kongo stories

Congo Week 1

A beautiful day…

Today was the day of the third visit of the October patient group. It was my first with them under ARV(anti-retroviral) treatment. As I arrived at the clinic, many other patients were there. One was at the entrance complaining of different ills and aches and in the waiting room was a lot of new patients. Seems like the prediction of increase of patients is materializing as they are finding out thought he grapevine that we offer life with HIV.

At last I meet the October group. A group I had met in June and we had talked so much about starting treatment and doing it right to get the best outcome and it was our time to check if everything was going to plan.

There were only 6 out of the 7 patients and I was told the 7th was unable to walk to the clinic. Immediately I set out to fetch her and brought her over to our patient support group. They were all so happy to see her and greeted her with clapping. This clapping would be heard throughout our meeting as we cheered one after the other who felt better than when they started.

People are gaining their appetites, including the 7th patient. They are showing side effects, but it is no t bothering them. They are concentrating on the positive changes like the universal return of appetite. It must be stressed how big a deal this is for us infected with HIV as the biggest sign is weight loss and without appetite this is the inevitable.

We talked about the 8th patient who didn’t make it to the ARV program, as he died two days before we started. They said it was a design by god, as if he had died after starting ARV’s they would have felt it was the ARV’s who pushed him to death’s door and would have challenged their belief in the ARV treatment.

They expressed sadness over it, but accepted it as God’s will and are happy that they are better now. We did the pill count and all 7 notched up 100% adherence! Even with nausea, diarrhea and vomiting, they have taken their pills and are now reaping the benefits.

We talked about seeing one of the babies showing a rash all over her body and shared on that. We talked about how the 7th patient felt about being picked up by the MSF car and how that disclosed to the community that something was going on with her. She replied that her health was more important than anyone’s opinion. You go girl!

We asked how was the nutritional help faring and they all agreed that it was a great help to get the soy meal, corn meal, oil, salt, sugar and dried peas. I asked them what they supplemented this diet and most responded with vegetables and cassava leaves. Seems like the only source of protein are the dried peas.

We asked each individually a set of 20 questions relating to symptoms, both emotional and physical to gauge how body and mind relate to their well-being. Surely enough those who were having trouble finding sleep and expressed sadness were also the ones dealing with the most bothersome symptoms.

To wrap this up the patients are visiting each other outside of clinic days to lend support. They want to help out in anything they can to further the program’s reach and scope. They are willing to mentor new patients and hold their hands into this venture of hope and responsibility and they are doing it as a family. Concentrating on the benefits even as they are experiencing side effects. They have adopted the triumvate of taking their meds, making an effort to eat better and keeping a positive attitude in their life.

Our roundtable scheduled around their waiting time gave us the opportunity to check on one another, give each other support and information. The clinic was never interrupted and we were able to give them medical care, emotional support and continuing education on the management of HIV disease. What else could we ask for?

It is something we have been working on for months and it’s beautiful to see it working seamlessly and how we have delivered such complete care without requiring more time from staff or patients. Bagira’s HIV clinic, 12 points!
































Congo Week 2

WEEK TWO…


Last week I reported that out of the 7 patients, 2 were still not well, but that they had had their appetites return. This week patient 6 is much better and out of the hole and patient 7 was walking much more than before. All had 100% adherence to the ARV treatment and Patient six had a new reason to feel better; she has gotten engaged to another patient in the October group!

We’ll soon be toasting their nuptials with the ARV “cocktail”!

Group two, or the November group had their candy pill count day and start of ARV treatment. We counted the candies left in their pill bags and all had taken them improperly. Out of 9 patients, 7 took more than they should have, 1 took less than they should have and another didn’t show up in time last week to be part of the candy pill trial.

I was fuming! We went through their HIV/AIDS knowledge and again, they were fudging through the answers. This was no humble group. They ask for money, for transportation, they show up when they do and it’s all give me, give me, and give me…

I voiced my anger at their irresponsibility. Explained to them that this was to practice taking the real pills. If these were real pills, 7 would have been intoxicated by the higher doses they took, another would have been on her way to develop resistance by having taken less than she should have and the last one, well….

One of the medical exclusion criteria is active tuberculosis. Those testing positive for active tb, can enroll after completing the first stage of tb treatment that lasts two months. One of the patients was going to get the bad news. We reminded everyone in the group about this exclusion criteria and that it is in the best interest of the patient as one of the drugs in the 1st stage of tb treatment is incompatible with the HIV treatment.

After a brief meeting with the medical team, we came to the conclusion to postpone starting treatment until next week and to repeat the candy pill trial. The patients were told that next week the ARV bus would be leaving with or without them. Those in time and those who showed progress in their candy pill trial would get on the bus.

Clearly they have taken for granted the privilege of being among the first chosen. There are so many who need to get started on this scarce treatment and they are still behaving like it is another handout that comes with no responsibilities. Wrong!

Making appointments is a known marker for adherence as is the candy-pill trial. Excuses such as the kids ate it, is a serious thing. As if they are to take them as ARV and they have them accessible to the kids, it’s the kids who will be intoxicated by these very strong medications. Next week, the story will be different, I am sure.

I do several sensibilisation presentations every week. This week took me to a youth group, STD clinic patients and another for medical staff. In all three the question about condom’s pores being larger than the virus popped up. The source? Cardinal Alfonso Lopez Trujillo, of the Dominican Republic acting as president of the Vatican pontifical council for the family had said, “The spermatozoon can easily pass through the ‘net’ that is formed by the condom.” Despite widespread scientific consensus that condoms block the HIV virus.

I am not about to challenge the church, as I will lose more than I will gain. I appealed to their common sense. Do you think you are more protected against HIV with or without a condom? Even if you think the condom is not 100% effective? They all answered they felt it made sense that with a condom there was more protection than without.

I also said, if the catholic church was right, prostitutes would not be charging less to have sex with condoms. And then I asked the men, why were they paying extra to get infected…

Next week, the November group saga continues and I have been invited Tuesday to a brothel to speak to “les femmes qui vivent seule”(women who live alone, women without men, or commercial sex workers). This should be interesting…

The novelty of the ARV Program has left the VCT Clinic a bit like the first child when a new baby comes home. I will spend time with them, honing the counselling skills as well as taking care of the counsellors themselves. The number of positives this month of October was 40% out of a total of 176 people tested.

Venturing to young patients we have found a way to adjust the adult dose for an 11-year-old girl. First we have to address the uncle’s decision (she’s orphaned from both parents) to keep her from knowing her HIV status and our obligation to have all patients understand what they are taking and why. Any suggestions?




















Congo Week 3

Larry’s Homecoming

In establishing my role in MSF, I have envisioned a program whose “legs” come from the patients themselves. Patients filling the holes in the picture of a holistic ARV program. To this end I seek to bring hope to the patients and show them the fruits of good adherence. Next step is doling out responsibilities to the patients in helping the clinic so that it can be all it can be without adding to the burdens of the medical team.

I talked to a friend and he agreed it was something he wanted to do. To my fortune, he’s black, positive for 16 years, looks alive and healthy and has experience working in HIV for many years. He’s also kept himself without meds for 15 years through good nutrition…a message that appeals to those without access to treatment.

In a week, we’ve been walking all over, a rarity for expats as we are usually ferried about in imposing 4-wheel drive land cruisers. This has given us a lot of proximity to the people of the areas; Bukavu, bagira and Kadutu. It is now standard that we are followed by a coterie of children, greeted by all with the musical, Jambo Jambo (think Lionel Ritchie, All night long) and many men who are prompted to call Larry over due to his imposing musculature.

They are surprised at my Swahili as they expect me to be the typical mzungu. Though limited to daylight hours due to security reasons, We’ve talked so far to an average 100 people a day from casual street contacts, improvised workshops in garages, markets, busy street intersections, bars and scheduled interventions.

Due to the large number of people who can’t believe we are both positive, we have started to do live HIV tests. We explain that this needs to be done with proper counselling and confidentiality, but because we have already tested positive and for the sake of dispelling doubts, we are just performing a rapid test. A lab technician explains the test to the public, puts on his gloves, cleans our fingers, pricks it and then the test develops a red line with a twin confirmation line on the control side and mouths are agape.

It’s driving home a message of you can’t tell HIV by the way someone looks and it’s wise to use protection. A theme the Catholic Church and other churches have ganged up on the use of condoms as futile, since the virus is smaller than the membrane wall of the condom. This has given everyone a much-sought sacred excuse not to use protection. The results are impressive.

I get the comment from everywhere I talk. It’s starting to affect the double prices charge by the commercial sex workers as they are now charging a single, no condom price. Last month’s seroprevalence at our test clinic was 40%; last week was around 80%. It’s unbelievable that in spite of this bleak backdrop, moral leaders show such leadership. They want to save souls, forgetting about the bodies where the souls reside.

We’ve talked about Congolese sex with prostitute clients, sexual abstinence and monogamy after the test with youth adding the use of condoms for those venturing outside this recipe. We’ve talked about priorities and how they will affect our future when so many are infected. How so many sport two mobile phones, jewellery, new clothes, but are always begging for food in this lush paradise.

Hunger is evident, the causes are not. It’s lush and the trees are laden with fruit, but no one climbs them to be picked. They prefer begging and complaining about the lack of access to food. There are at least 5 major food agencies manning therapeutic feeding centres, all in the lushest of environments. I would not be surprised to find out the food is grown locally…it’s that fertile here.

To address this issue, we gathered Bukavu’s best and brightest nutritionist to a roundtable discussion to forge a common document on nutrition and HIV. The document will be dual; one, a guideline for nutritionists, another, for the patients in an easy to understand concept. The discussion started the usual crowing of the professionals, followed by nutritional facts and it ended with Larry and me talking about what was important to us as patients.

Between the virus, the medications and the antiretrovirals it is a juggle between diarrhea and constipation. Being regular is a blessing and proper nutrition helps us achieve that…I think it was the first time they actually heard directly from patients about what they wanted to achieve with nutrition, and about time. I believe in a few weeks’ time a document will be forged by everyone coming together on this mutually beneficial initiative.

We will go on market rounds once with every patient group to see, understand their eating habits and show available and accessible alternative to their eating choices. Larry’s physique has emboldened the patients to see the relevance of better choices in eating. I have also seen how Larry is fine-tuning his message to one germane to Bukavu’s needs.

So what has been accomplished this week? Major sensibilisation drives to commercial sex worker clients, youth and women with HIV. We started the live test demonstrations with huge attendance enabling us to talk to many on prevention, the benefits of testing early. The message is simple…with HIV you either find it or it finds you…if you find it, there’s much to do to prevent illness…if it finds you, you are already sick with aids and the road is hard and difficult.

I talk to people regarding the context they live in…poverty. But poverty can be a point of departure in life or just your fate. Understanding HIV infection and how to stay negative is a way of staying healthy so that one can attain goals such as having a family and watotos (children), the most common goals of poor Batavians. Denying risk behaviour and falling victim to the ever-mounting statistics is no way to have a family, at least one that begets a future of continuity.

These are the challenges faced here. Men behaving badly, women subject to their whims, church-led edits against use of condoms for HIV, economic hardship, tribal conflict, rape, hunger all in the midst of the lush mountains and rich soils of the eastern Congo…

Patient update: October group reported 100% adherence, most out of the side effects from the ARV’s but one is in the hospital for anemia and liquid retention. Bear in mind we are starting with the sickest patients and their conditions at baseline were not favourable to begin with…the good news is that the treatment has been largely well tolerated and has brought out6 of the 7 patients from the regular course of infection.

November group started out terribly, as we had to reschedule their start date, is 100% adherent and all have regained their appetite in spite of side effects from the treatment. They are also coming in on time and enjoying very much Larry’s nutritional talks.

Of special note two patients have come out of their HIV closet. Maman Josephine and Nicole. We did three radio broadcasts on Sunday where Maman Josephine spoke out against HIV discrimination, as she has been barred form selling candy at the market because she’s HIV positive. At the end of the interview, Nicole felt there were questions not asked, grabbed the reporters microphone and starting interviewing Maman Josephine herself!

This is no small feat for someone living with HIV sign off a radio interview, Bukavu’s only mode of mass communication saying, my name is Maman Josephine and I am bagira and I am HIV positive!

Leaving behind a group of HIV positive volunteers to give a face to the issue has been a goal of mine and what a gift has been to have two angels come to the fore…it augurs well for the program and it bodes well for the reduction of stigma in Bukavu…bravo Maman Josephine and Nicole, welcome to the club!























Congo Week 4

HellHo’

Peering down a muddy alley, through the wafts of excrement, humidity and vomit all creating a whiff of the inhumanity about to be revealed. It is the quartier of the femmes’ qui vivent seule, a dilapidated row of clapboard housing where doors reveal two beds enclosed by sheets. The only privacy afforded to clients while their children wait outside. There is no floor to speak of and the filth is all around.

This door/room placement is repeated down a ravine where they are set up. It’s a bit of a commune, replete with Madame President who seems to be a sort of pimp to the others. We went there to talk to them about HIV and its prevention and also because this way they could service clients during the talk. I asked one client about the use of protection and he said; I have two wives, 5 children and numerous casual contacts and I never use protection. It doesn’t feel right, besides, the church says they don’t work. The pores of the condom are bigger than the virus…

The women started to talk; no one uses condoms. Asking clients to use them is guaranteed that they will go to the next one and lose their client. They are hungry and need to eat. Some are habitual visitors to the STD clinic week after week. Many have children with them. I told Madame president if she doesn’t protect herself, her children would become orphans. She replied, jamais! I will kill them before I die to prevent them from being orphans!

I had talked and heard enough, it was time to go. Time to reflect and try to understand how a people can be so miserable that the opportunity to take care of themselves in the most basic form is unattractive, even when the visible scars of disease and infection abound. Even with children to look after, their lot is miserable and it is hard to comprehend. Any suggestions on how to engage these women? They are Bukavu’s almost certain, epicenter of HIV infection.

To cap off the day we started a tuberculosis adherence program to get all the patients in line with tb treatment requirements and deliver peer support for the 8 month long and tedious multi-tiered treatment. First a roundtable, each patient sharing their experience with tb and where they were in their treatment timeline. There was everything, from one that was being desensitised to get her started on treatment to one that was 3 weeks away from completing the full course of treatment.

We also have a wonderful illustrated tb presentation from the tb centre in Bukavu that shows the story of Baba, a head of a family and his experience with tb from infection to cure. This presentation aims to give the science behind tb disease and treatment in an accessible manner with local illustrations. Since we had already shared our stories, the illustrations and accompanying text, reinforced and validated the voices of the patients themselves. These created a strong understanding of the subject matter and understand the commitment needed to defeat tb.

We added that as HIV positive people it was to our interest to cure it and avoid it so that we could concentrate on beating AIDS and keeping our fight focused on HIV alone. We explained that with our feeble immune systems, we were more likely to develop tb disease than other groups and not following the full treatment course resulted in resistance, having to start tb treatment again from zero and having to take more drugs…not a pretty proposition for anyone present.

Wednesday came about…time to see how the 2nd patient group did with their second, and last, candy pill trial. We had invited a patient from group 1 to talk to them and answer their questions and of course, we had the medications and supplemental food ready for those who showed progress.

One by one they gave their bags of candies and we did the count and all were 100% adherent! The second group got to start ARV’s today. We clapped, held hands, sang a song and talked about our lives about to change as from now on, twice a day we would be reminded we were HIV positive, possibly for the rest of our lives…

The testing centre was going to be my focus this week as I became alarmed at the 40% prevalence rate we had last month. The counsellors mental state is of grave importance at this moment as they are only two doing the work as well as the testing and giving out the news to patients every day, 6 days a week. This week we had 9 out of 10 testing positive on Monday; 7 out of 9 tested positive on Tuesday, same Wednesday and it shows no signs of abating.

Why the sudden explosion of people getting tested, and why the high prevalence? WHO estimates the area to have a 5 to 10% seroprevalence for HIV infection. Our testing clinic numbers are really off the charts. One big reason many are coming to get testes is the fruits of our outreach. Some have also said they knew me from the radio interview I gave last week and again this week.

Patients in the program are spreading the word and our outreach efforts are paying off. They know we have something to offer if test is positive. There is hope that something can be done. Still, we need to address counselling the counsellors, because at this rate, they will burn out fast.

As jobs are scarce here, our counsellors are afraid to acknowledge to the mzungus in the team that it’s heavy on them. They feel it will show them to be weak and they will be replaced. This is not the case, but it is how they feel. We will come up with a way to handle this properly and caringly as they are valuable to the program and their jobs are not on the line, specially in light of the unimaginable situation they are in of telling so many tested that they are HIV positive…

Had a full week of sensibilisation…spoke to a church leader’s group, orphanage family group, std clinics, dock workers and in all I sense an awakening that they are realizing there is light to be had even if one is HIV infected. Globally, there are many obstacles; as we fight big pharma to relax patent rules and lower prices, we fight governments to allow us to bring medicines in; we struggle to train and facilitate infrastructure to administer the drugs and then the patients still ask, is this for life? They frown about the side effects and they look at you like if you are crazy if you think they are going to take this medication. Specially one that doesn’t cure you from HIV…

It’s not easy, but for every 10 of those people, you have others willing to take you up on the offer to live a healthier life…these people make it all worth it…

A sad news flash…the local resident transvestite, Kevin, was found dead this morning from poisoning and a severe beating. Kevin knew how unacceptable his/her behaviour was as she insisted on dressing up as a woman…showing how strong those feelings are, that even in a inhospitable setting, exposed to daily taunting and ridicule, she still put on her make up and worked the streets of Bukavu. It was a tragedy waiting to happen and it is today over for Kevin…

As human rights groups look for the next battles…let’s not forget how decrepit the lot is for gays in the rest of the world, where a killing like this prompts only sighs of relief from the population instead of repugnance and resolve to find the culprits. Where in Ethiopia, gays are jailed for being sexual…for life. Where in Guatemala, gays are officially excluded from HIV treatment by their government even as treatment is available for all those who need it.

I operate under the cloak of marriage and have no kids to show as my wife is negative and I don’t want to infect her. This is my official line so not to jeopardize my mission and my life…it is that real…





























Congo Week 5

The film begins…

The week brought more radio emissions, went to church, looked at a pork project, visited rape victims, talked about prevention without mentioning the troisieme moyen and welcomed a little girl to once exclusive club of ARV’s…and the cameras started to roll.

Went back to the girls who live alone, tested in front of a whole town, paid a visit to the traditional medicine man.

She was lying out in her bed like a Goya model with a sweet face and standing besides her was a young girl, a very young girl. It was the rape victim’s ward in Panzi hospital; a modern medical facility sponsored by the Norwegian government in the heart of a troubled community. The wards were full of beds and the beds were full of women, mostly young all recovering from the horrors of rape, eastern Congo’s war on women and it’s future.

We had gotten permission to interview two of the patients, our choice to capture the necessity of offering ARV’s to those who come in before 72 hours after the fact and avoid becoming another statistic of seroprevalence. The first one had been raped and rejected by her family as used goods. I glanced around. There was a girl naked, catatonic, shaking uncontrollably. Obviously a recent admittee…wrong, she’s been in the ward for three months now, still horrified.

I decided to ask the sweet young girl and asked her age, 13 and proceeded to ask her for her story. The Goya model stopped me to say, she was just there keeping her company. I sat on her bed and asked, well, what’s your story…”I live in the woods and the RCD (Rwandan-backed army) army came in looking for the Mai Mai (eastern Congo rebels). They accused me of being the wife of a Mai Mai and 8 of them raped me. I was 9 months pregnant at the time and during the gang rape I started having contractions and this made them rape me longer. When they finished, they pulled out my dead baby with their hands and left me unconscious for a day in the woods. That’s when I was brought here by a NGO. My husband doesn’t want to have anything to do with me and I cannot even see my children. I have nothing…

On the radio, a controversial roundtable on condoms and their efficacy. A doctor, the HIV Bureau Chief, the owner of Prudence Condoms and myself were among the guests. I was left for last and after they recited figures in percentages, microns and other measures it was my turn to talk. I said I was no doctor, no scientist…just a person who when I used them, tested negative, when I went into a relationship and stopped using them, became positive and since then, using protection have not had my partner change serostatus…

Sunday it was church in the Pentecostal church of Bagira. Singing, our testimonies as people living with HIV and then the sermon. “When one tests for HIV, hate fills their heart. They hate god, they hate everyone and since they figure they will soon die, they don’t want to go alone.” We’re Satan personified and the devil must be defeated…

Larry did his finest (to date) presentation to a group of health officials. He spoke about the talk of peace, but he still saw a war raging…he called it genocide and spoke to a wake up to fight the continuing war Congo has on each other. In 1994 seroprevalence was 5%, after the war it jumped to 20% due to the influx of foreign parties joining the fray; Angola, Uganda, Tanzania, Rwanda all raping the country’s resources and plundering it’s women to terrorize all into submission.

The continuing disregard of the abc’s of prevention…abstinence, fidelity and condoms was making peace untenable for the many who continue to disregard life and it possibilities.

Finally it was time to tell la petite, our program’s first young person, about secret brewing inside her. To start her on a life long treatment it was necessary to disclose her HIV status even though her family has hidden this and the cause of her parent’s death form aids all her life to spare her the bad news.

I told her about an illness that until now there was little to do except wait to die. That the treatment was life-long and it would still not get rid of the “microbe”, but it would rid her of the stunted growth that has left her looking like a 6 year old instead of her 11. I told her, if taken properly and with the help of better nutrition and kuyitika (positive attitude) she could fend of the recurring candidasis, diarrhea, fevers and gain weight and look forward to going to university like her dead parents would have liked.

I welcomed her the next day for the workshop that started the process for the December group. I asked around all 11 of the 13 invited who showed up to introduce themselves to one another and share when they learned they had the virus. La petite said in her frail voice…”yesterday”.

We have an incredible testament to the fair selection process. There’s an army major who has already interrupted his initial treatment, two Rwandans (country that has repeatedly terrorized Bukavu), two on terminal stages and a pregnant woman. I explained the importance of adherence, presented the major as the face of resistance and how he will have to make an effort to make this chance be the one that works as there is no other treatment line available.

We talked about their responsibility to make it work, as otherwise they would be the authors of the resistant strain epidemic, and just what the world waits for Africa. On a more poignant level, they must show la petite fille, the example she needs to make the future shine again in this beautiful land in the great lakes of the heart of Africa.

On another muddy day we descended to the hellho’ again to capture the girls who live alone with the camera. They showed us their lairs one by one and discussed dreams, clients, and children all in the most unsettling of settings. Not so much the muck and stupor of too many men, but the promise it held for certain infection to so many others. The fathers who descend to patronize these women and bring home to wives and children another nail in the coffin of poverty and disease. Women who disregard what they know best to make a couple of dollars, 5 if they sleep over.

In a rond point (traffic circle) we gathered to test in front of the community of Kadutu. We spoke briefly, got pricked and tested in front of a couple of hundred people, all hungry to see if it was true that these two men were saying the truth about having HIV. A few minutes later, the tests showed the tell tale red bands of a positive result; not enough, our nurse, Mai, tested to show a negative result, live and direct.

The film crew is here, capturing all this for others to witness and hopefully realize the struggles and bring hope to those caught in the midst of this ongoing story.

Patient update. October’s group is now being seen twice a month, we saw them last week and we’ll see them next week. The 7th patient is still in hospital and retaining fluid and not getting better.

November’s group had their second clinic visit under ARV’s. 8 out of the 9 showed weight gains averaging a kilo (2.2 pounds) in a week. The 9th decreased her weight by the same amount. All had side effects, but nothing to write home about. One volunteered to speak at the December group’s starting day, sprouting another seed in getting patients to help the patients. Another has knitted washcloths that I will bring with me to sell and siphon the proceeds back to her.

I don’t believe in give-aways, but I do in helping people who are doing something to get out of their hole. I hope you help Mme. F with disposing of her excellent, hand-knitted cotton wash mittens.













Congo Week 7

A patient harvest



The final week is here…sensibilizations, transmissions via radio and in person. Tranmitting hope, showing in flesh positive test results and showing how appearences are deceiving. Helping patients understand that the pills don’t work on their own, they bring life, but also responsibilities. A responsibility to change behavior to responsible behavior to one’s body and to protect others. To nurture one’s body with beetre nutritional choices and cleaner water…all to minimize intake of microbes that challenge a weakened immune system.

To strengthen one’s resolve by tapping on to our positive thinking and letting our will to live, defeat our fear of dying. To understand that staying silent and ignoring the obvious, doesn’t get rid of the problem, on the contrary, it makes them bigger and less maneageble. Coming out with the infection takes the weight put by others out and makes the fight a concentrated one on fighting hiv.

This week we saw all three groups…the October and November group came back 100% adherent. The November group started the their third week with the full dose of Nevirapine, giving most the unpleasant side effect of skin allergies, challenging their adherence, but they remained vigilant and came back 100% adherent.

One patient from the December group described her hopes with the upcoming treatment as one that would reduce the amount of virus in her blood, elevate her white blood cells and she needed to make a change in her behavior to make it work. The message was transmitted…

The first patient group has volunteered for shifts in keeping the clinic clean. The 7th patient, in hospital, has volunteered to transmit her knowledge to another waiting patient so she can be ready to start her arv’s next month. Maman Josephine has returned to selling her things in the market, all this after coming out publicly about her hiv status. More patients came back with more knitted bath gloves, understanding that it is better to work than beg.

These are the fruits of our visit to Bukavu. These were the goals behind the patient program, to get them to take responsibility and charge of their lives. To leave fear behind and let them concentrate on their fight with hiv. To change their attitude towards the infection from one of dying and being sick, to one of living and being useful again.

We went to the heart of the conflict, the army base. We witnessed their capture training where beatings prepared them for the enemy. Beatings that made your hairs stand on end as they slapped soldiers in the face, beat them with sticks that would break repeatedly from the pounding as they lay pinned to the ground. Another being disciplined with over 50 stick lashes as he hugged involuntarily a cement column, being whipped on his back over and over.

We did a live test demonstration for the soldiers, our cameraman, pep, volunteered to do a test to show also a negative test result. He was brave to do it, as it could have tested positive. When we asked how many wanted to get tested, all raised their hands in unison. This shows a willingness to face the problem head on. It is now up to us to meet their needs of privacy and confidentiality.

Coming to a known testing site involuntarily discloses their pursuit of an answer to their status. They want testing to come to them and make it easier for them to test without any sort of disclosure. The counselors are against the idea as they fear patients reaction to a positive result may endanger their welfare. There are obstacles in every direction, but there are also solutions and compromises to be made.














Congo Week 6

Week 6

• 5 patients from the October group have volunteered to do weekly shifts to keep the clinic clean.

• The 7th patient from the October group, still in hospital, has volunteered to train a convalescing patient to be ready for the December group.

• Maman Josephine has returned to her market stand after disclosing her HIV status on the radio. Due to her long absence from the market, she’s having a hard time buying candies to sell.

• 2 patients from the November group have started knitting bath gloves to make extra money and another is slated to give her testimony to the December group and answer their questions.

• 17 patients have volunteered to grow more seeds for other patients who have no access to land and share the crops and know how.

When I started with MSF, I wrote the cover letter for the educational program. It was titled, “Get off the cross… we need the wood”. It was about getting the patients out of being sick, to being healthy; from dying to living; from passive recipients, to active in their new responsibilities.

Since arriving in the Congo, we’ve (patients, larry and myself) talked extensively about adherence, about making changes, making choices, making priorities; to think about living with an infection, not a disease. I believe that patiently, the nuggets above show that it has started to happen. They are living with their HIV and it has been part of the plan since day one and I feel blessed to have seen it with my own eyes.

Both October and November groups are 100% adherent. The November group was in their 3rd week visit. This is the week when they are taking their full dose of Nevirapine and some showed skin reactions that bothered them a lot. I assured them, it would go away in time and to keep taking their doses as indicated.

The December group is doing their candy-pill trial and getting ready for the big day, Wednesday, December 3rd.

The second baby born out of our prevention of mother to child transmission program is called baby Carlos…a healthy 4.5 kilo bouncing baby. The perfect example of the need to test and insure that no baby is born with HIV in Bukavu anymore…I hope baby Carlos becomes a symbol to mothers to be of this miracle that is having a baby born uninfected with just a single pill on a single moment.