Can I Get A Witness?

Data collection, and all the ensuing absurdities, has far surpassed anything I could have even begun to fathom. Broken in to pairs, and matched with a Community Health Extension Worker (who acted as our translator) we dispersed in to the surrounding villages, walking, usually miles a day, door to door administering household surveys. I have sat in the dirt, on jerry cans, in heaping piles of cow dung… with babies in my arms or clinging to my skirts… in the sun… covered in flies… and in just about every compromising position imaginable (well, maybe not every position imaginable) … all to administer our survey.

Along the way I have amassed a suitcase full of images and memories that will stay with me a lifetime, destined to be drug around my person forever, attached to my ankle like a jailer’s ball and chain. Truth be told, I am wholly unfazed by the environments in which I have found myself. I am surprised with how comfortable and at ease I feel in these surroundings, doing this work… surprised by how much fun I have had in spite of everything else. I have much I want to write about, so bear with me. I wrote a little each day, and as such, have separated my entries in to separate posts for the sake of clarity.

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June 12, 2012

Today, Tanvi and I were sent to Inkisanjani with Geoffrey. It was market day in Kimana so many of the bomas were empty save for the children playing in the dirt.

When will mama be home? We asked. When the sun is low in the sky, they replied.

I love the way things are phrased here. If your stomach hurts… it is feeling provoked… if you’re off to bed you are told “lala salama” i.e. peaceful sleep… instead of burying the dead they are planted…

Tanvi, Geoffrey, and I walked up and down, through dried riverbeds, transversing treacherously steep paths. Tanvi in her haste had worn sandals, which were no match for the thorns, rocks, and topography. She slid and slipped her way up and down the winding route, much to the delight of Geoffrey and any locals gathered to watch the foreign creatures on their journey. Tanvi grew up in India, and has a lovely, lilting British accent, which made her cries as she tried to navigate the path sound more adorable than fearful.

We wound our way around a mini-mountain to find one particular boma. The household head, we realized about half way through the interview, was ragingly drunk, which better explained his insistence that I marry him, the constant staring, and the nonstop demands that I give him my number. At the interview’s end, my “number” in hand, he thrust his angelic two month old baby in to my arms for bahati nzuri (good luck). We snaked back around the mini-mountain and through another ravine… passing a school on the way. The children ran in droves from the concrete building, bare feet pounding the dirt as they screamed, palms outstretched.

“GEEEVEEEEE, GEEEVEEEE.” “GEEEVEE MEEE.” “GEEEVEE SWEETS.”

It is not the first time I have heard such demands. And it won’t be the last. The norm here it seems, is to expect that any interaction with a mzungu will garner some sort of hand out. This prevalent belief introduces the potential for massive bias in our research findings. Our translators tell us that many individuals try to create the “right” answer in lieu of the truth. They believe in doing so that they will receive something… despite the explicit converse acknowledgement in our introductory consent form. I could say much more about this topic but frankly I don’t feel qualified enough yet to do justice to this vast and incredibly intricate and delicate subject.

Many of the school children followed us nearly all the way to our next boma, where we encountered an incredibly shy young mother, living with her two babies and her parents in a small hut. The woman, whose name escapes me, nursed her chubby cheeked six month old throughout the interview’s duration. As we were wrapping up, I flipped through her antenatal care booklet, distributed by the Ministry of Health to all pregnant mothers upon their first antenatal clinic visit, one last time. Except this time, something caught my eye – a checked box – HIV reactive. She tested positive on her second visit. Prophalyxis treatment was recommended, the margin’s notation read. A date for a follow up visit was set. Except she never went. Our young mother delivered her baby at home, with the help of her mother, (who, as a result, is possibly also HIV+) and had not received medical attention since.

As I gazed at the dirtied page, I felt the vast tracts of untamed land around me constrict. I had been sitting for the past half hour or so watching a baby innocently suckle at his death sentence. I fell uncharacteristically mute. Tanvi and Geoffrey were wrapping up the interview as I feebly shoved the booklet under Tanvi’s nose to read. We wordlessly acknowledged what was before us. I felt more helpless in that moment than I ever have before. We gathered our things and left and I was instantly overcome with a desire to turn our feet around, march back to the boma and do something – though what good I could possibly have done, or do, remains unclear. Instead I descended upon Geoffrey with questions. What now? Is there anything we can do? Was there any treatment available? Why would she knowingly skip her visit if she knew she was positive? Surely they educated her about the risks her status posed to her child? What would become of her?

There are no ARV treatment programs in this district Geoffrey told me. The Mbirikani Clinic, a private nonprofit hospital run by a woman from Chicago offers free ARV treatment for life to anyone diagnosed there… except our young mother, her feet her only mode of transportation, her responsibilities in the home paramount for day to day survival, would never be able to reach Mbirikani on foot… likely never be able to reach Mbirikani at all. She is young, ignorant, and uneducated he said. She will grow sick and die. So will her child. This is what happens here. Geoffrey either missed my crestfallen face or chose to ignore it, quickly switching topics. Riding on the same breath that sealed mother and baby’s fate, he laughed at something on the path ahead of us.

As soon as we got back to KBC I accosted Jenna. Telling her what had transpired, pleading with her to detail a different end to a story I already knew too well. Instead Jenna repeated Geoffrey’s answers, albeit far more gently. I saw myself then through their eyes: a young, naive, idealist who, like everyone else in this field, had to learn these lessons sooner or later – first hand, the hard way, the way that makes you feel like you’re drowning.

Jenna and I’s conversation turned to the multiple barriers affecting this mother’s decision. I have studied each of these convoluted, compounding factors, but it is not until the devastating results of these sociocultural and structural deficits sit 5 feet from you flowing in to the mouth of a child who may not live to see their first full year of life that they become real.

Our mama has never been to school, nor have her parents. Gaging her understanding of her condition is well beyond the scope of our research, but even if the nurses at the antenatal clinic were able to teach her about HIV/AIDS sufficiently to allow her to prevent transmission, and were able to get her on prophylactic treatment to prevent mother to child transmission (something the Ministry provides funding for) options for her own personal well-being are few and far between. HIV/AIDS is highly stigmatized. Our mama would likely find herself homeless if her parents were aware of the virus-laden blood flowing through her veins… a predicament that would kill her and her children well before the virus could. Since no one in her life can know about her illness, she is thus unable to justify shirking her daily responsibilities of caring for her children, fetching water and food, caring for her ageing parents, and so on to attend a clinic… the exact reasons she stated for missing her follow up antenatal visit. As I have previously noted, women have no personal capital with which to make financial decisions. Our mama and her family are the poorest of the poor. They farm no land, sell no crops, and own no cows. All of which are indicators of wealth. Even if they possessed the money to pay for transport to Mbirikani, our mama would be unable to access the funds to do so. Even if our mama understands that feeding her child breast milk can pass along her deadly virus. What is she supposed to do? Watch her infant starve to death? Listen to his hunger stirred screams?  It is not as if markets stocked with infant formula exist around here… it is not as if she could afford to, even once in a while, purchase some cows milk as an alternative. The irony is not lost on me – the very sustenance of this child’s life doubling as the sinister liquid pallbearer of his death.

Whenever I think about that baby I envision the childhood he will never have. The little legs he will never run on. I see his sweet, round eyes, full cheeks, and cupid bow lips cooing in pleasure… full of life. For now. It seizes my heart in a way that I am sure is akin to cardiac arrest.

My mind then, inevitably wanders to thoughts of my own mother. Her loving embrace that even now sometimes feels like the only safe place left in the world. My implicit trust in her to always have my best interests at heart. Her desire to protect my brother and I from harms way. These are traits universal to mothers around the world – a fact that in no way detracts from how incredible my mother is – however this perspective makes the plight of the young mama even more heart-wrenching. I am sure she is doing all that she can to protect her children in the best way she knows how given the options she has at her disposal and the information she possess that guide these decisions.

I want so desperately to help in a tangible way, at this very moment. To have grabbed her hand and have had an answer, a solution, a remedy.

Instead, I bear witness.