Thursday, June 9, 2011


Halfway through an impromptu meeting with my photography group this morning several awkward gazes to my waistline alerted me that my fly was down. I often arrive at school like this. Colleagues used to pull me aside and discretely tell me. It happens so frequently these days that they just point down. I hope that this isn't some kind of metaphor for my life. At 24 this is not a problem I foresaw having.

Injuries take longer to heal in Mozambique. We were told about this in training, that due to the humidity or the heat or something that wounds would persist. I have some nasty scars from infected insect bites on my legs that I didn't take care of.

Medical problems come easier too. I've had parasitic insects lay eggs in my toes (I removed them myself with a needle, as is the custom. Doesn't hurt), I have had skin problems come and go, and of course there are the toilet issues that plague everyone. Parasites, absesses, infections, blood in your stool are all maladies volunteers have had, just off the top of my head.

Suffice it to say that you can't be a hypochondriac and be here. You have to stay conscious and positive about your health. Getting sick sucks, but is all par for the course for a volunteer, what with Maputo just a day's travel away there are few maladies that are actually scary.

But imagine you are Mozambican, and you get sick. First, let me describe our health center here in town:

You enter the complex with offices on the left, the main treatment center ahead of you and to the right. You see people milling around the entrance. As you approach you begin to see the line to get into triage. It's huge, has a couple hundred people, lines the hallways and wraps around the hospital buildings. It's a lot of mothers and kids. You get charged 50 meticals just for your place in line, the locals pay 1 metical.

There are masculine and feminine wings to the hospital. There aren't enough beds so at least a few people are on the floor on straws mats. Some of the rooms are for seeing patients, others are eerily empty. The prenatal care center is the nicest part of the hospital, which is a relief. The lab where you get tests like stool samples is a treat. The front desk is covered in papers and the back table in blood.

In our entire district there is one doctor. In Mozambique, a country of about 20 million people there are less than 1,000 doctors (most are women), and the majority of those are in the capital city of Maputo, which lies at the southern tip of a 1,500 mile long country.

So imagine you are Mozambican, and you get sick. But first let's think about conception of disease.

You've never taken a biology class of any kind. You might have had some science of some kind in secondary school, such that you you may know that science exists. Now, someone tries to explain to you that a being, so small that it cannot be seen, will enter into your body and begin to replicate itself using your bodies resources and a protein manufacturing blueprint called DNA. Not only this, there are even more infentesimal beings called "viruses" that are hardly alive at all, but are similarly dangerous and hijack your own bodies DNA to replicate themselves. Would you believe them?

Note: here is the most tremendous problem with raising awareness about HIV and AIDS. Without a basic understanding of biology, without a micrscope to see cells, how could you ever believe that a DNA carrying, malignant protein was real? What would sound more realistic, or at least more resonant: some foreigner who barely speak your language explaining the tiny, evil protein, or someone from your community that blamed it on your angry ancestors (or scientology)? I remember my dead father, let's say. I remember what he was like and even now that has an effect on me. His presence in my life is real. Beings too small to be seen? DNA? Or even more basically: the word "protein". The word "cell". Jibberish.

Now imagine you are Mozambican and you are sick. Imagine how stressful and scary it would be. People get sick all the time here, and the vast majority of people die of infectious disease. Infectious disease happens fast, without treatment malaria will kill in days. People you know, family members, have died of these diseases. One day they were fine, and a few days later they were dead. Disease is an invisible, incomprehensible, murderous force. Could there be anything more terrifying than that?

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