my perspective on things, but I wasn't prepared for how much the next stop would change me.  We left the shabeen-filled streets to enter the grounds of the Katatura State Hospital.

This hospital and the people who work in it should make every American stand a little taller and prouder.  To say that this facility is vital to Namibia is putting it mildly - U.S. foreign aid dollars literally mean life for someone who would otherwise have a death sentence from HIV.  They mean a mother can celebrate the birth of her newborn with a better chance of seeing that infant live.  They give parents more time to provide for their families and ensure that at least in some cases, generations of families can stay together longer.

The U.S. Embassy and USAID staff who set up our tour were kind to our overpampered American sensitivities: we toured the hospital on a Friday, when the hospital only accepts new patients.  I suspect that a normal day would have been overwhelming due to the number of treatments on an average day.  There are currently 13,000 patients at this hospital, 9,000 of whom are active.  ("Active" in this context doesn't mean they send Christmas cards to their doctors - it means they are on a continuous cycle of ARVs, HIV management through antiretroviral drugs.)  We started in the paperwork-heavy administrative wing of the hospital, where we got to see first-hand the U.S.-donated computer systems that help doctors treat HIV patients efficiently and consistently.  Namibian health care isn't just fighting the HIV virus, it's also fighting the social stigmas and misunderstandings that lead people to deny they have AIDS or fail to use medication appropriately.  The computer systems help them reach out to patients to provide the support and reminders they need in order to make the treatments effective and prolong their life.
Even the paperwork provided a somber reminder of the heavy load these doctors are carrying - the "archive" room held too many lives cut short. 
The hallways of the hospital were decorated with art that reflected real Africans, not the touristy version in paintings at the markets we visited.  These photographs captured the small joys of daily life in a harsh environment - children jumping on a bed, families sitting together and old people eating simple bowls of food.
The next stop was the pharmacy, where the continuous, rhythmic sound of pills being counted into jars reverberated like a death song throughout the large space.  Patients sat against the wall of the waiting room, blank faces gazing with no curiosity as we walked through, and who can blame them?  We were in business suits carrying cameras, while they're waiting for yet another dose of pills that are their only hope against a disease they did nothing to deserve.  The pharmacy serves 250-300 of these patients every single day.
I’d maintained composure up to this point by focusing on the facts and figures of the information we were hearing: the number of patients rather than the lives behind those numbers, the fiscal details rather than the understanding of how many lives could be saved with an average American’s weekly food budget.  But the information got harder to process in the next section of the hospital, where we met with pediatricians who are responsible for treating children. They're proud of the fact that anti-HIV efforts have dropped the percentage of pregnant women with the virus: one in five Namibian mothers suffer from HIV.

Pediatricians in Namibia were faced with the problem of explaining the need to take the rigorous anti-HIV pills on a regular basis to children who did not yet know what AIDS is. So they developed a curriculum to train young children: "Why I Take My Medicine." The comic-style book tells an exciting tale of the good "body soldiers" and the bad guy...the bad guy stays sleeping if children take their medicine, but if they stop swallowing the pills the bad guy starts to wake up and the good soldiers are in danger. This heartbreaking story works until the children are six, when they're told about AIDS. It's not until they're 10 that they reach "full disclosure," and must begin to deal with the fact that they were born with HIV and must deal with the medications and possible death for the rest of their lives.
These pediatricians have formed a bond with their patients over the years, since the treatment keeps the children closely connected to the hospital staff. The oldest patient in the pediatric wing is 21. He should be transferred to an adult program now, but they haven’t quite figured out how to ensure the transition occurs. The pediatricians have been the guy’s therapists, counselors and guides for his entire life; they worry that if they ask him to trust the less personal nature of the adult hospital treatment, he’ll stop taking his medications.

There was no stopping the tears by now – there’s no stopping them every time I relive this experience. I gave up on taking pictures because I desperately wanted to communicate compassion and admiration for the patients we encountered as we walked through the white hallways, rather than doing anything to separate myself from them any more than usual. No photographs captured the essence of this place, anyway – a combination of hope and despair, disgust and resignation.

The final stop on our tour will haunt me until I die.  We walked across the hospital emergency entrance in the cool Namibian spring air to reach another wing, with a simple sign above the door announcing “Maternity Ward.”  As my eyes quickly adjusted to the inside lighting I saw that I was surrounded by a large room filled with rough benches, slabs of wood with no backs or armrests.  And the benches were filled with women, mostly young but not all, each holding a baby or a toddler awaiting their anti-HIV treatment.  To say that the moment put things in perspective is an understatement – it undermined every worry, frustration or irritation I have experienced, and scrambled my priorities in a split second.  Tears streamed down my face as I edged my way past the women to the administrative offices in the back where we continued our briefing with a doctor proud of the progress they’d made in reaching pregnant women with prenatal care and education.  I struggled to contain my emotions because I so wanted to encourage his enthusiasm for the accomplishments they’d obtained, but I’ll admit there was no way to do so completely.  My fellow travelers subtly passed Kleenex to each other without making eye contact, because any communication about this experience - even non-verbal - would demolish our attempt to focus enough to process the sensory overload when we were back in our van. 

I couldn’t wait to escape and yet I never wanted to leave.  No documentary or fact sheet or photograph could have prepared me for such close contact with the kind of sadness I saw in those womens’ eyes.  No percentages or statistics capture the sheer number of children born with little hope.  When we gathered outside again, the amazing doctor who had led our tour asked if I had the flu – we’d just left a room of dying babies and this wonderful woman, who couldn’t have been much older than me – was concerned for my well-being.  I tried to explain my emotions without ignoring the progress that this woman and many like her had achieved, but thankfully she understood.  This job was new to her, she explained – until recently, she worked in the rural areas of Namibia where there were no fancy state hospitals or computers that ensured doctors knew who needed another round of pills.  When she walked into the maternity ward she saw not a scene of hopelessnes or injustice, but an organized system of life-bringing medicines that could keep babies alive and education that could keep women from passing HIV to their newborns.  I’m so grateful that I had the chance to get her perspective on it, but still am haunted by the facts and images behind the reality of the people’s harsh existence.

When I visit Namibia again I will spend much more time in Katutura and other townships.  I want to understand their reality, their limitations and the victories that each day brings over starvation and illness.  Until then, I will share my pride in America’s foreign aid funding to anyone who will listen, and will fight like crazy to ensure that we continue to reach out a helping hand to those who need it most.  I can make economic arguments about the global market and Namibian exports of beef (coming soon to a grocery store near you!) but it really comes down to that moment when I realized that I never understood the level of despair humanity can endure, and I want to live in a country that does anything it can to help make it better.