May 4, 2011.
I was hired last year, April 2011, to be a training consultant for the MTN (Microbicide Treatment Network) to help create and facilitate a series of trainings for their clinical trial staff in South Africa, Uganda and Zimbabwe. The trials were trying to assess the effectiveness of microbicidal vaginal gels, products that could someday help women protect themselves from HIV in situations where condoms were not an option.
My colleague R and I were asked to deliver trainings that focused on client-centered approaches to adherence counseling, strategies that would move away from simply directing women to use the gel but instead explore their experience of using the gel; what made it easy, what was challenging. I decided to write daily Facebook updates of my African adventures for my friends and colleagues back home. Since Facebook at that time only allowed 420 characters in their updates, I had to make my entries short and to the point. Here are all my entries, combined, and aptly entitled:
Returned to San Francisco from Washington, DC last night, where I met a lot of new colleagues who are involved in the MTN (Microbicide Treatment Network). They’re studying vaginal gels that could someday protect women from HIV while still allowing pregnancy. Will be going to Africa next week to be a part of the counseling training portion of the clinical trials, along with A and R. A big honor, and very exciting.
Off to Africa in a few hours. 3 countries, 4 cities, 6 trainings, 150+ participants. My 2 colleagues and I will teach a client-centered approach to assist adherence counselors. I'm excited, apprehensive, emotional. Bringing laptop and camera; will post updates. Found this African saying: ‘If you want to go quick, go alone. If you want to go far, go together.’ So, if only electronically, I'm taking you all with me!
29 hours have elapsed since I locked my door on Folsom St. in San Francisco and entered this hotel room in Johannesburg. Exhausted, but happy to be here. The hotel is right next to the old police headquarters. My cab driver said that up until 1994, if you were black and found in Jo'berg after dark, you were taken there and interrogated. If they didn't like your answers, they threw you out the 10th floor window.
my first sunset in South Africa
9 hour sleep, then out to the Apartheid Museum. Strong visual history of the long struggle for independence, achieved less than 20 years ago. Sat on a bench with a black youth, watching a video about Mandela. When 2 white men entered, the young man stood and gave up his seat. Feeling awkward, I stood up and offered him mine. He wouldn’t look at me. Am still thinking about what to have done differently in that moment.
My colleague A and I decide to walk through the hotel's neighborhood. We're the only whites we see. Very powerful, being the only one, the other. I’ve felt it as a homosexual, but rarely as white. We saw many churchgoers and can feel history in the streets, memories in the buildings. We saw two amazing birds in the street: a magnificent stork with a giant blue head, and a huge multicolored duck. Tomorrow: Soweto!
Spent morning in Soweto, a vast area outside Jo’berg. It has a long history before, during and after the worst of apartheid. Today it’s a thriving community of over 3 million. Visited the Chris Hani Baragnawath Hospital, the largest hospital in the Southern Hemisphere, possibly the world. Met many of the staff who will be coming to our 1st training tomorrow. Feeling the importance and honor of what’s about to begin.
Off to the training this a.m.: 65 nurses, counselors, pharmacists and physicians will be in attendance. We’ll end by 5, hop in airport shuttle and fly to Durban, where I plan to take a dip in the Indian Ocean, shark nets and all. We received a Travel Security Alert last night: Ugandan activists protesting rising food costs were tear gassed by police. We’re hoping things will calm down soon — we fly there on Sunday!
Our 1st training was very successful. The passion that the staff has for these microbicide trials is palpable and moving. The hope is that at the end of 3 years, products will (finally!) be available for women to protect themselves from HIV. We arrived in Durban 2 hours ago. The hustle and bustle and huge energy of Jo’berg has been replaced with a tropical mellowness. It feels like an African Key West.
Visited 2 clinics today; powerful interactions with staff. 5 thousand women will be enrolled; hopeful results should be available in January 2013. Last night, as we arrived at the airport, I walked thru the most diverse crowd of people I’ve ever seen. The varieties of clothing, skin colors, headdresses, languages, saris, Indians, blacks, and Afrikaners was incredibly heart-opening. Got to my room and had a good cry.
Went to the Indian Ocean. Shark talk had me nervous. The waves were high, the current strong. The water was perfect though; I went in waist-high. It was warm and welcoming. We hurried back to the road, hailed a taxi, got home before dark. When I checked all my pockets, my beautiful camera was gone! As I toss and turn and try to sleep, I know what I must do, especially in this country with its long history. Let it Go!
Our 1st Durban training went very well. Counselors are responding positively to the key concept of our approach, i.e., the client is the expert on her life and her abilities to use the study products (tablets or vaginal gels.) I left home one week ago. Thanks so much to all of you for your wonderfully supportive responses. I really appreciate it. We’re here for two more trainings before we head north . . . to Uganda.
The heat and humidity were oppressive today (air conditioning broke down) as we did our 2nd Durban training. Drank a gallon of water to get through the day. We’re closely monitoring the situation in Uganda which is our destination on Sunday. We won’t go if the situation worsens. Thinking positively, we started our malarial drugs today, a necessary precaution for Uganda.
Went to an incredible mall to replace my camera. The malls are unexpectedly grand, with lots of security; everyone can go and feel safe. You’d think you were in the US due to their size and selection, except for the unbelievable diversity of the shoppers. Black and white Africans, bi-racial and East Indians, Asian tourists, white Europeans; (we’re not seeing other Americans tho) . . . it’s absolutely fascinating!
One of the training participants today was a woman living with HIV. She told me that in 1999 her AIDS medications became so expensive (980 rand a month; about $160) that her family chose to cut back on food so she could live. She said they were all starting to starve to death . . . and then the Bill Gates Foundation began providing the medications free of charge. Her spirit was very strong. I’ll never forget her.
Another powerful moment: an African man practicing his counseling skills as I circulate round the room, offering suggestions, etc. I sense he’s stuck, so I approach, reaching out to touch his shoulder. He sees me out of the corner of his eye and moves quickly from his seat, towards the floor, hand raised, like I’m going to strike him. I feel terrible and apologize. So does he. I wish I could take that moment back.
Rainy Durban day. We Just finished our 4th training and have gotten the green light to proceed on to Uganda. It’ll take us most of tomorrow to fly there. We’ll check into our Kampala hotel tomorrow night, conduct the training on Monday, and then fly out early Tuesday to Zimbabwe. We’ll be in Uganda a total of 32 hours -- and we’re feeling confident that we’ll be fine. We’re glad we started our malarial drugs. Onward!
Had our last dinner in Durban at a great Thai restaurant. Feeling really good about the trainings here, and what we’re bringing north to Uganda and Zimbabwe. We saw a newspaper headline this a.m. that read: “Lion Spotted on Local Beach.” I don’t know if it’s true, or just a way to sell more papers. But I love that image: a lion walking along the sand, looking out to sea. I hope he’s in my dreams. Good night . . .
A white airport shuttle driver this morning said the apartheid years in Durban were not as bad as those in Jo’berg, that even in the worst of it, there was enough work for everyone in Durban, which helped keep the violence in check. He asked if I’d noticed how many black men in Jo’berg had scars and burns on their faces and arms. I told him I had, but that I hadn’t really understood the past those wounds reflected.
I asked the driver what he wanted for South Africa. His response: Stability! I suddenly saw a big spider monkey on the side of the road. Then we saw a dozen more under the trees. He pulled the van over and we watched the mothers and their babies and some older males as they ran along and then jumped up onto a wall. We were amazed to see them, just running free. We thought they were amazing. His response was: Pests!
We’ve arrived in Kampala, Uganda. The airport sits right on the shores of Lake Victoria. There’s one road that goes into the city and it meanders through an incredible series of neighborhoods: sounds, smells, sights, stores, smoke, soldiers, scooters; it’s a hypnotizing hour-long ride. As we pulled up to our hotel, some armed men came out and checked the bottom of our cab, looking for bombs. What a day it’s been!