Sunday, May 3, 2009

Botswana and my thinking

I have been back from Botswana for over a month now.  I am trying to analyze how the experience has influenced and possibly changed my thinking about my approach to life and HIV disease.  I think that there has been a shift in what I think is important and how to approach the work that I do, and even change it in the long run.

Let me be clear that I did not experience Africa, I experienced Botswana and a few days in Zambia.  Not everything I have learned and realized can be extrapolated to other countries, maybe nothing can as I have not experienced them.  As I read and am pointed out similarities between various parts of Africa, I might consider that some of my thinking might apply.

 There are a number of significant understandings that arise out of my Botswana experience. 

1.    Botswana is considered a middle income country in Africa and has achieved an official Gross Domestic Product of $13,000 per person because of the Diamond industry which all goes into the government coffers.   (this income is there for the people in infrastructure, water,  govenment jobs and basic health care including HAART, but not as direct personal income) This compares with its neighbours as follows:  South Africa $10,000; Namibia $5,400; Zimbabwe $200; Zambia $1,500.  The USA Gas a GDP of $49,000.  For Africa it is well off – but in the world it is poor.  I met people who live on less than $100 per month is a country where food cost just a bit less than in Vancouver.  Cell phones are ubiquitous because they are the only means of communication.  Most people walk everywhere or use the minivan bus system where one can travel across town for $.40.  Many people have their own goats and chickens.  A number of people I met where raising nieces and nephews, AIDS orphans I would say, although the topic was carefully skirted,  as well as doing the traditional support of elderly parents.  The people are poor.

2.    HIV is rampant at about 24% and estimated to be up to 35% in some population groups.  This compares with 18% in South Africa, 15% in Zimbabwe and .6% in the USA and officially .4% in Canada.

3.    HIV is highly stigmatized – no one talks about it.  I worked with several people in their twenties who had lost their parents. They would not say how they died - the stigma is too much.  This is in a country where up to 1 in 4 or 5 are HIV+.

4.    As a result of 27 + years of HIV and the death associated with AIDS, my generation is missing.  There are noticeably few people around in their 40s, 50s and 60s – at least that is my unscientific observation.  The staff I worked with were largely in their 20s and early 30s, reasonably well educated, but with little experience and maturity.  The lack of management experience was very noticeable and confirmed by several professional people I talked to.  The need for management skill and depth is huge. 

5.    The country is working hard to move from a agrarian culture and society to a modern technology 21st century culture in one generation and the learning curve is steep.  Old values do not change over night and influence all parts of life.

6.    It is a country that is about 80% Christian and that impacts a lot.  It is an accepting faith where things are not questioned and-or thought out.  Most things are accepted as truth and not put into context or culture.  This has an impact, I believe, on how people deal with HIV and sexuality.

7.    Traditionally this is a country with multiple relationships (at least one relationship at the town home, one at the farm home and one at the cattle station) as are many African cultures.  This impacts the spread of HIV and needs to be addressed.

8.    The culture still has a Bride price to be paid.  Two young women where I worked were engaged and when I asked them when they were to be married they matter-of-factly told me when their fianc√© was able to get the cows or the cash equivalent.  Interestingly, one of them kept after me to find her a husband in Canada before I found out she was engaged – and this was in earnest.  This impacts how men view their marriage as an ownership contract and impacts how women are treated.  Remember, I worked at a non profit started by women for women called Women Against Rape and most clients are there because of rape within the marriage.  This also impacts HIV.

9.   The Botswana government had a new HIV prevention campaign rolled out while I was there.  The tag line was One Life, One Partner.  It felt to me as realistic and useful as the Abstinence Only campaign that George Bush and the Republicans put out in the face of many studies that show the rates of infection in the wake of such a campaign are higher than with any other campaign.

10.  I was at an HIV conference last week and sat through a presentation on how another country in Africa, Kenya, was stepping out and getting Certified HIV Teachers into all its 18,000 schools over the past 8 years.   Interestingly, I ran across an evaluation of that valiant effort in a professional HIV/AIDS journal  this weekend.  It focussed on some of the major problems Kenya is encountering in this effort.  The major one, as always, was the lack of adequate resources.  That is expected.  Another big one is the fear about and the unwillingness to talk about sex and sexuality, even when the students are asking to talk about it.  And lined up with that is the fear of backlash from parents who do not want sex and sexulaity discussed because they fear that talking about these issues will encourage young people to indulge in sex – and we all know that does not happen when you ignore it and also that everyone just runs out from the class and hops to IT!  

This is compounded even more by the "proper and common" religious perspective that these are sinful things – indulgent and licentious.  Combined with the fundamentalist positions (especially RC) that all sex is for procreation it becomes a very strong restraining force – not understandable in a poor continent that cannot feed the people it already has.   I always wonder why it is OK to condemn people to death (literally to kill them) by denying them theknowledge of,  access to and approval for condoms and that those as yet not conceived, never mind having been born, take precedence over the living.  Of course, the Pope yet again made another egregious, outrageous, unscientific statement about condoms not working while I was there.  Does no one advise this man, who seems to have his head stuck in another universe?  His guilt, in terms of lives lost as I see it, is unspeakable  ( I know, I know : Judge not that you be not judged – Matthew)

11. The result is that condom use is not talked about as HIV prevention, or STI prevention and not even advertised – a major policy issue.

12. Another thing that I got some hint of and confirmed with several black Africans, is that there is still the distinct odour of colonialism and patriarchy on the part of some whites.   I got it a fair sense of this in the airports and places that were schedule controlled in comments such as: "This is the African way", "Welcome to African time.".  Several quite direct things that I observed, were actions by an older white woman and another by a young white man – essentially talking down to black citizens in derogatory tones for NO reason.

I could probably go on.

So what has that done to my thinking?

 While the one-on-one HIV work is essential and needs to be done everywhere – the treatment and care, the counselling, the individual advocacy, the solace giving and the grieving are all vitally important and we have to continue all of them.

But the experience in Botswana, plus some information I have learned and realized since then – the subject of the next post - are altering the way that I think and where I think I want to exert my energies.

All the above care and nurturing work needs training and resources.  To pay for the care and the requisite training, needs funding that will only come as the result of public and political awareness, public care and concern and the will to intervene based on the belief that all human beings deserve to the right to live a dignified and pain free life, the right to achieve the opportunities that life lays out.   That is not to say we all get to an equal place but we all have the right to equal opportunity. And we are so far from that in spite of all major religions telling people to live in love, equanimity and caring for those who need it.

There are very limited resources made available in the so called first world.  There is less available in the so called 3rd  world to deal with this pandemic  that we could/should have controlled by now; but there was and is no will.  Remember Ronald Reagan?  – well, his spirit is alive and well and living globally in 2009.

I find myself angrier and angrier.  At the pettiness, at the outright hate of the religious right of all religions and philosophies, at all the judgement and condemnation based on illness, addiction, sexual orientation, race and economic status, culture and education. The bigotry.  What can impact on any of these in a small way?  How?

There are no resources, so I am thinking more and more about advocacy, collective that is, education and policy making.  I have many skills – where can I best use them?  May be not where I am right now.   I hope it becomes clearer for me – and that I will find where I can do my best – and maybe, that is where I am right now.  

Confused ? – so am I :) ! That is the whole point of this post - to articulate my quandry.




  1. Adriaan, in our meditations we are taught to ask 'What is mine to do? And that is, I believe, where the answers come to us - when we set our intention to be of service in a particular area of life, and ask, we are shown the way to do so. And the way is different for each of us.

    Your anger, your passion for this situation echo that of Stephen Lewis as enunciated in his Massey Lectures titled 'Race Against Time' published in a book by the same name. The HIV/AIDS problem in Africa is so huge.

    My response has been to join the Grandmothers to Grandmothers campaign to raise money to support the Stephen Lewis Foundation's work to support those grandmothers in Africa who are grieving the deaths of their children - the missing generations - and raising their grandchildren, usually in conditions of appalling poverty. The description of the Grandmothers groups includes grandmothers and grandothers - in other words, anyone who is interested is welcome to join. Because Stephen was the UN Envoy on HIV/AIDS in Africa for 5 years, he has on-the-spot contacts to make sure the funds actually get to the people who can make the best use of them. Go to the SLF website for more information because that is only one program the SLF is involved in. The Grandmothers campaign grew spontaneously and organically from the 2006 HIV/AIDS conference held in Toronto, when Canadian grandmothers were so touched by the African grandmothers brought to the conference. There are now more than 220 grandmothers groups in Canada and if I remember correctly we have raised over $6 million so far. My fabric artist friend, Valerie Hearder, in Nova Scotia, has set up a small company called African Threads to import, using fair trade practices, embroidery tapestries from African women to sell in North America. She contributes 15% of her profit to the SLF, in addition to the direct support she gives to the women's fabric art cooperatives that produce the art. Each of us can help in so many creative ways.

    I hadn't intended to get on a hobby horse in response to your expression, but there it is. When some of us suffer, all of us suffer is a message that more and more people are getting. That is the message of the book 'Blessed Unrest' as well, and I think there is a world wide move afoot towards sharing of information and resources that can only bode well for us all.

    As each of us does what is ours to do, we all move forward toward life more abundant.



  2. Considering the short time you spent here, you've learnt a lot. Many people who have lived in other parts of Africa before coming to settle in Botswana usually say that Botswana is not representative of Africa as a whole.

    Maybe in terms of quality of life Botswana is ahead of several others but I think in terms of socio cultural struggles, it's not that different.

    Patriarchy abounds both at home and the wider society despite laudable pronunciations that equality is here for all;
    child laws may exist but children are still treated like 4th class citizens - always put last;
    religion is king;
    superstition and "muti" is the reason for everything bad;
    change is a western evil.

    One thing is interesting though, even though condoms are not marketed for all the benefits they can bring, a surprising number of condoms are distributed freely every year. Just in this region over 1 million were distributed last year. The net result is that a wide section of the public relies on this free distribution so when it's out don't see the need to purchase any for themselves. There have been many campaigns held in the rural areas in an effort to advertise the benefits of condom use and at such events many condoms are distributed.

    The problem is, without sustained provision of these condoms people return to old habits because unfortunately, they don't see the benefit of actually buying it themselves. Even if they did, you not gonna get condoms in most villages, especially the really remote ones.

    So, the problem persists, but I believe if we keep trying we'll get there.