Tuesday, July 1, 2008

Snapshot of an Ocean

This is a paper I recently submitted to my advisor-- part of the last few bits of my MPH requirements.

It's long-ish but gives a good picture of PC in Botswana and what I'm actually doing for work these days.


Just about two years ago I was sitting behind a desk in a Boston office building. I was five years into a career in International Education, working my way up the corporate ladder and filling up my resume with promotions and experience. I had taught in China for a year and returned to the States where I dove into an administrative position for international English schools. After three years I finally had my dream job in marketing that would allowed me to work creatively and travel all over Europe, meeting students and agents from around the world.

I felt successful, challenged, productive and yet completely unhappy.

I couldn’t stop thinking that something was missing. In China I had taught English to wealthy children all day and then walked home through streets thick with poverty and sickness. Now I was shmoozing with international business leaders in swanky hotels, completely shielded from the countries and culture that surrounded me. I was restless for something.

Two years later I’m sitting in a cement house in a tiny Botswana village. I’m exhausted, dirty, homesick and yet completely happy.

Peace Corps service puts me at a grassroots level where 33% of this population is infected with AIDS and the need is unmistakable. Despite my 43 credits in International Health Courses and my two months of intensive pre-service training, I feel incredibly small against the enormous tasks of HIV prevention and youth behavior change. Even so, I am eager, motivated and urgent.

At Boston University I took a course in HIV/AIDS where the professor told us that this disease would be part of our careers whether we wanted it or not. Epidemiologists, teachers, lawyers, social workers, statisticians—whatever we chose as careers in international health—HIV/AIDS would be there waiting for us. I remember this professor for his candidness and yet his determination.

I also remember sitting at a house party a week before I left for Botswana and someone drunk and laughing at my impending assignment: “It’s like you’re trying to drain the ocean with a teaspoon.”

This is my teaspoon:

Every morning I wake up at 5:30 and shiver through a bucket bath. I walk to school in time for the 6:50 bell when 350 secondary school students file into Assembly. I stand with the teachers and watch the children sing their morning prayers. After this I work.

I hold interviews with teachers and administrators, observe guidance classes, attend school clubs, visit local NGOs, arrange meetings with village nurses and speak with the village chief and his development committee. I walk through dusty streets and use my broken Setswana to chat with locals and shopkeepers about their concerns for the village. After work I buy dinner at one of the tiny tuck shops and make my way to my house across town. “Across town” is just a 30 minute walk through a population of just 3,000 village residents, most of whom work at the fields on the outskirts of town. I had asked for a small village where I could work on developing my language skills and so I’m quite pleased with this assignment. Once I arrive home I spend the evening typing a report and assessment of my community: its strengths and weaknesses, its stakeholders, its change agents—its potential.

The Lifeskills projects have one purpose: to strengthen the capacity of the school and community so they are better able to prevent HIV infection among this generation of vulnerable youth.

Three months from now I will finish my community entry report and begin to initiate intervention projects in line with this mission. I am hoping make these projects as sustainable as possible and, as a result, will work to incorporate the ideas and assistance of the 24 school teachers, 9 staff and 5 administrators at my workplace. One of the many Peace Corps slogans is “If you’re working alone, you’re doing something wrong.” I’ve explained this concept of capacity building and sustainability to every person I’ve interviewed and they seem eager to become involved. It is incredibly motivating to finally step out of the MPH student role and start seeing the reality of this public health philosophy and jargon.

Unfortunately, the reality of public health in the third world can also be incredibly discouraging:

The Guidance Counselor tells me that eight teenagers have become pregnant in Kumakwane in the past six months. The NGO tells me they are currently servicing 212 OVCs, nearly a tenth of the village population. The nurse tells me she sees endless cases of HIV positive women becoming pregnant again and again: increasing the rate of transmission and multiplying the orphan population.

Although I’ve been in this community just a few weeks it is evident that I have my work cut out for me these next two years. Fortunately, I have an amazingly supportive and motivated village community as well as nearly 100 fellow volunteers (nation-wide) to assist and encourage me. In the Lifeskills program we are just 12 people comparing notes and brainstorming our way through education bureaucracy and a bizarre culture. The other Peace Corps Botswana programs include the District Aids Coordinators, Community Care Based Workers and NGO Volunteers. All of us are here to drain this ocean of AIDS. We are terrified and overwhelmed every day—we are crossing our fingers that our work here has an impact on this horrible epidemic and its rising trend line.

Fortunately the government of Botswana is extremely active in promoting the social welfare of their citizens. Peace Corps was invited to Botswana in 1966 (the year of their independence (from Britain) and stayed for nearly 30 years, assisting with development work and general health care. In the 1990s the United State government decided that Botswana’s economic and population health had stabilized and Peace Corps assistance was more urgent in other countries of the world. We withdrew from Botswana then, but not for long.

In 2001 the Botswana president requested that Peace Corps return to his country to assist in developing strong HIV intervention and prevention programs. At that time over a quarter of Botswana’s citizens were HIV positive and infection rates were rising. Peace Corps agreed to return and assist Botswana in managing this vivid health crisis.

In April, 2008, my group (“Bots7”) joined the 50+ volunteers already serving in Botswana. We began as 61 volunteers varying in age, gender, professional background, gender and marital status. About 20% of our group is senior citizens, 10% married and 30% in their early 20s. I’m smack-dab in the middle at 28 which is actually a nice place to be for connecting on some level with everyone.

Unfortunately, in just 2 and a half months our numbers have already dropped to 53. Most people have left us for family emergencies and medical complications. Two of our volunteers ET-ed (early terminated) just after site placement. They told us they did not feel they were well suited for Peace Corps afterall and we were pleased that they made their choice to leave before their communities formed a connection and dependency on them. Still, there’s a certain “family” element to our group and it was hard to see them go.

After school this evening the Deputy Headmaster asks me if I’d like to take a walk with her. We pace through long stretches of farmland and greet the string of villagers as they make their way home from work. For the first time in a week I have a conversation with someone about politics and family instead of health and prevention. I know that “building relationships” and “inspiring trust” are meant to be my goals here but somehow I forget all that and just focus on walking with this woman-- this friend. When I come home I feel more invigorated and alive than I have in months: this social connection filling the spaces where my professional energy wanes.

Peace Corps is working 24 hours a day, 7 days a week but it is also living. It’s a balancing act between pouring into your community and finding the things that fill you up and keep you going.

Sometimes it’s analyzing village health data and sometimes it’s taking a long walk with a boss who feels more like a friend.

Either way, I’m surviving this and enjoying the challenge. Behavior change, language learning, cultural integration and community assessment are all enormous tasks but coupled with meaningful work in a gorgeous community, are also inspiring.

I dip my teaspoon and begin.

1 comment:

Blanche said...

what wonderful, moving words jess. you are an amazing writer and hope that you get published one day !