African Women Confront Bush’s AIDS Policy

Yifat Susskind of Foreign Policy in Focus writes:

...[G]rowing numbers of people around the world know that sub-Saharan Africa is the epicenter of the AIDS pandemic: three-quarters of AIDS deaths worldwide have been in Africa, and today the continent is home to nearly two-thirds of all of those who are HIV-positive (more than 25 million people). Fewer people know that most Africans living with HIV/AIDS are women, and that young women are now being infected at a rate three to four times higher than young men. For many, this information is absorbed through a mesh of stereotypes that make human misery
seem like a natural condition of life in Africa .

But while AIDS—like the litany of this year's natural disasters—may have originated in nature, the magnitude of its destruction is a man-made catastrophe. Consider the following:

• Since the 1980s when AIDS first emerged, the United States has demanded “economic austerity measures” in impoverished countries. In Africa , these policies cut national health budgets in half just when public health systems needed to be ramped up to combat AIDS. Today, the pandemic is the single
  greatest obstacle to economic development in Africa .
• To bolster already-huge profits of U.S. pharmaceutical companies, the Bush administration has blocked the sale of affordable generic drugs that have saved millions of lives in rich countries.
• Women are made particularly vulnerable to HIV infection because they are denied the rights to refuse sex or insist on condom use. As the majority of those living in poverty and the poorest of the poor, women are more likely to contract HIV and more likely to develop symptoms of AIDS soon after they are infected.

AIDS, unjust economic policies, and women's inequality are mutually reinforcing crises; combating any one of these requires addressing them together. But too often, public health programs, government policies, and even activists compartmentalize issues, missing critical points of inter-connection that are keys to effecting change.

AIDS in DC

The press coverage yesterday was depressingly scarce. 18 years of World AIDS Days and I guess everyone just doesn't care anymore.

Today the Washington Post's Darragh Johnson talked about the Whitman Walker clinic's mobile testing unit that was out on the streets yesterday. Despite the fact that:

Washington's rate of infection is alarmingly high -- at Whitman-Walker's clinic in Southeast the positive test rate is 6 percent -- and it's not going down. In 2001, in cities with more than a half-million residents, the relative numbers of Washingtonians infected with AIDS outpaced the country's other big cities, according to a thick report on "HIV/AIDS in the Nation's Capital," released in August by D.C. Appleseed Center for Law and Justice, a public interest organization.

So. To recap. Each of the numbers below represents the number of AIDS cases per 100,000 residents in 2001:

Washington -- 119

Baltimore -- 117

San Francisco -- 67

New York -- 64

Philadelphia -- 58

In 2003, two years later, D.C.'s number had jumped to 170.

(Johnson [2005] "In a City With A Big Problem, Trying to
Turn A Corner on AIDS" The Washington Post 2Dec05 )

Noone wants to get tested. The mobile testing unit spent the day hanging out and encouraging people to come and find out their status, but to little effect.

*

Some good news: Yesterday the Guardian reported:

Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

(Bosely [2005] "Europeans reject abstinence message
in split with US on Aids " The Guardian 1Dec05)

One of the many canals in Amsterdam, taken by the lovely Maz (while I stayed in and wrote my paper!)

Patti Smith & other Adventures in Amsterdam

On Thursday I arrived in Amsterdam... and wow. This just really seems to be the city of the future. It's kind of hard to believe that the Dutch have got it so right... I mean, what on earth are we doing in the rest of the world? Granted, I've only been here a few days, but the overall impression is one of serenity and efficiency. Public transportation is great, police presence verging on nill, and despite what you would think, no public 'scenes' so endemic of US/UK societies on a weekend.

Maz and I have had a wonderful time relaxing and catching up the past few days. On Saturday we went to see Patti Smith at Paradiso which is a converted church and must be the coolest place to see a gig ever. I've never really listened to Patti much, but she was incredible live. Despite being a living legend, she has to be the most unaffected musician ever (and yeah, I'm including all the musicians I know that aren't anywhere close to being a legend!).

The hostel is a bit dull, but clean and warm (and at 27 I think maybe that should be my main criteria for hostelling). The red light district was a strange sight, the city goes from picturesque to ummmm pornographic in a few steps. But crime seems to be a lot lower and we did find our fave hang out spot of the weekend slap bang in the middle (just in case you're concerned, I am leaving with far less money than I arrived with!).

I don't think I've ever had such a great weekend :)

Morality and AIDS

It has been far too long since I last posted... somehow every day life never seems to compare to the urgency and immediacy of travelling. I always find I am thinking much more deeply about things and write far more in a new environment than I do at 'home' - wherever that may be at the time.

I just had an email asking me if I didn't think 'moral issues' were at the root of the AIDS epidemic in Africa. No - I don't. I think the root cause of AIDS is a particularly clever 'germ' that has learned to spread through sex (or human reproduction) something we humans are highly embarrassed about and something we will continue to do, furtively and otherwise, until we are extinct. I'm not a biologist and can't document the way the virus has evolved and spreads biologically, but would recommend reading Guns, Germs and Steel to see how germs develop and AIDS in the 21st Century for more on the biological transmission of the virus.

I can tell you that women are much more vulnerable to infection (both biologically and socio-economically) and that poverty is a major factor in the spread of HIV/AIDS. Conditions of poverty lead to poor nutrition, higher exposure to disease and suppressed immune responses. A compromised immune system is much less able to resist the attack of the HIV virus. Poverty also decreases options. Faced with the choice between starvation and possible illness later, most people concentrate on short-term survival. This pushes millions of women around the world into sex work, and millions more into dependent relationships.

The reason why Africa, as opposed to say the US, is the most heavily affected region is due to many, many reasons, but not 'morals.' Probably the two most important are the level of extreme poverty (in sub-Saharan Africa, 83% of children are severely deprived of at least one basic human need: food, safe drinking water, sanitation, health care, education, shelter) and that health care is minimal and treatment rare. Sub-Saharan Africa has the highest percentage of untreated STI's: it has been proven that untreated STI's increase transmission risk. HIV is far more likely to be transmitted just after infection and in the final stages of the disease (when viral loads are high), treatment reduces viral loads and thereby decreases new infections. Treatment also acts as a deterrant by reducing stigma and encouraging testing; those who have an incentive to protect themselves if HIV-negative and the knowledge to protect others if HIV-positive.

"As so many of our patients have noted, what is the motivation for learning one’s serostatus [HIV status] when there is no possibility of being treated for opportunistic infections or of access to prevention of mother-to-child transmission during pregnancy, much less of being treated with antiretrovirals when needed?"
(Castro and Farmer (2005) “Understanding and Addressing AIDS-Related Stigma: from Anthropological Theory to Clinical Practice in Haiti” American Journal of Public Health Vol. 95, No.1 pp.53-59)

It is noteworthy that the most common AIDS-related assistance to heavily burdened countries has consisted of education about the disease and condom distribution to prevent HIV transmission. Many of those at greatest risk know that HIV is a sexually transmitted disease and that condoms can prevent transmission.

Their risk stems less from ignorance and more from the precarious situations in which hundreds of millions live; gender inequality adds a special burden, and is the main reason that, globally, HIV incidence is now higher among women than among men.
(Farmer et al., (2001) “Community Based Approaches to HIV Treatment in Resource-Poor Settings” The Lancet Vol. 358 pp.404-409)

The prevention strategies currently used will not stop HIV incidence or AIDS deaths among the poorest populations, especially among poor women. It is time to focus attention on treating the millions already affected, both as a moral necessity and a wise investment in the future. Treatment, both antiretroviral and for opportunistic infections, must become integrated in the fight to combat HIV/AIDS in all countries and in all communities.

Maasai village

Between safaris in the Serengeti and Ngorongoro Crater, we stopped at a Maasai village. We visited a school and the children were really impressive - nursery class counted to 40 (made me realise how little I had taught my class!)

Thoughts, reflections and things left unsaid

I've only been back a few hours but it already feels like my time in Tanzania could have been a dream. I think the most significant lesson I learned is that maybe the most important thing in life is your attitude. It was easy to be narrow minded and not think about the struggles of people around me: to feel frustrated at hustlers trying to sell their wares instead of respect at the persistence with which they try to eke out their minimal existence. On days I allowed myself to feel irritated, everything seemed to build up becoming more and more frustrating and alien. On days I thought more about the position of people around me, I felt humbled and extremely lucky. My trip was a truly amazing experience and one that I was only able to indulge in because of my extremely privileged background.

One of the things I will remember and admire the most about Tanzanians is their kindness and generosity. Travelling by myself in a strange country was perhaps the most daunting thing I’ve ever done, but I met such astonishingly good people my journey was much easier. Everywhere I went along the way I was invited into the homes and lives of people who had to nothing to gain from their kindness. People offered to help me find hotels, meet me in air and ferry ports, take me around town and even to stay in their house when they weren’t there!

I’ve read sooooo many books and studies on Africa, but nothing compares to actually seeing the everyday struggles of people. Being in a village that is only connected to minimal health care facilities through dodgy dirt roads and seeing the huge obstacles people face every day just to get to work things make much more sense. If nothing else, I come away from my stay in Tanzania with the overwhelming sense that infrastructure (roads, buildings, access to clean water) must be improved first and foremost. Children can’t go to school if they have diarreah from unsafe drinking water, the school is too far away for them to travel, or the roads are so dangerous they cause an accident that kills them on the way. Women would have more time to study if they spent less time fetching unsafe water; the more educated a woman is the less likely she is to catch HIV. I keep hearing that throwing money at the problem won’t help, which is true to a certain extent: throwing money at corrupt officials won’t help at all. But cutting off funding when so much needs to be done is not the solution either: development aid needs to be effectively spent so that people have a fighting chance of improving their lives. I’m not sure if my students learned anything during my weeks with them, but they (and everyone else I met) definitely taught me!

scooting round Stonetown

The past three days have been a blur - literally. I've had so much sand and grit in my eyes from zooming around Zanzibar on the back of a scooter that most of the time I haven't been able to see a thing. The first two days I really enjoyed it, but today, 1/2 way into the journey to Nungwi beach at the very tip of Zanzibar, I felt so sore I would have gladly given up the convenience of scooting for the "comfort" of a dalla-dalla. On the way back, I would gladly have paid big bucks for the dalla-dalla comfort, only the fear of offending my host that kept me glued to my rock-hard seat (for those of you that think I'm exaggerating - I have bruises!).

Despite my discomfort, Zanzibar really is paradise. I thought all beaches were pretty much the same, but today I was astonished. The sand was white, the water warm and turquoise, and the waves broke so gently next to the shore it was impossible not to dive in. I've never understood why people are so obsessed with going to the beach, but after Nungwi, I get it. I toured a spice farm early in the day, afterwards we 'sampled' some of the most heavenly fruits I've ever eaten. Starfruit, mangoes, tangerines and many more which I don't remember the names of, but after all the rice and beans I've eaten over the weeks, it seemed a world apart.

I keep seeing signs for WHO, ActionAid, Save the Children, et al's Zanzibar office and thinking what a blessed existence the staff must have to get posted here. It's hard to remember with the seeming abundance that poverty is much more rife than you'd at first believe. One rather sordid measure of this is the plentiful sight of middle aged muzungos cavorting with teenage prostitutes in just about any bar you go to in town.

Nungwi beach

All the way at the top of Zanzibar, Nungwi beach was gorgeous and well worth the harrowing journey.

Mtoni Palace Ruins

This is where the Sultan Said lived briefly. He kept his favourite of the 99 concubines (slaves) here to be used at his pleasure. The ones that fell out of favour would be returned to the auction block and replaced quickly.

Stonetown coast

ICC Arusha

Monday morning I sat in on the one of the courts for International Criminal Tribunal for Rwanda and heard a woman talk about the genocide. She testified that one of her family members had convinced a group of Tutsi's to come out after a week of hiding because peace had been restored. When she and the others came out and registered the men were immediately killed by machete's and clubs. The ones that had any money paid soldiers to shoot them so they would die by gunshot instead. The women and children were rounded up and handed over to armed soldiers who gang raped the women repeatedly. It was heartbreaking to hear her testimony, especially as it was continually interrupted by objections from the defense. The prosecuter asked for a closed courtroom because she was going to name people who would know her identity and it could be dangerous for her as they were out of prison. After strenuous objections from the defense it was eventually granted by the judges and I had to leave.

This morning I went back for a couple of hours before my flight left Arusha. I met Lincoln, a reseacher from NY, who saw the initial cross-examination yesterday after I had left. He told me the defense had really been badgering the witness, especially about inconsistencies in the French and English statements she signed. The witness spoke Kinyarwandan, and couldn't read or write: how she was expected to spot inconsistencies in two languages she didn't speak when she is illiterate is beyond me. Today the defense continued to berate the witness, calling her a liar and at times yelling at her. I know it's their job, but it was very frustrating to watch the defense attorney's treatment of the witness. I felt that most of the questions the lawyers asked the witness were designed to be misleading. My overall impression of watching (admittedly very little of) the trial, was that justice really fails the poor and uneducated.

the Serengeti

When I started planning my time in Tanzania, it never occured to me to go on safari. My goal was to help the children and learn as much as possible about poverty, HIV and just life in general in a developing country. After much encouragement from my mum, and a mass decision from the volunteer group, I left on Thursday morning for the Serengeti. It was a wonderful experience and something I will never forget. We spent two days in the Serengeti and a day at Ngorongoro Crater. The animals were beautiful and it was so nice to see them in the wild. I don't think I will be able to go to the zoo after seeing a lioness play with her cubs a few feet away and a herd of giraffe happily eating together on the Serengeti plain. The safari was an extremely different reality than what I had experienced for a month in Mwanza. Instead of being the only cluster of Muzungos in town, the only Tanzanians we saw were 'servants'. After being used to beans and rice (or ugali) for weeks on end, the buffet table had every Western food you could imagine. Instead of walking or catching dalladallas everywhere we had our own driver. It was quite surreal to for us (the volunteers) to be able to enjoy ourselves to such an extreme extent after witnessing the every day struggles of most people here. It was a fabulous experience, but one that I am extremely glad I had after seeing what Tanzania is really like.

The Serengeti wildebeest migration

Duma (Cheetah and Cub)
Our guide in the Serengeti told us he had been doing safari's since 1978 and never seen a Cheetah in a tree before!

Twiga
The Giraffe was one of my favourite animals.

Simba
This lion was rather shy and hid from us as soon as we approached, the lioness was inches from us and didn't move when we approached!

Goodbye Mwanza

Sadly, after a month at the orphanage, most of the other volunteers and I were concerned about the accounting and felt that the director was not being entirely straight with us. Although it must be emphasized we have no proof of any wrong doing, the prices Fred quoted us for things seemed to be extremely high. Whether the reason for this was because he assumed we had loads of money and wasn't bargaining or something more sinister, I didn't feel comfortable handing over cash to Hisani. I decided it was best to give things, not money, to Hisani. The children loved the toys and colouring supplies I brought with me. Unfortunately, the dresses I had made for the girls weren`t ready on my last day, so Rachel has promised to pick up the dresses next week and take photos so I can post them on here. Over the past few weeks I have talked to Joseph at length and seen how transparent his accounting and fundraising is and that his participation in the community is truly making a difference to so many lives. I decided that the leftover money I had fundraised would go much farther at Fonelisco and gave him US$100 for his orphans.

Although there were times I felt I was loosing an uphill battle, I learned so much at Hisani and I will always treasure my time there. The memories of the children's love, hope and resilience in the face of such overwhelming hardship will continue to inspire me. I loved teaching and playing with them, and saying goodbye on Wednesday night was one of the hardest things I`ve ever done. To be completely honest, I only lasted an hour at the goodbye dinner because I was too upset to stay any longer.

Biala and Matungwa at the goodbye feast
Our last night in Buswelu - Biala clearly had enough to eat!

Streetkids

I wandered through the market trying to block out the noise of all the onlookers screaming at me. I was in no mood to try and fend off the enterpreneurs, taxi drivers or beggars all trying to catch my attention in hopes of making their evening meal. I repeated hapana, hapana, hapana (no) as I walked with my eyes down trying to keep the attention I was getting to an absolute minimum. I was so in my own world that I almost snapped hapana at a little boy who came up to me asking for something to eat. I bit my tongue just in time and did a double take. The reason I came to Tanzania was to try and help children like him, and yet I almost dismissed him out of hand. He had sulked back into the shadows, expecting me, like everyone else, not to help him.

I told him to njoo hapa (come here) and three more little boys came out of the shadows and started following me. I took them to the pizzeria place down the street and after washing we all sat down for dinner. Nickolas, Jameson, Ngusha and Samwel (10-12) were soon joined by Brian (9) and were all very sweet and told me they wanted to come home with me. I explained that I couldn't adopt them (legally, the government of Tanzania won't let people adopt unless they have been a resident here for 2 years - so all of you back home can breath a sigh of relief!) but that they could go to an orphanage if they wanted a place to stay. They all told me they wanted to go, so I called Joseph who said he would be happy to take them in. I gave them all Fonelisco's address (it is close to the city centre) and they promised me they would go - I just hope they do.

Spending an hour with the boys made me feel so much better. It made me realise that even though being asked for money all the time is really frustrating, and feeling like I am constantly being ripped off is a bit frustrating, I am so lucky. I can't imagine the resilience of being nine years old and trying to scrape together my next meal every day and a place that's safe to sleep each night.

Mwanza -> Missungwe -> Ngudu -> Mwanza

I left Mwanza very early and arrived in Missungwe at 9 o'clock yesterday to find all the dispensaries (local doctor's offices) closed. After walking around the village for a bit Patrice and I finally found someone that worked at the dispensary, who said he would go off and find his boss and open the office up. While we were waiting for him to come back, we hopped on bicycle dalla-dalla's to the hospital in search of their VCT (voluntary testing and counseling) unit. We were told again that as it was a Sunday, the VCT unit was closed, but the doctor on duty talked to us about HIV in the area and estimated that about 1/3 of the people in Missungwe were HIV positive and as yet, there was no provision of ARV drugs in the district. Anyone who's t-cell count was low enough that they needed ARVs would either need to pile into a dalla-dalla for over an hour to reach Mwanza (not very feasible in the advance stages of HIV disease [AIDS] when diarrohea is often present) or have to pay for the medications themselves at retail price (not an option for the vast majority of the very poor district). When we returned to the dispensary, we talked to the head of the lab who had come into work especially to talk to us. He told us that the local dispensaries (which due to the sparsely distributed population are usually the only health facilities most people in Tanzania can access) are not able to talk to people about HIV, test for HIV, or prescribe ARVs.

The bus to Ngudu was the biggest vehicle I've traveled in yet, and easily the most frightening! By the time we arrived in Ngudu I was worn out by all the travel, but still had many people to meet. The first person I spoke to was the District officer in charge of AIDS, who told me that the only ARV medications available to people in the district were a single dose used to prevent mother to child transmission, there weren't any drugs available for ongoing treatment of AIDS patients. Again, people that needed ARVs had to travel to Mwanza (2.5 hours away on the fastest route) or buy them themselves. I spent just over 24 hours in Ngudu and met the chief executive officer, his secretary, the district commissioner, the executive officer of the hospital, the chief medical officer, the head of the VCT programme, a few patients, and a group of traditional healers.

I was primarily interested in access to treatment and in an area where treatment options weren't available it was not necessary for me to talk to patients. Despite me saying this several times, the doctors insisted that I speak to two female patients. One of the patients was in the final stages of the disease: she was suffering from diarrhea and abdominal pains, had lessions all over her body and under the sheet was clearly little more than bones. Through my translaters and the doctors I couldn't work out if she actually knew about her HIV status, or if it was just her father that knew. The second lady I talked to was a mother of eight children and came to the hospital complaining of abdominal pains, the doctor told me she did not know she was HIV positive and hadn't gone through counseling yet. It made me extremely uncomfortable to talk to both of these women who were suffering a great deal and know that I knew more about their medical status than they did.

It was a whirlwind visit and one that left me feeling really exhausted. I came back to Mwanza feeling very worn out and depressed.

Ngudu hospital women's ward

Illomba traditional healer

Reasons my mum's glad I'm in Tanzania

1) I've started praying regularly - The roads are so horrendous here it's hard not to. Although cars, buses and dalla-dallas are normally flying down the road at such speeds it's terrifying, when they slow down I am even more frightened. A sudden stop means we're about to hit something, there's a 'puddle' in the road, or we're about to hit a pothole so massive we might capsize.

2) I'm getting more exercise than I have in my life - I'm lifting, carrying or picking up children all the time, I walk everywhere I possibly can (see above), and my stomach muscles are getting a massive workout going over all the bumps in the road.

3) I don't want to have sex - Spending as much time as I have recently visiting hospitals talking to patients (all female) and health workers (all male) might be the best abstinence programme ever.

4 weeks

There are something like 50 children that show up for nursery class every day, ranging in age from three to seven, and in ability from not knowing how to count in Kiswahili to being able to think in English. The ones that are really naughty in class are almost always the brightest children who are really bored by the slowness of the other students. Over the weeks I've learned a lot about the children and managed to put together a group that works really well together. One community boy, Dayo, was absolutely demonic when I taught him the first week in a massive nursery group, but this week he joined my morning class and was incredibly well-behaved and respectful... in the smaller class size I was able to give him enough attention and challenge him so he wasn't bored.

This morning I taught my last class at the orphanage. We spent an hour writing, drawing and colouring, then left for the field where the boys and I played football. I was wearing a skirt and flip-flops, not the best gear for running and kicking (I can imagine my brother laughing at me as I write this) but I really wanted to get the girls involved and thought if I was doing it in a skirt they might join in too. No matter how hard I tried I couldn't get them to join in for longer than it took me to turn around, so after about 1/2 an hour I took them all to the shade and read "The Cat in the Hat" and a few other stories and told them it was our last class together. The children were so sweet and all gave me a hug, I cried when it was time for them to go :(

I can't believe I've been in Tanzania a couple days shy of a month and only have two weeks left. I've gotten used to being called muzungo all the time now. I realise that it isn't meant to be rude, just that people here aren't used to seeing them. Over the weekend when we took the kids to the dance off, Biala was sitting on my shoulders. All of a sudden he says "Madam! Madam! Muzungo!!!" then points at some other white people. Rachel and I asked "Biala what are we?" and he says "Rachel! Tasha!" (pointing at us) then "wazungos" (pointing at the other white people).

Last class at Hisani

Biala

Dirt Rollercoasters

I stopped by Fonelisco today. Joseph and the children gave Max and I a phenomenally warm welcome: the local volunteers sang for us and the children ran up and hugged us when we arrived. Joseph invited me to join him on a trip to one of the rural villages near Mwanza to hear from traditional midwives, so a short while later I jumped into a 4 wheel drive with a Dutch researcher, Joseph and a local translater.

It took about an hour to drive out to the village. I have to say that all my previous reports of awful road conditions were blissfully naive. This was the road to end all roads. There were potholes covering the entire road for the entire journey. We had to drive through giant muddy "puddles" on about a dozen occassions, knowing if we got stuck we'd be the ones to jump out in at least knee deep mud and push the car out. I was extremely grateful to be making the trip in a 4-wheel drive and NOT a dalla-dalla!

When we reached the village, we learned that the women had been waiting all day for us and had just given up and left. We tore off in the direction they had gone to catch them, and spent about an hour rounding them all up again. After so many delays, they were finally able to begin their performance. The women had recently undergone a two week residential training programme through CARE International, during which they had put together skits which warned of dangers in childbirth. Maternal mortality is a major problem in Tanzania, and our long journey to the village showed one of the main reasons: most of the women are spread out really far from hospitals. A contributing factor, is that when women start to have difficulties in childbirth, they are far more likely to consult the local 'witch doctor' than go to the hospital. The witch doctors can't help and often end up delaying the woman so long that she doesn't reach a hospital in time, if at all. These traditional healers acted out the dangers of going to witch doctors and when women should go to the hospital immediately. Their performance was wonderful, drawing a large crowd from passers-by and a very warm response from the onlookers. Work like theirs is a really effective way to educate people and they are doing their communities an enormous service.

Condom holes, stigma and 2nd class citizens: AIDS in Tanzania

I've spent most of this week talking to lots of doctors, nurses, specialists and local people about AIDS in Tanzania. For my masters dissertation I'm trying to gather enough information to compare access to ARV treatment (AIDS treatment drugs) in Mwanza region to Metropolitan Washington DC. Getting anything done here takes far more time than I had imagined, and it is only after being here for a few weeks that I am just now managing to successfully meet with people. This week has been an eye opening experience.

On Monday I met with Singira, a doctor at a local dispensary, who told me that the biggest problem by far is that people are afraid of the stigma associated with being HIV+. Singira said that men who contract HIV are usually affluent and well connected. They fear that the community will discover they have AIDS and shun them, so they don't seek treatment even when they obviously have AIDS. When they become very sick, they would rather stay home and die than have the communities know they have AIDS and get treatment. Biologically, women are two to six times more likely to be infected through heterosexual sex with an infected man than a man would be with an infected woman. This usually (although not always) means that men infected with the virus have access to sexual relations with more women because they are wealthier and can attract more partners or can pay for sex, and have therefore been exposed more times. It also means that once they are infected, they can spread the virus more easily to more women.

In Tanzania, women are made much more vulnerable to infection through lack of empowerment and cultural practices that render women more at risk. Women’s initial biological risk increases with each cut or scrape that occurs during sex. Patrice, a staff member of Hisani, told me that FGM (female genital mutilation) is common in rural areas, that 'dry sex' is encouraged to increase male pleasure, and that forced sexual encounters is the norm. These practices are often caused and encouraged by the belief that removing women's desire for sex will keep them faithful. According to Dr. Kabole at AMREF, HIV prevalence rates in Mwanza region are something like 2-4% of all men and about 16-20% of women.

Patrice, two local health workers and I discussed trying to stop the spread of HIV over lunch. I was shocked when the men told me they had never used condoms and asked whether or not they were effective. In the region with one of the highest HIV prevalence rates in the world, health workers didn't believe themselves that condoms worked, and wanted to know what they could tell people who asked the same question. They were dubious about the effectiveness of something that could be destroyed by oil and told me that when you fill a condom with water, some water would form on the outside so there muct be holes in the condoms which the virus could pass through. I tried to explain that water on the outside was most probably caused by condensation, like a glass of water on a hot day, and that condoms are the most effective prevention technique we have. I asked them was it better to use something that has a 3% failure rate or something that has 100% failure rate. They were not entirely convinced so I have promised to bring condoms and air temperature water to the office to try and prove that the water does not go through holes in the condom. We talked for several hours, and all of us agreed that effective prevention techniques were missing and necessary to stop the spread of HIV.

Despite all the depressing things I've heard this week, Dr. Kabole made me feel hopeful this morning. She told me about an exciting microbicide pilot programme that is about to be started in Mwanza region. Microbicides are not yet available, but would prevent the sexual transmission of HIV and other sexually transmitted diseases when applied topically. They would give women the power to protect themselves, and have been very well received in Tanzania, with 98% of the women surveyed enthusiastic about participating in an effectiveness trial. Let's hope development can be sped up and microbicides in general use as soon as possible: millions of lives are at stake.

For more info on anything in this post, please email me: I would be more than happy to answer questions.

Snake Charmers

I picked up the clothes I had made on Friday, I've been wearing them ever since and feel much less like a tourist! I am so impressed with them I've decided to have dresses made for all the girls at the orphanage by the same tailor. I hope that they will be ready before I leave so that I can post pictures of them.

On Saturday we loaded up all the children in two dalla-dallas and drove out to Bujora to watch the annual dance off. Unfortunately, as seems to happen with depressing frequency here, the date had been changed from the one posted... so we had 2 dalla-dallas, 2 staff, 13 volunteers and 30-odd children in the middle of nowhere with not much to do. We decided that rather than go home again without seeing anything the children should take a tour of the museum, which they thoroughly enjoyed.

We headed off again on Sunday and arrived with plenty of time to gt comfortable before the dances began. A few minutes later some scraggly looking drummers showed up and pounded out an amazing rhythm... only dissapear again shortly. We were beginning to think the dancers weren't coming when they suddenly pitched up in bright matching costumes. Two troupes were competing against each other, trying to attract the biggest crowd. For three hours we ran back and forth between the two groups... but the tribe that brought out giant snakes to dance with at the end must have won - noone could look away from the spectacle!

Bujora snake-charmers

Bujora drummers

Bujora dancers

Takwa Hopital

This morning the newer volunteers and I visited the regional hospital in Mwanza. Today the doctors weren't in meetings and were able to give us a tour of the hospital. They have no computers, the files are all done by paper that spills out in an enormous room. The equipment they are using is fairly primitive, and very costly for those that don't qualify for free health care (children under five and pregnant women). One of the doctors told me that they would be greatful for any donations of childrens medications, the need is too great for the meagre funds of the hospital and they cannot afford to stock the necessary medications. We visited the mens ward, and saw the men lying two to a tiny hospital bed. Most patients didn't have sheets, and those that did were lying on dirty ones. The hospital doesn't provide food for patients, so unless you have family that can afford to and live close enough to bring you food, you scrounge other people's left overs or starve. The majority of patients were hopitalised from malaria, a disease that can be prevented by US$10 mosquito nets.

I visited the STI/AIDS/TB ward and spoke to the nurses there for quite some time, and was really inspired by their passion. Tanzania has recently received a lot of funding to combat AIDS (and to a lesser extent TB). The TB programme at the hospital is funded through the Stop TB programme at the WHO. The nurse on duty told me that MDR TB (multi-drug resistant TB) is really low in Mwanza and that patients are usually very good about taking the full course of medication under DOTS (directly observed therapy shortcourse) which is 2 months of coming to the hospital every day and then another 6 months of drugs. TB is the leading cause of death for people with HIV. The hardest thing for people is to pay for transport to and from the hospital, so smaller community programmes are being developed to enable more people to be treated. The ARV nurses spent a long time talking to me and were very helpful. Since October Tanzania has been rolling out a national programme to treat AIDS patients. The nurses told me that the treat under 200 people at the hospital, and that they are trying to scale up the programme as quickly as possible. The major obstacles they have are getting people to the hospital (transportation costs are expensive), the regimen is very complicated and some drugs must be taken with food and some without (for poor people with little resources eating at the right times is difficult), and the stigma attached to HIV makes people less likely to get tested even when they are sick. Despite these obstacles, local people are working really hard to get people treated and keep them alive. The resounding message this morning was: people here know what to do and are trying to do it, all they need is the funding to do it properly.

Johanes' turns 10

Today was a really long day, but very inspiring. A few days ago I met Joseph, the director of Fonelisco, another orphanage in Mwanza for street kids, at the internet cafe in town. He was looking for a new volunteer and thought I was her. I told Joseph what I was doing in Mwanza and he was very enthusiastic insisting that I must go and visit his orphanage and meet his kids and also offered to put me in contact with people for both the sex ed programme I am putting together for the orphanage and my dissertation research on ARV treatment.

Max and I went over in the late afternoon. We had no idea where we heading but saw a huge crowd of children and jumped out of our taxi. The children swarmed us immediately and talked to us loads, they wanted to know if we would be their teachers and if we would stay and all sorts of things. We went to Joseph's room and he showed us all the things he does to help the orphans: he paints and sells cards, gives drum and dance lessons, assists researchers and has this amazing plan to expand Fonelisco and build a modern hospital which could support far more orphans than he can at the moment. We asked Joseph why he started his orphanage and he answered simply "it is what I can do to help my country."

Max and I trekked back to Hisani in a couple of dalla-dalla's (with her encouragement I stayed on the whole way!) and arrived at 7 just in time to celebrate Johanes' tenth birthday. Some of the children don't even have birth dates, none of them have celebrated before, so this was a big evening. We played musical statues and gave the children biscuits (cookies), bananas and peanuts to celebrate. I've never seen English children dance the way the orphans did! :) Despite our best efforts, we couldn't find a cake anywhere. We had a really nice evening, it was lovely to see them all enjoying themselves so much.

quiz: What's the leading cause of death in sub-Saharan Africa?

Yesterday the newer volunteers and I went to the main regional hospital, although the doctors were too busy to show us around (we will go back on Friday) from what we saw of the place it was staggering that people could go there and get better. It was really dirty and open, it seemed impossible that it ever could be clean enough to help people that are ill. Unless you have (and have been tested) for HIV/AIDS, you must pay for medical treatment. In Tanzania, about 20% of the population live on less than US$1 a day, the World Bank's official definition of 'absolute poverty'. Having lived here for a few weeks now, it seems unbelievable that people can survive on that little, and even more impossible that they could pay for medical expenses. I would say on average I'm spending about $15 a day and I don't think I'm spending a huge amount (that's not including travel costs or accomodation).

After the hopital visit in the morning I taught my afternoon nursery class. This class is a lot bigger than the morning class and much harder to keep them all focussed. I am really happy that I have Matungwa, Joyce and Molokus, all Hisani kids, in the class and I'm getting to know them much better. Matungwa is painfully shy and extremely skinny, but he really beams whenever he's given the slightest attention. He's been at the orphanage since the beginning of the year and despite eating tons according to Grace, he's not putting on any weight. Marwa) is also in my class and he's really been coming out of himself this week. Before the volunteers arrived at the Centre, Marwa used to just sit on the ground every day and not really communicate with anyone. This week he's joined in quite a lot and has coloured in some really wonderful pictures in class.

Last night 11 of the 12 volunteers went out to the Chinese place for dinner, which made me feel guilty again, for the above reasons. We had a really nice meal together and piled into two cabs home to go home. Our cab driver seemed fairly relaxed and friendly. We asked him to stop somewhere so that the Irish and Ozzie contingent could buy a few beers for the road, and set off again. As we wound through the backstreets of Mwanza I asked the others what the driver was smoking, as it seemed a bit stronger than a cigarrette. A little while later on the main road my question was answered. We were flying down the road, when all of us spotted a car stopped on the road, all of us except the cab driver. He continued to accelerate towards it until we were a couple of hundred feet from it when he slammed on the brakes. It felt like everything was in slow motion as we skidded towards the car in front, our driver jerked to the side and over the concrete barriers missing by centimetres the open drain on the side of the road and the car in front. We all thought we were going to die so were very relieved to come out unscathed... it wasn't until a few minutes later we realised the cabbie was driving the wrong way back to the compound: through the worst of the damaged roads. The car tipped and swerved around the huge gauges in the dirt road, but we eventually made it home safe and sound. Phew.

Strength

I've spent a lot of my weekend walking back and forth to the main road. Because of the rain, we've had very sporadic electricity so haven't been able to cook since Friday. A lot of the places in town (Mwanza) have generators so on days without electricity the best thing to do is (if you're a wimp like me) walk to the main road, catch the dalla-dalla in to town and grab a bite to eat and catch up on emails. My diet for the past couple of weeks has been almost completely rice and bread, so I'm hoping the 2 hours (minimum!) of walking I'm doing every day will help work off all the bad food.

On my walk into town today I ran into Sabina and her family coming home from church. Sabina looked really sweet in her best Sunday dress, and it was really nice to see that she does have a family looking after her. Last week we had a meeting with Fred (the director of Hisani) and he told us that many, if not most, of the community children that come for lessons everyday are also orphans, they have just been absorbed by the extended family or neighbors. Alot of the children that come everyday are clearly not very well looked after at home, they are often really dirty and sick.

Most of the children living at the orphanage were street children from Kagera (an area with the highest HIV prevalence rate in Tanazania). Although there alot of these children are also AIDS orphans, usually the reason the children are on the streets is because they are fleeing abusive living situations. A couple of the children at Hisani were found living on their own, sometimes for years, after their parents had died. One poor boy watched his parents die only to be taken in by his grandparents who also died. Before he came to the orphanage he lived by himself for over a year; neighbors dropped off food to keep him alive but he had no other contact with people. It is truly incredible that the children are as loving and hopeful as they are.

Mangoti, one of the community children

Rats

I think I must have been tempting fate by writing the post about animals the other day. I woke up in the middle of friday night to some strange rustling noises. After a few minutes of thinking it must be a cat, then remembering there wasn't a cat in the house, then hearing screetching noises, I realised I was sharing my room with a rat. The rains have flooded the rivers and forced the rats up higher than normal and into the houses. I heard it rummaging around in the chest of drawers for hours. Needless to say, I didn't sleep much for the rest of the evening!

It's rainy season

I read a lot of things about travelling in Tanzania, only to arrive here and think, no, that doesn`t really happen. I read the mosquitos were really bad, but then there was hardly a sign of them so I thought it was all a bit exaggerated until Rachel caught malaria. I read loads of posts on a travel site about people being hustled out of money in Dar es Salaam but thought that no traveler would be silly enough to get in a car with people they don`t know; only to hear this morning that TWO of the volunteers got hustled in Dar by the exact same scheme.

I`d heard about May being rainy season here, but after two weeks of hardly a drop of rain, I didn`t really believe it. Yesterday we passed the new Canadian girls on the dirt path to the orphanage and joked about it looking a little rainy. It started dribbling a bit a few minutes later, and literally as soon as we stepped foot in the orphanage the heavens opened. It must have poured down for at least an hour - the dirt roads all flooded and the girls came running back after about twenty minutes drenched to the bone.

This afternoon, Rachel and I decided to try and find a new internet cafe in Nyakato, much closer to Buswelu and without all the hassles of town. As we set off the sky looked a little dark but we figured we`d get there before the rain started. We got on the dalla-dalla at Buswelu and had a really nice conversation with an old man opposite us. The roads had been made even worse by the rains yesterday and the dalla-dalla almost tipped over going round a corner. I couldn`t stand it any longer and said "shusha" (stop) and the old man laughed a little and said make sure you tell people what it`s like here, how bad things are.

It's so hard to describe, but the roads are horrendous. Only on the main road and in the very centre of town are they paved. All of the outskirts and villages are on dirt roads, which were bad to begin with but have now had two months of torrential rains and are virtually unpassable. Noone I know in the West would drive a car on these roads, yet Tanzanians are forced to travel squished into minivans and the back of pickup trucks without safety belts or often even seats. Every day we read in the paper about crashes that kill and wound most, if not all, the people onboard. My co-volunteers think I am totally nuts, but after so little time I have already reached the point that I would prefer to walk 45 minutes to the main road than risk it riding in a dalla-dalla.

So we walked to the main road and jumped on another dalla-dalla to Nyakato, only to get out and not be able to find the place. The rain started to come down and the choice was into Mwanza or go home. We went onto Mwanza and got out of the (THIRD!) dalla-dalla just in time to give the locals a wonderful view of two soaked muzungos. I think Rachel`s white t-shirt and blue bra made quite an impression on the men!

Choices

I feel quite settled in Buswelu and I'm really enjoying my time here. I've had my morning class for almost two weeks and we are starting to have a lot of fun together. After writing and drawing in their exercise books this morning I read them a story (one of my sister Abby's old Winnie the Pooh books) - which was really fun! They don't know many English words so I was basically acting the whole thing out and they loved joining in. Almost everything I said they would repeat with the actions - they especially liked the bouncing tigger bit!

Cody is leaving Hisani tomorrow and last night the volunteers and I had an incredible goodbye feast for him at Happiness' house. Happiness and her family have been so wonderful to the volunteers - they really have been so welcoming and kind and truly given us a home away from home.

One of the things I'm finding hardest is that the people I meet who are doing wonderful things here all want to leave. Grace, one of the teachers at the orphanage, wants to leave Tanzania because she doesn't think she'll find a man here who will respect her. Caf, also a teacher, wants to leave and go to Uni in the West because he can't afford school here (even if he could, the schools here aren't very good) and thinks he will be better off. I never know what to tell people who tell me they want to leave Tanzania. The ones that have (or can get) the means to leave are usually the ones that could help the country the most by staying: doctors, nurses, teachers. I've met some really wonderful people here and I wish that life was much easier for them, but I know that life in the West would be very different than what they imagine.

Cody's goodbye dinner

The Buswelu wildlife

This morning my class played a memory game - we had cards with lots of different animals turned face down and the kids had to find the pairs. Every time someone turned over an animal I had the class say the name in Swahili and English. My fave Swahili word has got to be Punda Millia (Zebra). I keep getting emails from people asking about the animals here, but I saw more wildlife on the cards this morning than I have in the almost two weeks that I've been in Tanzania. I've seen plenty of cows and goats, and there are an awful lot of chickens and ducks running around freely. One of the other volunteers told me that the fine for killing a chicken that isn't yours is 50,000 Tsh ($50) - a HUGE amount of money here, though it's hard to understand how people would know which chickens are which as they all seem to be running wild.

The animals in Buswelu are the kind you don't really want to write home about. Bats fly overhead frequently. There are MASSIVE spiders around the house - the American boys spent a few hours trying to kill one just outside a few days ago. It took most of a can of deet (insect repellent) and quite a bit of fire to finish it off. We've spotted dead scorpions quite a few times, frightening as the house has many, many dark corners where they like to hide. Rachel and I saw a creature we think was an enormous centipede slithering across the road last night - I've only ever seen something like it in Sci-Fi movies. Last but not least - loads and loads of mozzies. Rachel and Grace (one of the staff at Hisani) both have malaria, so I am being really careful about covering up and keeping insect repellent on!

Rangi

One of the things I've noticed about the children here, is that while most of them are quite intelligent, and all are both studious and hard working, they are not very good at thinking for themselves. The culture in Tanzania is very different to the type of environment that I grew up in. Children are taught to be absolutely respectful of their elders and are regularly beaten at school and home. I think this makes them very good at imitating: they learn to copy and to repeat things, but are too afraid to be creative and make mistakes. The consequence of this is that a lot of the chidren in the upper classes don't really know how to read, draw or write. They can copy something perfectly but don't know what it actually means.

The past week or so that I have had my set morning class, I've tried very hard to incorporate creativity into the lessons. This morning, I tried to have the kids make playdoh animals. I told them the name of the animal in English and had them all make their own one in different colour. Fish were quite easy, as were birds. After trying rabbits and cats for about half an hour we were all laughing too hard to keep going! My next ingenious (!) idea was to have everyone paint a picture with watercolours. I'm sure you can guess that after painting two pictures, a giraffe (triga) and an elephant (tembo), there was more paint on me, the children and the seats than on the pictures. They all had a good time though, and I'm sure with more practice they will get better. Last week I had them colour (rangi) things like 'a is for apple' all week: at the beginning all they did was scribble but by friday they were colouring in properly.

Happiness

Yesterday I took a big step... had my first solo trip into town. It was really nice to do some exploring on my own and I had a relaxed afternoon in the wonderful veggie Indian restaurant writing letters and talking to people. I've noticed that when I'm out and about by myself people talk to me a lot more, I think a big group of muzungos is a bit intimidating to the locals.

In the evening, Cody took me out to dinner with his wonderful Tanzanian family. Up until last week, Cody was the volunteer coordinator for Hisani, and he has been here the longest (by far). His friend Caf's family has adopted him for his stay in Tanzania. Caf lives with his sister Happiness, her five children and another family. Last night Happiness, Caf, Cody and I went to the Tilapia Hotel for a half-Thai and half-Indian meal. The meal was wonderful and the company even better. After the meal, Caf and Happiness insisted we stay the night at theirs and I had the best night's sleep since I've been here in a double bed with a real mattress and HUGE mozzie net. They've invited me round for supper tomorrow night which I'm really looking forward to.

I taught my wonderful nursery class this morning and afterwards headed straight down to the Hisani office in town. Fred told us about the Hisani programmes both currently and in the past. Although I have been involved only with the orphanage so far, Hisani works with both women and children. The programmes for women are mainly focussed on empowerment and trying to end discrimination. At the moment, Hisani runs a food and clothing drop off for women in jail and an HIV counseling programme for women and their husbands. They had a microcredit programme that ran successfully for two years until it ran out of funding and this is something that the other volunteers and I would like to restart if we can find funding. Rachel and I came away from the meeting with the task of putting together a sex and HIV education programme for the orphanage which I am really looking forward to getting stuck into tomorrow!

Cody and Molokusi

Sean teaching

Sukuma's and the FA Cup

Yesterday Sean, Kate, Zara and I went to the Sukuma cultural and museum in Bujora, a village about 10 kilometres from Buswelo. The Sukuma tribe is the largest tribe in Tanzania and makes up about 13% of the population. We had heard that on Saturday afternoons Sukuma dancers perform their snake dance to drums and wanted to tour the museum as well. It took three (terrifying!) dalla-dalla rides to arive in Bujora. We arrived in Bujora at about 1 o'clock, just in time to start our 2k uphill walk to the centre in the heat of the day! Along the way we chatted to lots and lots of people. Tanzanians are really friendly and almost all of them greet you when you walk by, lots also want to practice their English, so getting anywhere always takes longer than you would expect!

Eventually we reached the Sukuma centre to find it almost desserted. After lingering around the gift shop for a few minutes the museum manager arrived. He told us that the Sukuma dancers were performing somewhere else but offered to take us on a tour of the centre, which we accepted. The centre was founded by a Canadian missionary in the 50's, and it's kindof a strange combination of Sukuma cultural preservation centre and mission. There is a big Catholic church built in the style of a Sukuma hut, but much bigger and made from concrete. The inside has been decorated with symbolic Sukuma decorations adapted to fit into a Catholic church (or maybe it's the other way around!). It was really interesting to see, but we were all dissapointed we didn't see the dancers. Fortunately, we found out that starting next Sunday the big one week dance off competition between the Bagula and Bagika tribes begins. We are all going to go on Saturday for the final (and most frenetic!) day. More information about the Sukuma dance competition can be found here.

On the way home we stopped at the Gidelli Lodge to watch the FA cup final. We thought there might be a few people watching, but we never expected the scene that greeted us: every chair and every available surface in the place was occupied by what must have been every man in Gidelli sitting in front of the tiny tv watching the game! Arsenal won in the penalty kick off after two extra times, and the bar went nuts. You hear that football is watched around the world, but to see that kindof reaction to a game between to English teams half way round the world was pretty incredible.

Sabina and the community girls

The first week...

has flown by. It feels like I've been here forever, or at least it's been forever since I was anywhere but here. Time seems to stand still and rush past at the same time in Tanzania.

The past couple of days my morning class has grown- I now have eight students in the nursery class. Sabina is my favourite but she's a little monkey and very smart. All week Sabina has talked nonstop for the two hour class. She starts with "Madam" very loudly and then says loads of things which are gibberish to me. Grace, the lady that runs the Hisani Centre, told me that Sabina is correcting my Swahili when she does this. Everything I give her to do she races through and does very well. Today I think she was a bit bored and naughty so I made her sit behind the blackboard for a few minutes as punishment, when she came back to class she seemed really embarrassed and made me feel quite guilty. By the end of class she was happy again and walked back into the village with the other volunteers and I.

You can find my pictures here.

Last night all the volunteers went out for Chinese at a really swanky place. It was absolutely fabulous, and a VERY welcome change from rice and beans. After the meal, Max and I talked to Robert, our waiter, who told us about living in Tanzania. He usually works a 'double' (from ten am till after midnight) in the restaurant and takes home what is considered a "really good wage" in Mwanza - about $100 a month. Although we had a really lovely evening, it really put things into perspective. What the ten of us had just spent on dinner Robert earned in a month of working incredibly hard.

the basics

So far I've talked mostly about volunteering, this post I thought I'd say a bit about the rest of life in Tanzania.

There are ten volunteers at the orphanage (more arrive on Friday) - we come from the UK, US, Canada and Australia, soon there will be some New Zealanders as well. We are staying in an area we call the volunteer village, it is a fenced in compound with four houses that are still in various stages of completion. By the standards of Buswelo, we are very, very well off. We have electricity and running water. Compared to life in the West, things are primitive. Our electricity works in fits and starts - while cooking dinner the other night we had to stop half way through because the electrical socket caught on fire. Lights tend to have a strobe effects, if they work at all. Toilets are holes in the ground that sometimes flush and sometimes don't. I think the biggest thing I had to get used to was freezing cold showers. Hot water is unheard of in Buswelo. I've been here less than a week and learned that I can't face the cold water first thing in the morning (when the air is still chilly) so I wash my hair around noon when the sun is out in full force and it's quite refreshing then.

None of us expected there to be so many volunteers, so we are all adjusting to sharing rooms and group outings. Some have a much greater affinity to ice-breakers than others and there is an interesting dynamic between the extroverts and introverts in the group. It is really nice to have other people around to talk to and do things with, but coordination can be difficult.

My standard 5 class

Moja, mbili, tatu

Yesterday was my first full day of lessons. I have nursery in the mornings and level 5 in the afternoons The mornings are great fun, but a lot of hard work. I spend most of the time frantically looking up words in my swahili phrase book and asking the older children what things mean. The kids think it is fantastic I have no idea what is going on most of the time but my swahili is improving so they will have to watch out! Today I was trying to teach the kids how to say how old they were in English, but it turned into another swahili lesson. They know how to count to ten in English, but it was quickly apparent that they had learned the numbers by rote and had no idea what they meant. So we had most of the two hour lesson repeating "Una miaka mingapi" (how old are you) and counting in swahili: moja, mbili, tatu, nne, tano, sita, saba, nane, tisa, kumi and then repeating in English to try and teach them what the words meant. The children are really studious and tried to copy everything (and I mean everything) down in their composition books, even at five and six years old.

Yesterday John, one of the little boys, lost his pencil and burst into tears. These kids are hit in the face with a basketball while playing and don't even whimper, but cry if they lose a pencil. This morning when we arrived it was easy to understand why: the orphanage was in the middle of a big cleaning and all the children had moved their belongings outside. Each child had one small suitcase or plastic bag full of everything they own in the world. Most of them don't have anything to remember their families by, just a change of clothes and a couple of exercise books if they're lucky. They all know if they don't study hard and learn enough to pass the secondary school exams they will be homeless at 16.

Chini! Chini!

After having a fabulous Indian in town yesterday Max, Rachel (two of the other volunteers) and I piled into the back of a dalla-dalla and set off back to Buswelu. Dalla-dallas are mini-vans that function as buses connecting the villages to the town. Probably about 15 people could fit comfortably, but in the couple of rides I've had it usually seems to be between 20-25 people squished in together. The dalla-dallas are never in great condition, but this one seemed to have no suspension left what so ever. We were all sweating and slipping around as the dalla-dalla slammed into every bump in the road.

After our nerve-racking 1/2 hour, we arrived a short walk from the orphanage and stopped to see the children. Although it was a Saturday, all the community children had come for school so we spent the rest of the afternoon teaching. I took the littlest ones for my first lesson, thinking they would be the easiest. I had about 25 kids between 3-7. It started out quite well, but I think they realised quickly that I didn't know Swahili and then they all started jumping around. I quickly learned the word for sit down and told them chini! chini! which worked on some, but not all. I was trying to teach them numbers in English, so we counted to ten and then I had the kids come up and write them on the board. They were all very enthusiastic and tried very hard. Some were really shy but by the end of the hour they had all come up at least once to try and write a number. Some of them had far more fun rubbing the coloured chalk all over themselves than writing on the board! After their lesson, the girls and boys broke into circles and played catch with a tennis ball for a bit until it was time for dinner, when the community children went home and the children from the orphanage chowed down on their spinach and rice.

The other volunteers and I walked home around seven and it was already dark by the time we arrived at the complex. Kate and Zara (two of the Ozzie volunteers) had made all ten of us supper so we sat around and had pasta together. The rule with food here is eat lots when you can. We don't have a fridge so everything must be eaten when it's cooked. It's easy to get fruit, eggs, bread, rice and pasta, but veggies are hard to come by. Its my turn to cook supper tonight so I'll be trying to find something in the market later to throw together - fingers crossed!

Jambo

A big hello from sunny and beautiful Tanzania!

A driver met me at Mwanza airport yesterday and drove me the 1/2 hour or so to the orphanage. The airport is on the outskirts of Mwanza, and the Hisani Centre is in a village called Buswelu on the other side of the city. 600,000 people live in and around Mwanza, but you would never know that from looking at the structural dent people have made on the landscape. There is a small centre with buildings, but most of the surroundings have been built in to the hills and lots of people live in lean-tos and huts. The rock formations (at the bottom of this page) are incredible. They jut out of the landscape all over the country.

My initial impressions have been just shock and awe. It is so incredible different than anything I've experienced before. The noise, the smells, the colours. Everything is bright and colorful and everyone here seem so strong and beautiful.

I arrived at Hisani just before noon and the children all gathered round to meet me. The older ones were at school, so it was all the little ones that came up and talked . Two tiny children (TINY!) picked up my massive 30+kilo bag (more than 60 pounds) and carried it inside. They've learned to say 'Hello Madam' and their name and age in English, and so they introduced themselves one by one and asked me my name and how old I was. We had lunch and I unpacked everything for the orphanage. The children loved the toys, they had never had baby's toys before and seemed really pleased with them. I have some brilliant pictures of them playing with them. The kids love having their pictures taken and seeing the pictures afterwards. They all seem really small for their age, but are incredibly strong. Robbie, a 13 year old boy who seemed more like the size of a ten year old to me, picked up my suitcase and carried it on his head the entire 15 minute walk from the orphanage to the 'volunteer village' where we are staying. I couldn't believe he could manage it!

Serendipity

From the moment I arrived at the airport on Thursday I've had the most amazing good fortune. I changed my flights easily. No que when I arrived, so check in took ten minutes. I was more than ten kilos over weight (which should have cost 248 pounds extra), but when I told the lady at the ticket desk I was bringing donations for an orphanage she waived the charge.

Sitting having a glass of wine in an aiport bar I looked up and saw my friend Kym, from DC who I haven't seen in months. She had just flown in from India and was flying at the same time as I was to Uganda, so we had an hour to catch up while waiting to board.

My seat was 13A which I thought was a good sign. It wasn't until I boarded the plane I realised I've been given an upgrade so I had loads of leg room on my ten hour flight. The woman next to me was from Zanzibar, lives on the beach and has invited me to stay with her family if I go.

When I landed in Dar es Salaam customs was a breeze, my suitcase was intact and came out very fast. I was at the ticket desk to buy my connecting ticket to Mwanza in less than 1/2 an hour, which was extremely lucky because when I asked for a flight to Mwanza they said one was leaving in twenty minutes and held the plane for me.

The flight from Dar to Mwanza took about two hours and was very smooth. I got an amazing picture of the very top of Mount Kilimanjaro poking through the clouds, and saw the Ngogoro Crater from the air. Tanzania is so huge and so empty. Flying over it you just see huge areas of fields and wilderness.

Why I've started this blog

A few years ago I was privileged enough to meet an amazing AIDS activist from Zambia called Winstone Zulu. Winstone was the first person in Zambia to publicly talk about his HIV+ status. He told me that his 5 brothers and sister had all died from TB, and that if he hadn’t been lucky enough to receive a full course of TB treatment from outside his country, he would have died too. TB is the leading cause of death in Africa for people with HIV/AIDS. The tragedy is, just $10 worth of medications can cure it and give years more life to a patient. An even greater tragedy is that Winstone’s siblings had children, children that are now orphaned.

Winstone and his wife are now raising 35 children; most AIDS orphans aren’t that fortunate. More than 20 million children in the world have been orphaned by AIDS, most of them in sub-Saharan Africa. In Africa many children were looked after by kin when their parents died. Overstretched by the huge burden of poverty and increasing HIV prevalence, many families, communities and countries don’t have the resources to support these children. There is no cure for AIDS and the hardest hit areas often can’t afford treatment or prevention efforts: the numbers of orphaned children will only go up.

When I heard Winstone’s story I immediately wanted to go to Africa and do whatever I could to help. In two weeks I will be heading to the Hisani Centre in Mwanza, the second largest city in Tanzania. Hisani is a Swahili word which means kindness or fairness to those who are discriminated against by society. The Centre has only two members of staff and a handful of volunteers. It cares for street children whose parents have died of AIDS. About a hundred children live at the orphanage, and about another hundred children come to the Centre every day for school, food and medicine.

The Centre's meagre funding comes from overseas. For the most part this comes from volunteers who are asked to bring a suitcase of things for the children – clothes, books, toys, medical supplies (especially needed), even things like soap and shampoo - and to do whatever fundraising they can to help the Centre. Volunteers can design and implement projects with the funds they bring to the Centre.

In the past six weeks, volunteers’ funds have built a toilet and shower block (the children were using an outhouse on a neighbours property), six new chalkboards for teaching, two new dormitories (including indoor toilet and shower) to enable both children to be brought into the centre and for current children to spread out (they're sleeping up to 5 in a single bed), five new 3-level bunk beds, school shoes and backpacks for all the children, and dental work for the children who needed it.

Thanks to the generosity of my supporters, my suitcase contains clothes, toys, art supplies, books and first aid materials. I have raised funds to take with me and will keep you updated on the project the Centre embarks on. To those that have helped, I am deeply honoured that you are supporting me in this.

Natasha

Children in Tanzania 

Mwanza, on Lake Victoria 

Slums in Mwanza 

With my best friend Ali, the night before I left DC last year.