Keynote Challenge for 2010

The SAHARA conference 2009 focused on sociocultural issues surrounding HIV, and in an attempt to kickstart the conference in a diverse manner, they hosted 3 keynote speakers:
a politician,
a physician,
and an openly HIV+ activist.
I was most impressed by this final speaker. Why? Because he made me uncomfortable.

He started off his speech in a fairly predictable way, discussing what it is like to be an openly HIV+ person, the difficulties he's faced in his family and neighborhood, and his optimism for a potential cure during his lifetime. Then he turned his focus to the audience:

"There is a Voluntary Counselling and Testing tent in the main auditorium," he stated. "I challenge each and every one of you: Get tested, and come out. Today."

He told us that public health campaigns can't just focus on testing, but must also promote a sense of responsibility among HIV+ patients. He emphasized the word responsibility, as opposed to guilt. By taking ownership of the disease, he stated that patients may find the strength to publicly disclose their illness. And through these disclosures, the HIV epidemic will take on a face, a name, and a meaning.

"Let 2010 be the year in which we all come out. I hope that we can do this. And I challenge us to start here today."

This speaker's challenge was more powerful than any I'd heard of before, because it was personal. He was not challenging the anonymous masses. He was challenging us as individuals in a (relatively small) group of our peers, to start the charge today.

At my 1pm seminar on female circumcision policies in eastern Africa later that day, the speaker approached the stage as her credentials were announced: MD/PhD, published widely, involved heavily in HIV/AIDS research. She began her speech with, "I'd like to tell you all here today that I have been living with HIV for the past 20 years. I think I'm the first person to disclose here at the conference, and I thank the keynote speaker for his challenge."

Applause.
Ovation.
Was this really happening?
Over the course of the next few days, I heard 4 more people diclose their HIV publicly.

This campaign made me really uncomfortable because it made me question my own strength. Would I have the courage to wave my health status above my head like a war flag? If I don't, does that make me a hypocrite?

This campaign, if nothing else, makes people talk. Some comments I heard during the course of the conference:

I don't think it's appropriate to have the VCT tents here in the main auditorium. If you had even the slightest inclination that you might be HIV+, why would you want to find that out in a giant room filled with your colleagues? The publicity is totally uncalled for.

I'd be concerned that if I found out I were HIV+, I'd feel peer pressure to disclose publicly, and might regret it later. His speech was kind of coercive in that way.

I'm totally blown away by the fact that people are brave enough to say it in front of everyone.

Unfortunately, the fact that so many of us felt uncomfortable serves as validation of the social stigma of HIV. It is very real! The keynote speaker's challenge was valiant, and it may indeed do wonders for the HIV epidemic to remember that we are working with people, not statistics. But it is not realistic to expect this from our patients if we are not yet comfortable with it ourselves.

I was profoundly moved by each and every disclosure on stage. Despite my education, I was still overwhelmed to see that HIV does not discriminate. It is not a black person's disease, or a poor person's disease, or a women's disease, or an uneducated person's disease. I (again) applaud the people who are strong enough to come out. I thank the keynote speaker for pushing me outside my comfort zone. And I hope some of you can join me in considering his ideas for 2010....

KRUGER!

Kruger National Park, aka SAFARI!

felt kind of like entering Jurassic Park....
I don't care if Pumbaas aren't in the "Big 5" (Rhinos, Lions, Elephants, Buffalo, Leopards), they're still my favorite....
This guy popped out just as I was getting used to driving Andrea's stickshift car, with the steering wheel on the right side, on the left side of the road. But did I remember to hit the clutch before braking? Yes!......Rhino meets up with his family (since it's early summer in South Africa, we were able to see babies of all the animals):
(There are hippos in the background....)

Some birds hitch a ride on an impala.....

heading off on a Sunset Drive....
Baby spotted hyena.....waiting for the hunting party to return with dinner.....

LIONS!

(Still) On the way to Kruger....Blyde River Canyon....

Blyde River Canyon is the kind of beautiful place that the tourist who simply comes to South Africa for safari might miss. And it is not to be missed!

While we didn't have time for the 5-hour day hike that is supposed to be incredible, we did spend an hour exploring and photographing this picturesque place. I have officially been inspired to visit the American southwest.....

And...finishing the day off at "God's Window".....

On the Way to Kruger......

For my last few days in South Africa, I headed off to Kruger National Park with Andrea, another Doris Duke fellow. Kruger is located in northwestern South Africa, on the borders with Zimbabwe and Mozambique. About 5 hours outside of Johannesburg. As is to be expected, however, Murphy's Law came into effect and we got a flat tire halfway there:

Or maybe not so much flat as destroyed.....


Andrea looks excited here. But believe me, she was not. Quite the opposite. We're not exactly skilled mechanics but we do have the jack in there......
Suddenly I looked up and saw this:
This guy seemed to literally descend from the clouds. I was scared at first and about to go into ninja mode, but warmed up when he introduced himself by saying:

"Hi I'm Corne. I was behind you two and saw you swerve. When I saw it was just you two ladies, I thought I'd stop to help."

Why Thank -You Corne!


me watching Corne work...


documenting the situation is tres important!


and off he goes....
So our tire was fixed.
Life was good.
And we learned that there are some incredibly good people out there.

Rhino & Lion Nature Reserve

The day before the SAHARA conference began, I visited the Rhino & Lion Nature Reserve (click the post title to link to their website). The reserve is located in the southern part of Gauteng Province, South Africa, right near the "Cradle of Humankind," a World Heritage Site. According to the website, the Cradle of Humankind is comprised of 12 limestone caves.

"At least seven of the twelve sites have yielded hominid remains. In fact, together these cave sites have produced over 850 hominid fossil remains, so that to date they represent one of the world's richest concentrations of fossil hominid bearing sites.The scientific value of this area lies in the fact that these sites provide us with a window into the past, to a time when our earliest ancestors were evolving and changing. Scientists have long accepted that all humans had their origins in Africa."

I wasn't really interested in the ancient history of the region on this particular day, however, because I was headed to the Rhino & Lion Reserve TO PET BABY LIONS. Yes that's right.

TO PET BABY LIONS.

...and a Cheetah named Eddie......

...and a baby Hippo (yes this is a baby. Hippos get HUGE)....

...but mainly LIONS....

SAHARA Conference 2009

As part of my research year here in Africa, I attended the 5th annual SAHARA Conference in Johannesburg, South Africa, from November 30 to December 3. As an added bonus, I was accepted as a speaker to present my work from medical school in New Jersey!

SAHARA stands for "Social Aspects of HIV/AIDS Research Alliance," and the organization hosts an international conference every two years. This year, the theme of the conference was "Sociocultural Responses to HIV," to emphasize that HIV/AIDS is not only a biomedical problem, but also a cultural one. In order to successfully combat the epidemic, researchers and healthcare workers need to realize and address this fact.

The conference, in short, was amazing. I'm usually bored to death by Powerpoint presentations and monotonous speakers, and consider myself a harsh judge. That said, I was awake and intrigued by every single presentation. Not only did I learn more about the HIV epidemic, but also about cultures in different parts of Africa. In between sessions I was able to chat with the other conference delegates and only wish that I could stockpile all those interesting people into the nearest coffeeshop and keep them on hand for good conversation.

One particularly great speaker was Dr. Wreford, a British woman who moved to Southern Africa and over the course of many years, became a "diviner healer" with the Xhosa people of the Eastern Cape. She recently received her doctorate in anthropology and talked with me about the role traditional healers play in the HIV epidemic. Traditional healers, in Africa and elsewhere, are the healthcare providers most deeply entrenched in local culture. If 'Western medicine' could establish good connections with them, they could play a huge role in HIV treatment. Several years ago, I had a trying experience with traditional healers in Ecuador, and it was wonderful to chew over my thoughts and ideas with someone who had experienced both sides of this issue. For anyone interested, her book is titled Working With Spirit and is available via Amazon here:
http://www.amazon.com/Working-Spirit-Experiencing-Contemporary-Epistemologies/dp/1845454766/ref=sr_1_2?ie=UTF8&s=books&qid=1260351993&sr=1-2

My presentation (12 minutes of speaking to about 50 people and avoiding the word 'um') also went really well. For those of you who don't know about my project (and apologies to those who have heard wayy too much about it), it's called The P+sitive Story Project. Basically, the United States has done a really good job of reducing maternal transmission of HIV. At the same time, we've succesfully treated those children who were born with HIV with antiretroviral medications. This means that we have a small group of people who were born with HIV who are now surviving into adulthood. This unique cohort may have equally unique needs, and in general their sociocultural needs haven't been studied very much.

For my project, I interviewed perinatally-infected adolescents and young adults from the Robert Wood Johnson AIDS Program. I collected their personal stories about living with HIV: their challenges, fears, health strategies, questions. I compiled the stories into a 'storybook' that can be used
(1) to treat other HIV+ patients who may appreciate reading the stories of their peers;
(2) to educate the general public about HIV and reduce stigma;
(3) to evaluate the needs of this patient population;
and the project also addresses the interview process itself as a treatment tool for patients.

I was pretty nervous for my presentation, but it went over surprisingly well and I even had a line of people wait for me afterwards to ask questions. Now I know how college professors feel!

In summary? The SAHARA conference was awesome. Anyone who is interested in HIV/AIDS should definitely consider attending the 2011 conference, which will be hosted in Dakar, Senegal, and will focus on human rights issues surrounding HIV. As for me, I'm hooked and will definitely be on the lookout for conferences in the future. Now time to start saving for my own copy of Working with Spirit....

Giving Thanks

Things I am thankful for this year:

1. My work keeps me busy, yet allows me to be independent. Always challenging me with new questions and obstacles, yet no retracting, no rounding, and no note-writing!

2. I am travelling in a country where not only is my country's president admired, but actually revered. Electing a half-Kenyan man to our top office has spoken volumes about the American people to Ghana, and made my travels much easier. Not only that, but I can purchase:
-Obama biscuits
-Obama underwear
-Obama boxers
-Obama earrings
-the services of a taxi driver who has christened himself "Junior Obama"
and counting!

3. I live in a room with an understanding roommate, amazing wireless internet, and a very effective fan. And also that this room is in a coastal (cooler) city in an otherwise sweltering country.

5. My most recent bout of sickness was not malaria, cholera, or anything worse, especially since it came on just 72 hours before my planned trip to South Africa. *knock on wood*

6. I was accepted to present my work at a conference for the first time. *crossing fingers for the presentation next week!*

7. I am able to travel to see friends in East Africa for the holidays, which might otherwise have been pretty lonely at the ISH.

8. I have not been forced to eat any Banku/Fufu/Kenke against my will.

9. I have wonderful friends who write me emails. And fantabulous friends who comment on my blog. *cough* write a comment now *cough*

10. I was able to come to Ghana on a research fellowship for almost a full year, and still have 6 months left!

Benefits of Living at the ISH

Did you know that Nigeria is the densest nation in Africa, accounting for close to 80% of the population of all of sub-Saharan Africa?

Neither did I, until this year.

I live in the "International Student Hostel" (the ISH, as people call it) here at Korle-Bu Teaching Hospital, which means that I live with roughly 75% Nigerians, 20% Ghanaians, and 5% "Other." Accordingly, I have lots of opportunities to learn about Nigeria.

Just last night I spent an hour discussing political perceptions of the country versus actual living standards with Kola, a Nigerian student studying medicine here in Ghana. I learned that yes you do need to be really careful in Lagos as opposed to Accra, that Nigerians may actually have more in common with Americans than with Ghanaians, and that the countryside is even more beautiful than Ghana's. And last week my dorm hosted a "Durbar" to welcome new students: a Durbar is a giant Nigerian party. I've also learned that Niger and Nigeria are two totally different countries. A little confusing, but hooray for improved geography skills. :)

This opportunity has been really interesting. Who knew that by coming to Ghana I'd learn so much about Nigeria?

Unfortunately, this article

http://allafrica.com/stories/200911180368.html

shows the downside of Nigeria. Most of my colleagues here agree on the levels of corruption and danger in the country. They did come to Ghana to study for a reason after all...

Togo

Another stamp in the passport! This weekend I visited Togo, or more specifically, Togo’s capital city Lome. Actually, I was required to leave Ghana to renew my visa, and Togo is the closest border to Accra. This was not only my first venture out of the country, but also my first time traveling alone! 4 hours in a tro-tro found me staring across the border at a different country, one with more recent civil unrest than Ghana, but with an even more beautiful coastline and the home of Voodoo.

I walked across the border (a first!), and although I tried to take pictures, my camera was met with hushed “Obruni! Put that away! The police will arrest you!” Although getting thrown in Ghanaian prison would make for a great blog and perhaps even a future book deal, I chose to not enfuriate and terrify my family and took the locals' advice. After one quick shot of course…

(if you look very closely, you can see the black star of Ghana over the border, kind of right above that lady's head....)

Lome has been referred to as the “Paris of Africa,” and immediately after crossing the border I understood why: Most obviously, everyone speaks French. But beyond that, the women sell baguettes on the streets rather than Fufu, cabs are overshadowed by Vespas, pretty flowers and trees line the roads, and the streets include lots of European style bistro seating. (I’ve been looking for shady places to sit and enjoy the streets of Accra since September; now I know they’ve all been annexed to Togo.) Amazingly, the streets also actually had street signs (what a concept!) in French. Lome even takes advantage of its beachfront locale. The palm-lined beach stretches wide out to the Atlantic, and most of the city’s streets are actually sand. (I avoided the beach though, because Lonely Planet told me that's where I was most likely to get mugged. That and people poop on the beach. Ew.) The city reminded me most of New Orleans. Very cool.

I stayed at a (very cute) Swiss French hostel called Le Galion on Rue Camomilles, with the nicest garden area to sit and read.

It was great to have my own bedroom for a night and I settled in happily before dark. The night was not as pleasant as I’d hoped, however, because my nice soft bed turned out to be infested with bedbugs. Around 4am when the first roosters started crowing and I was still swatting at various crawlers, I decided to cut my time in Lome short and leave Saturday afternoon.

This still left plenty of time for exploring, however, and I spent all of Saturday morning on a walking tour. Lome is smaller than Accra and I easily walked across all of it in a few hours, including a meander through the market where I saw a woman carrying 4 cow’s heads in a bucket. Not sure what you’d cook with them, but hey, there’s something for everyone.

One of the nicest things about Lome was the people. Togo seemed a bit more off the beaten path than Ghana, and there were even fewer tourists here than in Accra (which is saying something). As such, people didn’t seem as intent on getting my attention as they usually do. One quick nod, and they left me alone. This was a nice break from Ghana. Or maybe it was that I just didn’t understand anything people were saying (beyond Merci or Ca va mon cherie?) and I could enjoy the city blissfully unaware of any catcalls.

Some of the more residential, quiet, tree lined streets outside downtown:

(My photography skills leave a LOT to be desired. These looked so much better in person. So I guess you'll all just have to go for yourselves!.....and I can practice on the camera....)

For those who are interested in the tourist route, Togo is the original home of Voodoo. "Wait!" you might say, "I thought Haiti was the home of voodoo!" Well the African slaves who established voodoo in Haiti and the Caribbean were originally from Togo, and it's there that you can explore a great market filled with fetish trinkets and the like (leopard skin potion anyone?). I didn't make it to Togoville, the best fetish market, because I wanted to leave before dark, but it could be fun the next time.

I also noticed a lot of UN vehicles and police around Lome, and even crossed the border with a few UN officials. I'm not sure the specifics of their missions there, but I do know that I could happily live in Lome for a while. A very neat place, and I'm sure the rest of the country has plenty of awesome things to discover. So for any of you seeking employment with the UN: request placement in Togo!