my official tittle in the Peace Corps is “community health educator”, there should be a focus somewhere in that tittle for SEX. Qualifications should include a certain comfort level when talking about sex, sexual activities, sex options, sexual behaviors etc etc- fortunately for the PC, I am qualified.
Everyday I seem to find myself in a new “interesting” conversation about sex. Today I was talking with the HIV counselor at the clinic, and his new trainee. I am working on an informational “take-a-way” sheet for the clinic. This will be given to everyone who is tested as a way to softly encourage their partners to get tested, and if they still don’t want to get tested, it will give them lots of ways they can lower their risks. Its really a think piece both to give them info and to make them think about any risky behavior they are involved in.
one of the bullets on this sheet is oral sex. In the states HIV advocates promote oral sex as a “low risk” sexual activity. That doesn’t mean that it’s as safe as using a condom, but if your someone that hooks up with a lot of people, and you change that behavior to just receiving oral sex– you can significantly lower your risk for contracting HIV (and several other STIs (and less risk for STI is also a lower risk for HIV)). If you are not aware of this advantage, just think about it for a minute. We know you can’t transfer HIV by kissing, so if you are on the receiving end of oral sex, you can still get your fix, without much consequence. This was a revolutionary idea to the staff at the clinic. When I started talking there was just the 2 staffers, by the time I finished (and answered some interesting questions) I had half the staff standing in the hallway listening in.
at one point I had to explain what a dental dam was- discovering in the process they don’t exist here. I then proceeded to take a condom and cut it lengthwise in half, showing them this was an optional stand-in that could be used. (I remember someone telling me this is how female prisoners in the states do it).
one of the other bullets was promoting male circumcision. This is a HUGE push here in Swaziland, and several other african countries. A circumcised penis has a significantly lowered risk of contracting HIV (and other STI’s). there are advertisements and literally parks full of “pop-in” tents, all over Swaziland promoting this procedure for sexually active men- however, men still have questions when it comes to this particular operation. I have often found myself in conversations (like on the bus, in line at the store etc) explaining exactly how the procedure is done and the benefits of lower risk sex.
When I was done with my educational session, the trainee asked “why doesn’t this sheet say anything about abstinence?” I giggled a little, I was impressed it had taken him over an hour to realize this. Not having sex, and using a condom are the only promoted ways to keep yourself safe from HIV here and the only way to lower that risk further is male circumcision. So, if I was a swazi, my choices are to never have sex, use a condom every time with my partner, or to cut off a part of my member… it’s really no wonder no one is listening anymore. In response to his question I asked what his bad habit was. “fried chicken” he says. I asked, “ if I told you that eating fried chicken would one day kill you, would you stop eating it? Never eat it again in your life?” he laughed, and said he understood what I was getting at.
It remains mind boggling to me that people continue to be so “hush hush” about sex- weather in the states, or in a country with the highest HIV rate in the world. Promoting abstinence and using condoms is not working. Its time we buck up, get real, and talk to people about other realistic options– my two sense anyway. The peace corps policy is that you have to have a bachelor degree to apply– however, given my daily conversations, they may want to think about waiving that stipulation for the porn industry.
Despite the somewhat awkward conversations I have, and the amazing ways I have learned to gesture things with my hands– I have really loved the last 2 weeks at the clinic. Working with the HIV counselor has been a HUGE learning experience for both of us, and I enjoy comparing information with him. I really feel like this is where my focus is going to be for the next 2 years. We are planing outreach, improving office visits and getting people comfortable talking about things that make them blush. I’m excited 🙂
So get out there! Talk about sex with someone important to you!
my mama raised me better than that.
Today I had planned to stay home and catch up on some writing/project planning, but I was woke up at 6am by Babe Gwebu (the HIV counselor at the clinic). He phoned to tell me about an RHM (Rural Health Motivator) meeting happening at 10am today. I got dressed, poured my coffee in a to-go mug and headed off without delay. I have been trying to meet a RHM for weeks. RHM’s are a group of volunteer women that are active in the community, visiting the sick, helping OVC’s and providing health information to people unable to come to the clinic. Every community has them, however they are not always as “active” as they should be.
When I arrived at the clinic I was delighted to see over 50 faces staring back at me. I should not be surprised that the RHM’s in Tikhuba are everything they should be, the clinic here is well run and managed- I have never been anything but pleasantly surprised by their efficiency. I had a brief introduction by a nurse at the clinic, who was kind enough to translate for me. Not many of the RHM’s speak english, as they are mainly an older crowd.
I sat through a 2 hour meeting, all in siswati. The senior nurse lead the meeting and covered multiple topics; malaria prevention/symptoms, immunizations for newborns, monitoring child growth and nutrition etc. I was impressed. They also talked about someone taking me on a day of shadowing, which I am excited about. The RHM’s are a part of the community, and know about the challenges of the people living here first hand. Being able to see these challenges and talk to them one on one will be a great advantage to the work I do while I’m here.
After the meeting, Babe Gwebu found me and asked for my help with one of his patients. I wasn’t sure what to expect, as he said he just wanted to see if I had any ideas for her. I entered the room to find a beautiful young women, resting her head on the cool cement wall. She was skin and bones, and exhausted—aged drastically by HIV. Babe proceeded to tell me her story. The woman’s husband had passed months ago from HIV, leaving her and their 2 HIV+ children behind– no other family remains living. She has been bed ridden for weeks, but had managed the hour walk to the clinic to get ARVs for her and the children. They have no income, no food; how could I help they wanted to know.
I was stunned. Peace Corps is about sustainable community involvement. The idea that you can give a man a fish and he eats for a day, but teach a man to fish and he eats for a lifetime. I racked my brain, named NGO’s I thought could assist her, inquired about a garden on their homestead, visiting the NCP to get food. All these ideas where exhausted quickly; her home is on the border of cheifdoms and no NGO will claim her, the river is far away and her garden can not thrive, there is no NCP near her, and she can not contact anyone to register her children as OVCs. She has ran around in circles, everyone sending her to someone else- no one willing to take responsibility. I was out of ideas. I get asked for money and “sponsorship” everyday, I kept thinking, if I help her, I have to help everyone. I don’t get paid much in the PC myself, and am running low on funds too. I apoligized and said I would make a few calls for her, hoping another PCV would have some direction for me. She thanked me, with tears welling in her eyes. She honestly, wholehearted THANKED me. I literally did nothing to help her, and she thanked me. I was heart broken after she left, but convinced myself on the way home I was doing her a service in the long run.
Sometimes I think that Chicago broke me. Bums asked me for money all the time, and it was rare that I gave in, knowing the money would be spent on booze or drugs. Even in Swaziland people see me as an ATM, trying to slide their loaf of bread into my order at the checkout, when they can probably afford it themselves. When I returned to my room I looked around. Half a cabbage I couldn’t finish was beginning to rot on my counter. Cans of bean collecting dust- sicking around to be my “emergency” meal. I have more food in this house than I can eat. I seriously thought I was going to be sick at the thought of this woman and her family starving tonight, while I sat around all this aging food.
I packed a plastic bag with food I knew I wasn’t going to eat, stopped at the shop and bought a bag of bread and a liter of milk and headed to the clinic. I surprised Babe Gwebu in the garden, first words out of my mouth were “i feel like a jackass- my mother raised me better than this…” he looked at me a little astonished as I handed over my bag of goods. I made him promise he wouldn’t tell anyone where the food came from, I didn’t want to make this a habbit- but I knew I wouldn’t be able to sleep until I did something.
He assured me he would get the food to the woman, and I am still making a plan to “teach the woman how to fish”. But i’m happy to know she will have something in her stomach while I do the run around for a while. Its amazing how quickly we can become jaded, and desensitized by the request of help. Some people have no option, and in Swaziland it can be a matter of survival. I know I can’t feed everyone I meet- but I hope I never forget how empty and self righteous I felt when she walked out of the clinic. Never again…