In this issue:
- From "waitress" to waitress
PIH's partner organization in Malawi provides sex workers with a chance for a new life, education, alternative employment opportunities, and health care.
- Water as a source of life and of loss
Reflecting on the power of water over the lives of the poor on a trip with charity: water.
- 3,000 grueling miles of support
One supporter will bike the equivalent of scaling Mt. Everest 4 times to support PIH's work around the world.
- Zanmi Lasante celebrates World Environment Day
2,000 people gathered to help PIH's partners in Haiti to celebrate the link between health, food, and the environment.
- Dateline PIH: Project updates from all over
Promotores purses, €9 million to treat TB in Russia, and fighting Dengue fever.
- Plus: Dangerous IMF policies; The power of communities; Maternal mortality in the world's poorest communities; Needing nurses; What matters to Paul Farmer; and Twittering about global health.
Above photo: Clean water for a community in Peru. © Socios En Salud
From "waitress" to waitress: APZU provides Malawi sex workers with health care, education and alternative employment opportunities
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Stella was forced to work as a commercial sex worker until PIH's partners in Malawi helped her find another way to support herself
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Stella’s eyes are tired, her face weary and aged beyond its years. She was born in rural Malawi to a poor family of subsistence farmers. At age 11, she went to live with an uncle in hopes that he would support her education. After enduring sexual and psychological abuse, She dropped out of primary school and ran away to Zalewa, a trading center, where she found work as a “waitress” in the Ufulu Night Club and Bottle Shop.* It was there that she began engaging in commercial sex work. She was barely 14 years old at the time. Her life continued to be filled with trauma. Once, she was abandoned in neighboring Mozambique by a truck driver who had hired her for the week. Penniless, alone and terrified, she made her way back to the border, only to be raped by four men in a roadside guesthouse. She ultimately returned to Ufulu—the closest thing to a home that she knew.
Zalewa trading center lies on the edge of rural Neno District. It is situated at the crossroads between Lilongwe and Blantyre, Malawi’s two largest cities, and the country’s western border with Mozambique. The corridor is a major trucking route for the region and is estimated to house over 1,000 commercial sex workers, the highest concentration in the country. Human trafficking is prevalent both within and beyond national boundaries, and Zimbabwean women now account for nearly half of the commercial sex workers operating in the area.
Poverty and gender inequality are woven into these women’s life stories. Few have had the opportunity to pursue an education, which would have given them the skills and means to find other ways to economically support themselves and their families. Nearly all have been bribed or assaulted by the same men who in one moment condemn them and in the next are their regular clients. The language of individual blame and immorality that many, including the women themselves, use to describe those who practice commercial sex work fails to recognize the structural violence that lies at the core of its existence.
The national response to the HIV/AIDS pandemic in Malawi has focused primarily on testing and treatment, with a stated focus on vulnerable populations. However, the needs of this population have been largely neglected—in part a reflection of the stigma attached to the women. Aside from the individual risks of exploitation and violence to which the women themselves are regularly subjected, the public health consequences posed by the commercial sex work industry are dire in a country with one of the highest rates of HIV on the planet.
In January 2008, Abwenzi Pa Za Umoyo (APZU), PIH’s partner organization in Neno, began collaborating with Development Aid from People to People (DAPP), an NGO that was operating a health center in Zalewa, to work with a group of commercial sex workers in an effort to strengthen health services and help them find alternative forms of employment. In February of last year, the center hired 15 of the women to work as community health educators in three busy trading centers. The center provided them with ongoing training focused on counseling commercial sex workers and their clients on sexual and reproductive health, making referrals for HIV testing and counseling and, more recently, cervical cancer screening. In the first few months after establishing this partnership, HIV testing at the center increased by over 125 percent. The number of commercial sex workers in the catchment area who have started antiretroviral treatment at PIH-supported sites has also increased substantially.
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Stella at the construction site for the new restaurant co-op, run by former sex workers.
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On October 2008, DAPP unexpectedly closed the Zalewa center citing lack of funding, despite acknowledging the success of its programs. PIH/APZU stepped in and assumed the salaries of the former DAPP employees, as well as all other operational expenses. In January 2009, the center began offering daily adult literacy training in three sites along the trucking route. The classes were open to all commercial sex workers in the area; 56 women enrolled. In February, APZU held an intensive 7-day training on business management. Based on the training, the participants developed a business plan for opening a restaurant co-operative in Zalewa. Renovations of the building and outdoor dining area are currently underway, and they expect to open for diners next month.
PIH/APZU hopes to develop the Zalewa site as a women’s empowerment center that gives commercial sex workers in the region the tools to find safer ways to support their families by addressing the women’s medical, social, and educational needs. In addition to strengthening women’s health services, including family planning and risk-reduction counseling, antenatal care, HIV care, prevention of mother-to-child-transmission (PMTCT) of HIV, STI detection and treatment, and cervical cancer screening, the site plans to increase opportunities for adult literacy, vocational training and small-business development. APZU/PIH will also expand the scope of the community education component; by early 2010, the goal is to triple the number of community health workers providing health information in the trading centers along the trucking corridor.
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Stella practicing her new writing skills.
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“There has been a tremendous improvement in my life, because this time I am no longer risking my life,” says Stella. “When I was doing commercial sex work, I didn’t know what might happen that night. It was always my wish to [...] not to have to do that work, but with such poverty, I was desperate and needed cash.” One year ago, Stella could not sign or even recognize her own name. She now attends literacy class five afternoons a week, and at 35, she has finally learned to read and write. When Tiyanjane Restaurant opens its doors in a few weeks, Stella will be ready to take orders as a real waitress, notepad in hand.
*Name has been changed.
Water as a source of life and of loss
Amanda Schwartz from PIH's Boston-based development team recently visited Haiti to learn how water affects the lives of the poor.
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Haitian women fetching water.
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Sometimes it takes a hurricane to realize the value of a bridge. And other times it’s only a matter of an afternoon rainstorm to understand the potential of a stream. In Haiti, it seems that no matter where you go, the power of water is indeed axiomatic: in clinics, in homes, in hilltops, it is the source both of life and of loss. I learned about the power of water—in raindrops and springs alike—in early May, on a visit to central Haiti with a team from charity: water, an organization that supports PIH’s clean water initiatives in Haiti.
In many of the communities where Zanmi Lasante (ZL) works, community members collect drinking water from natural springs that are near—or in some cases very far—from their homes. Because many of these springs are unprotected, the water that entire communities are living off of becomes a perfect breeding ground for parasites and waterborne diseases. In fact, only 45 percent of people living in Haiti’s rural interior have access to potable water, meaning that over three million poor Haitians are drinking water that is harmful.
The team from charity: water and I came to Haiti hoping to learn the story of water in communities where ZL works. We wanted to talk with community members living in areas where water sources are dirty, and in areas where charity:water has already donated money for sources to be protected. We wanted to know how water affects poor Haitians in their daily lives.
In the end, we didn’t learn this story from the children with bellies swollen from parasites (so much so that they propped their water jugs filled with dirty water on them for balance), or from the pregnant woman who had walked over an hour for water twice already when we met her. We learned the story of water when we walked with them—the children with swollen bellies and the pregnant woman—up steep terrain to the unprotected spring where they collect their drinking water.
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Walking through muddy streams to reach a
water source.
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Children fill their jugs with water before preparing for the long journey back to their homes.
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We walked through the mud and around the trees and over the thorny bushes. And when the rains came, we kept on walking, until our faces were dripping and our clothes were soaked. And when the ground under our feet turned to water, and the floods started tiptoeing past our ankles and our calves and to our knees, we kept on walking. That is what poor Haitians must do when they are thirsty or when they are sick, to get to a spring or to a clinic, and so we walked.
As we walked, I couldn’t help but think about the hurricanes that hit Haiti last year—about how quickly those floodwaters tiptoed over bridges, carrying them away as if they were just twigs and mango peels stuck in the way. And as a rainstorm turned streams to rivers at our feet, I heard the story of water from the young children and weary women walking with us, but also from the water-logged footsteps of our donors, ZL's water engineers, and project managers, who are determined to make water—in raindrops and springs alike—a source of life rather than one of loss.
3,000 grueling miles of support
To complete the Race Across America (RAAM), the transcontinental cycling race and longest human-powered race in the world, cyclists must cross the country in 12 days, biking over 3,000 miles. Time will start on the West Coast, from Oceanside, California, and won’t stop until the biker reaches the finish line—in Annapolis, Maryland. Cyclists will climb 110,000 feet of elevation—the equivalent to scaling Mt. Everest four times. The winner typically rides about 375 miles per day and finishes in 8 to 9 days.
Approximately half of the solo riders will drop out, some citing heat exhaustion in the deserts of the Southwest, where temperatures can quickly soar past 100° F, others a mental break in the Midwest, where, upon reaching the Kansas plains after the grueling Colorado mountains, racers know they still have about 1,500 miles to go. “It’s not a sporting event in the classic sense,” Tom Rogers, a 2005 RAAM participant, says in the documentary film Bicycle Dreams. “It’s more of sending a gladiator into a pit with a lion.”
This is Patrick Autissier’s third solo RAAM. Autissier, an HIV researcher at Boston College, is raising money for two charities, Nashoba Learning Group and Partners In Health. In 2005, he bowed out after 6 days. He finished his second solo RAAM, in 2007, in 12 days, sleeping 30 hours total—and raising over $12,000 for Partners In Health. This year, his goal is to finish the race in 10 days.
“The main problem on this race is the mental part, because of sleep deprivation,” Autissier said. “As soon as you sleep or you stop, you lose time. Sleep is an option. So when you go 3 sleepless nights, you start to get cranky, anxious, and after 4 to 5 days, you get hallucinations.
“I got that in 2007. I was riding in the middle of nowhere in the middle of the night and I didn’t know what I was doing here. It was like living a nightmare, but you’re completely awake. And you cannot get away from that. You think that you’re gonna go crazy. So it’s very disturbing... You don’t know what to do. You don’t recognize people.”
Many of the cyclists spend upwards of $20,000 or more just to compete—they are responsible for assembling their support crew, which often includes medical professionals, and acquiring support vehicles, among other costs—but any prize money is beside the point. The prize is in finishing the race—some call it the race of truth—and in the unexpected moments of beauty along the way.
“I remember in 2007 we were in Kansas, we had just passed Colorado, and there were plains on the left and on the right. It was sunset, and the colors were beautiful, and there were some deer running beside us. It was just magical,” Autissier said. “Those kinds of moments are what you live for during the race. There are very few, but when you have them, you keep that for the rest of your life.”
For more information on Autissier’s journey, or to make a donation, you can visit www.patrickautissier.org.
Zanmi Lasante celebrates World Environment Day
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Samples of some of the produce grown at Zanmi Agrikol's farm in Corporant.
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Over 2,000 people joined PIH’s partner organization in Haiti to celebrate World Environment Day on Thursday, June 4. Zanmi Lasante (ZL) and Zanmi Agrikol (ZA), a ZL program focused on agricultural initiatives, brought together the local community, including prominent local officials, farmers, student groups, women who displayed their own produce, and area vendors. The third annual event was held at ZA’s farm in Corporant, Haiti, approximately 15 miles from Cange in the central plateau.
The theme of the day was found on the back of the T-shirts ZL handed out to participants: Ann plante pye bwa pou nou jwenn bon manje ak pwoteje anviwòman nou, or in English, “Let’s plant trees so we can have healthy food and protect our environment.”
“It was a really great day because it’s not a day for children or mothers or fathers, but for everybody on the planet,” said Guilene Warne, a long-time friend of PIH who supported ZA’s founding and continues to work shoulder-to-shoulder with the ZA team. “Health and the environment are two things that walk side by side and go hand in hand. Protect it, conserve it.”
Zanmi Agrikol displayed and distributed the fruits of their work on their 35-acre farm, which lies downstream of Haiti’s largest river, the Artibonite. Mango and avocado tree saplings, as well as saplings of trees used for soil conservation, were handed out to participants, along with fruits harvested at the farm. The farm grows primarily peanuts, beans, and corn. The peanuts are harvested and processed at ZL to make nourimanba, a fortified, peanut butter–based “ready to use therapeutic food” (RUTF) used to treat severely malnourished children. The beans and corn are used for nourimil, a cereal-legume blend of rice and beans or corn and beans.
Speakers included ZL’s water engineer, Evens Jean Pierre, who discussed clean water interventions; Dr. Christophe Milien, director of the ZL program at Lascahobas/La Colline, who illuminated the connection between family planning and nutrition; and a Haitian woman whose daughter had been treated for severe malnutrition at a ZL clinic. As she spoke about the impact ZL had made in her and her family’s life, her daughter, healthy and happy, sat peacefully on her lap.
Dateline PIH: Project updates from all over
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Purses made by SES's promotores juveniles.
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Peru: In addition to their mentoring responsibilities, the promotores juveniles (youth health promoters) working with Socios En Salud, PIH’s partner organization in Peru, are adding small-business experience to their résumé. In the past month, the young men and women, ages 13 to 20, began crafting leather change purses that are sold among Socios En Salud staff and supporters, as well as neighbors and friends. The promotores juveniles plan to use funds from the sales to help pay for school supplies and uniforms, to support those continuing on to postsecondary education, and to assist their families. The health promoters, who supervise education programs in local public schools and provide mentoring and homework help to children ages 6 to 12, hope to establish similar self-sufficiency projects in the future.
Russia: Recognizing the track record of success of PIH’s partners in Russia of treating and controlling the spread of drug-resistant TB, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) recently awarded €9 million over 6 years to continue the work of the project in Tomsk, Siberia. This funding will help provide universal access of comprehensive treatment for all patients with drug-resistant TB in Tomsk Oblast, a first for the Russian Federation. PIH's partner organization in Tomsk will continue to serve as the principal recipient of the grant.
Peru: An outbreak of the mosquito-borne Dengue virus in April in a nearby community prompted Socios En Salud staff members, health workers from the Raúl Porras Barrenechea health center in Carabayllo, and members of local grassroots groups to form a task force to check water safety and provide information about the virus to Carabayllo residents. The virus, found primarily in tropical and subtropical regions, can result in high fever, severe headaches, nausea, and vomiting, among other symptoms; dengue hemorrhagic fever, a more severe form of the virus, can be fatal. Both types are transmitted by the Aedes aegypti mosquito. The strongest preventive measure against Dengue virus, according to the CDC, is to depose of mosquito breeding sites—mainly artificial containers that carry water. The task force visited approximately 200 homes over 12 days, checking water bins at each residence to ensure they were covered, taking water samples, purifying water supplies, and in some cases using abate, small bags containing larvicide that are placed in the water bin to kill mosquito eggs. The group’s efforts helped to stem the outbreak and highlighted the major role stagnant water plays in the lifecycle of the Dengue virus.
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