Bukavu Week 4

Bukavu 2.4

Pep left the team on Saturday to prepare for his next assignment for stern magazine in South Africa and Mozambique. The team felt hobbled as we had such a nice time, specially that we wrapped our time together riding on a UN tank.

The rest of the week was a bit more of the same, but at the same time more focused on what is our purpose here.

Panzi is the hospital that deals with fistulas; the telltale scars of sexual violence. It leaves the female body incontinent and broken, a pain that is hard to convey in words. We listened to 4 women and one little girl recount the same story of rape, abduction and abuse. Only the little girl was not rejected by her family as it was deemed too abusive on behalf of the rapists. Not that the rapists were punished, but the army facilitated her entry to Panzi Hospital.

We met another group of raped women and girls from outside Bukavu. The 6 year old was particularly hard to fathom. The stories have the same scenario…only the number of actors differs and then there is always the personal twist of cruelty and humiliation. Everyone who defends them is killed before them and they are raped amid the carnage with unthinkable endings.

I suggest that when Lisa Jackson’s documentary on rape as a weapon of war comes out, to watch it and understand that which I have witnessed here. I am glad to hear that Time has put the conflict in Congo as its cover story. It should give you a background on the 21st century’s first world war and the chaos people live here.

The oddest player here is MONUC (Mission Organization Nations Unies Congo), the United Nations Peacekeeping Force. In the same place where my diet is limited to goat meat, tilapia and Fufu, they dine on steak béarnaise and Tiramisu. They drive the pot-holed streets in brand-new air-conditioned Nissan Patrols. Electricity, high-speed Internet, jets and high-speed boats contrast to a place that is impassable by road, dugout canoes ply the lake’s waters and people are famished.

This bubble in the middle of all this hardship is guaranteeing that the mission enforces never have contact with those they are here to help. Not understanding your customer is a recipe for failure. Proximity is so crucial for aid to aid those intended and all I see is that many are attracted to the high salary base conflict areas bring to those who wear the blue caps + the adventure of a safari that features gorillas in the mists.

The one concern I have for them is HIV. Seems they have not been briefed on it properly as the number of children borne to young girls from contact with the blue caps show. There have been entire battalions sent back to their countries to break up teenage sex camps. The way the men of one battalion reacted at the news of PEP (Post Exposure Prophylaxis) said a lot.

Not one knew what PEP was; that it is now possible to prevent infection with HIV after exposure. They have no access to PEP. With so much unprotected sex going on between them and the civilian population plus the high HIV-prevalence, it is sad to see that all the money employed by MONUC, none is helping their soldiers and their sex partners from getting infected with HIV.

The one notorious contingent is known to offer $500 to women whose children are fathered by their contingent. Another is known for their envelopes; they leave the girls an envelope that once opened, bears one dollar for sex with the youngest of girls.

They understand the risk of sexually transmitted disease, but it is also believed that chances diminish with young girls. Makes sense, but the word statutory rape comes to mind. It is a mix of their fears and the poverty on the ground that helps keep these soldiers doing what they do. In the end, the protector is the violator and the people have deep mistrust in MONUC and what they are here to do.

I want to point out that not all contingents have the aforementioned notoriety of being sexual predators of young girls. Some are actually are known and respected for not looking for sex with locals and for their friendliness.

What I also see is little contact with the population and an aversion to everything that is Congolese. They drink wines, have sumptuous dinners and watch the World Cup on large screens while the people live under the blanket of blackouts in a land where there is 100% hydroelectric power, so much power, that its electricity is consumed as far away as South Africa.

A dog’s tale…

Elia, MONUC’s communications officer in Bukavu had gone to visit the Uruguayan battalion, which abuts the Chinese compound. She entered and heard the squeals of animals. She found a litter of puppies enmeshed in the barbwire separating the two contingents. The Chinese soldiers were fervently trying to unsnarl the puppies from the barbwire even as one fell through into the arms of Elia.

The soldiers demanded the puppy. Elia refused. They sent a commander to snatch the puppy from Elia. Elia refused. The commander went to the Uruguayan commander to demand the puppy’s return. Elia refused. Understanding her stubbornness, they came back with an offer…another puppy for her puppy.

It was then that all became clear to Elia. She had the biggest and plumpest of the litter and the switch was just to make sure the fat one wouldn’t escape their dinner plans. Yes, they breed 3 bitches for their offspring and it is such a delicacy that they stopped at nothing to insure the return of the plump puppy.

Change is in the air…

As the climate is changing from the rainy season to the dry season, other things are changing in Bukavu; MSF’s oft-announced departure is starting to send ripples to all.

The program was given 5 years to prove that providing antiretroviral therapy was worthwhile in the most difficult settings. Bukavu, sitting in the heart of conflict, easily fit the requirements. In those 5 years, patients would be given medication, local staff trained on delivering HIV services and a rollover would take place, as the national health program would assume the delivery of this service.

Patients have proven to be adherent, local staff has been trained and the national health program is stepping in. Transferring experienced staff from an NGO salary base to a national medical staff salary where chief doctors earn $20 a month is a sad reality to accept.

The national health program can deliver donated medicine, but will charge for lab tests, making it difficult to monitor for most patients. The nutritional and psychosocial components are not part of the national health scheme and money is coming in from many angles, producing a circus of new players that have no other reason to exist than to get their hands on the monies delivered. Afrivir, a clone of GPO, Thailand’s successful cocktail, produced here in Bukavu, is a long way from being WHO-approved, as the fight over who will cover the 2 million HIV infected Congolese is being fought on major foreign stages.

This is all done without patients having any say on all that is affecting their very lives. It is not enough to charge that the NGO’s and national Health programs are excluding our voice, but us patients are limiting our voices in a collective hush.

There are unanswered letters to local and national officials. People are discriminated because of being HIV+, losing work and the ability to send their children to school. Services are not reflecting their needs and concerns as everything is delivered without question or consent.

Sure, many things are being done very well, but to do this the best we can, we must become part of the decision-making process. We are the reason aid is finally coming in, but nowhere is the patient visible, but at the receiving end.

Patient to patient education is the best way to deliver the best adherence. + Counselors bring personal experience to their counseling skills and to promote services such as PMTCT (prevention mother to child transmission) who better that an HIV+ mother with a healthy baby?

Time has arrived to demand our place in the delivery of services, and the disbursement of aid. NGO’s need to utilize this underused human resource, as it is perhaps the best chance for HIV+ people to make a living until the stigma of HIV is won over.

We need to leave the clandestinity of hiding in fear of what may happen as nothing can be worse than what is happening today. It is high time for a PVV summit. It is scheduled for Friday afternoon. We will seek common ground and seek direction and plan actions. It is time to coalesce to unleash power…

I am happy to say the meeting took place, voting unanimously to seed securing access to treatment as the most important issue to fight for and a plan of action.

They want inclusion at the decision-making table by creating a community advisory board, at MSF’s transitional plans and at the PNMLS (Programme National Multisectiorelle Lutte contre le SIDA). There is a committee to find work and food.

I need help to connect them to TAC (Treatment Access campaign) in South Africa and in finding contacts in the World Bank and Global Fund to find out what has been given, to whom and for what so that the patients can get all the information necessary to make their claims to the appropriate parties.

All leads and contacts will be appreciated.

Ps a major headway was made Friday in Bagira. Yvette, Maman Josephine and I disclosed our status in front of over 100 incredulous people. I did my usual live-test and then came a man from the crowd demanding that Yvette be tested. He said she was too beautiful to be HIV+and he wanted confirmation.

To everyone’s surprise she acceded and became the first local person to do a live test…

It was recorded on radio Okapi and chosen to go on National Radio this coming week…this is like getting a spot on Thomas Gottschalk or in 60 Minutes…

On a personal level the team was very happy at Sergi’s 2nd place prize in Madrid’s Film Festival for his documentary on Sierra Leona’s amputee football team, “Against Gravity”. Check it out! And many congratulations to our director, Sergi Agusti.

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”.