Letters From An Island Son, Far From Home

Stefan Verbano grew up on Guemes Island, the son of Chris Damarjian and Larry Verbano. He graduated with a bachelor's degree in Jornalism from the University of Oregon and is currently serving as a Peace Corps volunteer in Zambia, Africa.

His home base is a small rural village near Mansa, Zambia where he is working with the local population to establish rural aquaculture and agricultural sufficiency. Through his writings you get a sense of the joy and frustration at trying to make a difference. Stefan has agreed to share his letters with his home community.

PEPFAR

Wednesday, March 13th, 2013 

“Today, on the continent of Africa, nearly 30 million people have the AIDS virus including 3 million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims - only 50,000 - are receiving the medicine they need. Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says:

‘We have no medicines,’ many hospitals tell people. ‘You’ve got AIDS. We can’t help you. Go home and die.’

In an age of miraculous medicines, no person should have to hear those words.

AIDS can be prevented. Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year, which places a tremendous possibility within our grasp. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many. We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief, a work of mercy beyond all current international efforts to help the people of Africa.

This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS. I ask the Congress to commit $15 billion over the next five years, including nearly 10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean. This nation can lead the world in sparing innocent people from a plague of nature.”

Former U.S. president George W. Bush said these words during his 2003 State of the Union address, launching the President’s Emergency Plan for AIDS Relief (PEPFAR) and the single largest disease prevention effort undertaken by any nation in history. Half a decade later, in the beginning of his first term, President Barrack Obama renewed the plan, committing additional funding to keep up the momentum gained over its first five successful years of implementation.

At present, the rate of HIV infection in Zambia hovers around 14 percent. That is, one in every seven Zambians is a carrier of the disease. But this data is in terms of “reproductive age” teenagers and adults, and ignores the thousands upon thousands of orphaned children and elderly people trying to live a normal life while the virus replicates unceasingly in their blood. Mothers pass HIV on to their babies in utero, via contaminated blood during birth, or by breastfeeding when the newborn’s esophagus is covered in sores. In newly infected bodies, the viral load spikes well before the onset of any symptoms, causing many sexually active adults to be transmitters of the disease without even knowing until it is too late. Culturally, young men and women choose to have multiple concurrent partners, married men have mistresses in different cities and, after the death of a husband, widows are “cleansed” by a brother-in-law. Half of this country’s population is children. Life expectancy is less than half of the developed world.

Anti-retroviral drugs (ARVs) give off a glimmer of hope in the face of these dismal circumstances, keeping the viral load low in the infected body and thus reducing the risk of transmission and preserving the immune system’s ability to fight off the opportunistic diseases and infections which would otherwise come as the death knell for untreated HIV victims. The onset of AIDS (when a host’s CD4 - a specific type of white blood cell - count falls below a threshold signifying a compromised immune system) has become more rare with the decreased production costs and widespread use of ARVs, allowing people to be HIV positive and still live relatively normal, healthy lifestyles through old age.

What ARVs do for treatment, voluntary counseling and testing (VCT) does for prevention. Clinics and hospitals across the country offer free testing and individual and couples support services for those who have yet to reckon with their HIV status. Mobile testing facilities travel to villages in remote areas where a slight prick, a drop of blood and 15 minutes can tell someone with relative certainty whether they are infected or not. When they are in stock, condoms are free at government health clinics, and can be found at every checkout counter at every grocery store. Across the country billboards and walls are painted with public service announcements urging people to talk to their partners about HIV and to get tested.

But the virus is still shrouded in a haze of misinformation, irrational fears and taboos. Uneducated Zambians living in rural areas have little grasp of cellular biology or viral pathology, leading them to think they can acquire the virus by means other than sexual intercourse and blood-to-blood contact, or that medical practices intended to reduce the risk of transmission will leave them invincible. Sharing plates of food, kissing, hugging, sleeping in the same bed, using the same toilet - these are all ways some of those without proper education think the virus can be spread. The “virgin cure” myth claims that an HIV-infected person can cure their disease by having sex with a virgin, which would almost be ironic if it wasn’t so horrifying. There is even an absurd rumor that first-world countries purposefully infect condoms with the virus before shipping them off in care packages to Africa. The benefit of male circumcision, which has actually been proven to reduce the risk of female-to-male HIV transmission, is misperceived to be a guaranteed protection against the virus, prompting some men to abandon the use of condoms entirely. The Ministry of Education refuses to teach anything but “abstinence only” sexual education in primary and secondary schools, which is almost comical considering teenagers on the verge of becoming sexually active make up the most naive, vulnerable and uninformed segment of the population at risk for contracting HIV.

Looking to step into the ring for the fight against this debilitating epidemic, a dozen Luapula volunteers working in the agriculture, health and education sectors each brought a Zambian counterpart from the villages to Mansa in early March for a week of PEPFAR training. We tackled the issue from all fronts - sexual culture, gender roles, stereotypes, education and logistical problems, superstitions, religious implications. A portly, bald-headed and good-humored Zambian man served as our Bemba translator for counterparts with limited English proficiency such as Ba Raphael - my neighbor and point person for all health-related programs in my village of Mwanachama, next to whom I sat for those five days of sessions, stealing glances out of the corner of my eye every now and then trying to gauge how well he was comprehending the lessons.

Ba Raphael is an older village man with wisps of gray hair beginning to spring up from his closely shaved head and beard. He walks slowly and hunched over with calculated steps, probably resulting from a lifetime of backbreaking village labor and sleeping on thin, broken-in foam mattresses. I talk to him in English like I would talk to a 7-year-old, and he responds in Bemba as if I am just another villager he ran into on his way to the well. Our elementary conversations are constantly stalled by my pleas of “landeni panono panono, napapata!” (speak slowly, please!). But I get it. Everyone he has ever known has probably spoken Bemba as a first language, and I suppose that even after being the Muzungu’s neighbor for a year and wrestling with the communication barrier during every interaction, it still strikes him as ridiculous that anyone living in this place would be unable to follow along in this rapid-fire, sing-song language.

Given the geography of where the education and health volunteers attending the workshop live and work, most of their counterparts were relatively well-educated and affluent. They were teachers in schools or clinic staff, spoke fluent English and showed up to the sessions every morning dressed in snappy suits or immaculate chitenge dresses. Though I knew Ba Raphael pulled out all the stops to sport his Sunday best, he wore his socioeconomic status on his sleeve. His dress shirts were faded and torn at the seams; his ankles peeked out from the bottoms of his slacks; his leather shoes were scuffed and worn. But he arrived punctually every morning to take his seat on my right, and he took careful notes in Bemba with slow, loopy cursive handwriting. Whenever we would break for tea or lunch I would turn to him and ask:

“Mwaumfwa palwa finch twalanda lelo?” (You understand the things we are talking about today?)

In response, he would always just smile and nod. I could tell he was overwhelmed with the amount of English being spoken by the PEPFAR facilitator and the volunteers and the staggered pace at which all of the conversations were translated. He was shy, listening intently but seldom raising his hand to comment.

Multiple times a day the dozen volunteers and their dozen counterparts would break into small groups and engage in role-playing exercises simulating real-world interactions with issues of sex and disease. Needless to say, the volunteers hogged most of the spotlight for this HIV-theater, but some of the Zambians suspended their quiet and deferential temperament for a time and joined in the show. During one act, a plump, maternal village woman who had up to that point been sitting silently with the countenance of a saint jumped headfirst into the role of an enraged mother who had just caught her teenager sneaking back into the house after a long night of “high-risk” activities. The ya mayo adopted the shrill, scolding tone I hear on a daily basis in Mwanachama, and shook her finger like a dagger in the face of the volunteer playing the part of the disobedient daughter. For a moment, the volunteer broke character and a look of legitimate fear crept across her face. The audience members looked at each other in shock, but quickly dissolved into doubled-over laugher and applause.

For the racier discussions about sexual attitudes and customs, we broke up by gender and put a wall between XX and XY chromosomes in order to speak more freely. I do not want to speculate on what was involved in the women’s side of the cultural exchange, but I can say that the men opened up to a surprising degree about everything from having mistresses to sexual attraction to what coitus positions they favored over others. I was told for a second time about how some Zambian men let the fingernail of their right-hand pinkie grow long in order to stab at a woman’s abdomen during intercourse, forcing her to contort her body in certain ways. In traditional medicine, men imbibe potions and powders to make their erections last for hours, while women take plant extracts that dry up the vagina’s natural lubrication, creating more “friction” for the man - something that all of the Zambian men in the room chuckled at looking sinister while the Americans recoiled with expressions of confusion and terror. We talked about circumcision, oral sex, infidelity, child rearing, condom use, what constitutes a “virgin”, and why divorce is “unacceptable and an affront to God”. All of these discussions, of course, were centered on questions of HIV culture and superstition. Some of the answers were obvious; a woman who purposefully dries herself out is at a greater risk for internal bleeding, thus increasing her and her partner’s risk of HIV transmission if either are positive. Others were more opaque: a new couple who begin a sexual relationship but agree to use a condom during intercourse and only have unprotected oral sex are conducting themselves on the middle ground of HIV risk - transmission is not guaranteed even if either are infectious, yet they are still engaging in a risky sexual activity which should be discouraged.

On the fourth day of the sessions, one of the free testing organizations operating out of Mansa set up shop in a vacant room at the guest house where we were meeting. The idea was for the volunteers and counterparts to introduce themselves to the HIV technicians and counselors and ask questions, but testing was also conducted as an educational experience. Most of the volunteers including myself opted to have their blood drawn and analyzed, though none of us was holding our breath. Being outsiders in this place, Zambia volunteers on the whole practice some of the most extreme forms of HIV prevention, bent on returning home with no long-term medical complications from living in sub-Saharan Africa for two years. But, in a show of good faith to our counterparts, we took our turns one by one to get our fingers pricked.

I was at the bottom of the pile. Walking into the sitting room and knocking on the door to one of the bedrooms which, just for the day, had become a makeshift HIV clinic, my brow was free of anxiety. A scrawny young Zambian man who could not have been much older than myself answered the door with a sheepish smile and beckoned me in. His name was Lawrence. I sat on the vacant bed in the cramped room full of boxes containing test slides and rubber gloves and needles. He broke the ice with the usual gamut of questions; “When was the last time you had an HIV test?” “Do you know your status?” “Who are you going to share today’s results with?” “When was the last time you had unprotected sex?” “Do you currently have any sexually transmitted infections?”

My name, contact information and answers to these questions were entered into a log, and Lawrence asked me if I was ready to begin the test. I said I was. From a sealed box, he pulled out what looked like a miniature date stamp - like those used by post office workers or librarians to make satisfying thumps - and pressed it to my middle finger. He pushed a button on the bottom and, with little more than a tickle, a perfectly round drop of blood rose up above the skin, which he caught in one of the test’s reservoirs. This flimsy little test slide was about to tell me whether I was infected with a potentially fatal virus or not. So much depends upon a mass-produced, government-subsidized piece of plastic and cardboard the size of a stick of gum.

The technician squirted a tiny amount of some viscous solution into the other reservoir, and my blood began to make its journey up the absorbent sliver of sponge. In the down time, I began to pick Lawrence’s brain.

He told me horror stories of people dragging their feet through the door of his clinic with their heads hung low; people whose defeated faces said they knew their statuses long before their own respective drop of blood had made its end-zone run across the test slide. For them, two faint black horizontal lines would appear, where for me there would only be one. He told me of some patients breaking down in hysterical tears upon learning their status, and of others who accept their fates stone-faced and rigid. He told me of times when he would have to hide the completed tests from his patients for what felt like an eternity until he was convinced they could handle the weight of the result. During his time spent operating mobile clinics in far-flung villages, Lawrence would spend the workday knocking on doors of mud huts looking for voluntary patients. He had been beaten, had  objects thrown at him, had been called a sinner and devil-worshipper, and had been welcomed with open arms into the homes of people with nothing inside except hungry children. He had been to college - had studied medicine at a university in Lusaka - and yet opted to begin his career by being punched in the face and chased out of yards day after day by ignorant villagers too scared to know the truth about what was happening inside their own bodies.

His bravery brought a tear to my eye. These are the people, I thought to myself, who are going to save this country; the ones who know they could easily jump ship and earn a healthy living working in some comfy first-world hospital - the ones where the most unruly patients are spoiled white children who refuse to say “awww” and expect lollipops at the end of each visit - but decide to stay. They decide to shoulder some of that pain and suffering; to look into the eyes of people crippled by fear; people who are dying on their feet, and attempt to offer a shard of compassion. Lawrence looked tired that day. I cannot imagine what he thinks about before he goes to bed every night. His karma is no doubt balanced, but I imagine he sees the faces of all of those people for whom he has no good news to give. I can’t imagine how it feels to see those two black lines appear and, from the deepest recesses of pity and courage, conjure up the right words to say. I could not do his job, and I told him so.

How many people in this country have stood in my shoes, waiting for those black lines to tell them their fate? How many times have patients had to swallow an answer they were not prepared to hear? How much good are all the collective efforts of men like Lawrence and programs like PEPFAR doing to curb this “plague of nature”? We must remain vigilant in our struggle. We must remain benevolent in our vision. We must remain steadfast in our hope.

- Stef


"The opinions and impressions expressed herein in no way represent the official stances or policies of the United States Government, the United States Peace Corps, Peace Corps Zambia or any appendage of the Zambian Government. These writings are intended for a small, select audience comprised of the author's friends, family members and associated parties back home, and are written in the capacity of a private U.S. citizen abroad and not officially as a Peace Corps Volunteer or U.S. Government employee."