Bukavu Week 3

Bukavu Week 3

Saturday

Full week, full team
Pep Bonet and David Arasa have joined us this week. Pep is again at his best taking pictures and David is lending Sergi a hand with the camera. Pep is the photographer whom I met years ago in Zambia. It was through his interest in the project that we got to make the documentary, “Back to Life”; so it is fitting and thrilling to have him here with us.

Not 30 minutes after traveling 4 days to get here…Palma de Mallorca-Barcelona-Amsterdam-Nairobi (cancelled, rerouted)-Dubai-Nairobi-Kigali, we go off to a sensibilization for youth in Kadutu.

What are the signs of AIDS?
Skinny
Bad skin
Straight hair
Tired
Diarrhea
Skinny

Luc and Elysee, Two of the youth program coordinators had taken the test Friday and they agreed to be live-tested so people can compare against my test results. Elysee, a lanky 27 year old was perfect for our role play.

“Which one of us do you think has the virus? Elysee or Carlos?”
“Elysee” shouted the youth gathered in an open courtyard where tables are usually busy with checker and poker games.

Who thinks Carlos is negative? And all hands went up… Time for a live test.

The tell-tale red line came across the rapid test soon after my pricked finger dropped a few drops of blood. No line came in Elysee’s test. He of the skinny arms, not I, was negative. I, not he, was positive. The youth couldn’t believe their eyes.

The message was clear,
Les aparences font tromper (appearances can fool).
Il faut se proteger (Protect yourself from HIV).

Abstinence.
Be faithful after testing for HIV.
Use protection.



Monday.
We meet Joseph to see him take his medications. He is in a serodiscordant marriage. He became sick in 2003, tested positive. He prudently had his wife tested and she tested negative. Since then, they have used protection and they are still sero-discordant.

He claims getting tested saved his life. “Most people here avoid testing because they don’t want to get bad news. But for me it was the contrary. Testing saved my life. Had I not tested, I wouldn’t be alive today, my wife would be probably also be infected.”

I met Joseph back in 2003; he was selected to be among the first patient group getting antiretroviral treatment. Back then the goal was to demonstrate that people living in conflict areas deserved these life-saving medications and the biggest hurdle was adhering to the treatment.

I can say confidently, that goal has been reached. Patients I met in 2003 are all alive and are mostly on their fist-line treatment, proving their adherence.

Patients were asked to share their experiences to other patients and the community at large. That has happened unevenly, but it is happening. But the are many questions that are now pressing.

The pills are being brought free of charge by MSF. This is a finite program that should be rolled over, in theory, to the national health program. Pharmakina is making antiretroviral, but have not been WHO approved, making them absent in the viable solutions to deliver medications. If approved, who will pay for them?

The one person who is absent at the decision-making table is the patient himself. The United States had ACT UP that took its place among the decision makers and veered the slow-moving drug approval process to parallel trials, cutting the time a drug was approved, among its many accomplishments.

We sat at the table to make sure our needs were being met through legislation, funding and delivery of services.

In South Africa, TAC (Treatment Access Campaign) took its place at the table turning over a government who denied HIV and patent laws, and brought access to antiretroviral to many.

In Congo today, this is the missing piece. The money is here, the local service providers have the know-how and the pills are here. But the biggest hole is the absence of PVV’s in the tables where all decisions are made.

The week was full of presentations to young girls; medical students and we were able to follow six girls who wanted to get tested for HIV. We are promoting this practice to make sure providers go through the test process themselves and be better advocates for HIV.

We visited Congo’s Fistula Restoration Center, Panzi Hospital. It is a beautiful place tucked away from the chaos that is Kadutu where many women, 380 this week, are being treated for vaginal wounds. It is a place that is impossible to leave with heavy mind as one sees and listens to women and girls tell their stories of rape.

“My intelligence abandoned me and they kept raping me. I have one question, is there any medicine for these emotions I have? I need medicine for these emotions”, said one woman to me.

The little skinny girl with a disheveled look was taken by a military man; raped and left with a fistula so severe she is still incontinent. This situation leaves them scarred and visible for others to see that she cannot control her bodily functions. This is a daily event at Panzi, the rape center.

They don’t talk among themselves as there are Rwandan women there who mock them as most violence come at the hands of their Rwandan men. The fortune to meet and talk with others like them is lost on ethnic divisions that continue, even here.

We met a New York City girl, Linda Jackson, who is doing a documentary on sexual violence. She said, nothing like the stories she’s heard here. Women raped in front of their children and husbands. Then in turn watch their children and men killed. One said that after they ripped her man’s abdomen open, they cut his arm below the elbow, handed the hand to their children and said, say goodbye to your father.

This place is not for the faint at heart and after the brutality they must cope with pregnancy and disease. Most can never be mothers again or ever in the case of the 12 year old. They are left battered and shattered with newborns to tend and possibly infections that will last a lifetime.

But the woman asking for medicine for the “emotions” told me clearly that once they found shelter and food, the biggest pain remains inside.

We ended the week and Pep wrapped us his visit with a ride through town, at night, on patrol with the UN Peacekeepers. It was a thrill to ride among heavily armed, uniformed, mustachioed Pakistani soldiers. I got to ride in a tank that had as a centerpiece a big cannon with huge bullets hanging from the side. Next week I will talk some more about MONUC and how people perceive it here.

The filming is going on, not without bumps as we were stopped in the middle of shooting an educational video by Congo’s CIA, the ANR.

They claimed that the permits we had were not valid enough. Seems like when you think you have covered all layers, there’s yet another one. I am happy to say that our friend Laurent talked to the director and we have our new permits as of one hour ago.

Ps. This is David’s first “reality tour”. He speaks with girlfriend Tere back in Spain almost daily. It is difficult to explain what we see to those who haven’t been here. In between the police roadblocks on behalf of the only insurance company in the country(they take 300 dollars a year, or your car... and they never pay out) to we filmed in a harbor market where there is a prostitue village with hundreds of people he said to Tere...

“I get the impression we are saving lives”.