encounters

May 22, 2006

Finally, after far too much time, my last article about my encounters in Zimbabwe. I’m truly sorry that it took so long, but right after coming back from Zimbabwe, I was really not in the mood to write, and the last weeks were consumed by the preparations for my work in India. This article is the most important to me; I don’t want to say anything else, because I think it’s self-explanatory.

During the last four weeks in Zimbabwe, I started working with HIV positive people in Mbare. As promised, Natasha found some affected people who were ready to meet me and help me with my project. The Sunday after the barbecue, we met in Mbare to visit the first two of them. Siman’gliso accompanied us on our walk through the ghetto, and on the way I was terribly nervous. How do you ask people who suffer from a fatal disease, if you can join them a bit on their way to the grave to make pictures? How do you talk about how it feels to know that you are dying? How do you get them to tell about their everyday problems without being rude and insensitive?

With a dull feeling in my stomach, I enter Anna’s house (I changed the people’s names on their request) and we take a seat in her living room. The house is big, eight rooms, and the living room well furnished, with sofas, a couch table, two TVs (one of them, however, without sound), and a vitrine with all sorts of stuff. On the wall above the fire place there are some pictures of Anna’s family and an image of Jesus, in vivid colors and with a metallic shimmer. Next to it, made of plastic in bronze look, a copy of Dürer’s praying hands. Natasha speaks some sentences with her in Shona, then suddenly she turns to me and tells me that I can now ask Anna anything I like. I didn’t expect to take over the conversation that abruptly. Frankly speaking, I don’t know what I expected at all; maybe I figured on Anna talking all by herself, or on Natasha doing the interview, so that I could hide somewhere in the sofa. Completely unprepared, I begin to stammer some questions that are crossing my mind. Of course, this does not contribute to diminishing my nervousness and I start moving around anxiously on my seat and fumbling my fingers. Anna is princely amused and laughs about my incertitude, and if at the end I was as relaxed as she was, then it was definitely not my merit.

Anna is 43 years old, has three children aged between 11 and 24 and has been knowing about her infection since last year in June. Several times while we are talking, she breaks into a heavy cough. She is just recovering from a pneumonia that bound her to the house during the last few weeks. So far, one side is fine now, but the other one still troubles her. She talks about the days when she found out that she is HIV positive. With the beginning of last year, she started feeling not well. She fell sick regularly and lost weight increasingly, but at the beginning she didn’t want to believe that it could be something serious. Finally, in June 2005, she decided to make the test, and when she got the result, her world fell apart. Yet at the same time, it was also a step ahead. Anna accepted her destiny, she took it as granted and began to fight. In her opinion, most of the people don’t die from AIDS, but from denial. Emilia for example, who was a close friend of Anna’s daughter Theresa, never could accept the fact that she was infected with the HI virus. When she finally did, it was already too late. With proper treatment, she could have lived some more years, could have seen her daughter grow up.

Instantly, Anna signed up for the CD4 count. The CD4 T-cells are a special kind of lymphocytes that coordinate the immune reaction in the human body. The HI virus affects these CD4 cells and contaminates them with its own genotype, so that the infected cell – rather than observe its function in the immune reaction – starts producing new HI viruses before it finally dies. Although the body tries to compensate this by producing more CD4 cells, in most of the cases the loss outweighs the production and the total number sinks continuously. Thus, an immune deficiency arises, and infections, that usually pose no problem whatsoever for the body, become invincible, dangerous enemies (see Netdoktor). Counting the CD4 cells in the blood is necessary to coordinate the ARV treatment and thus of course to start it in the first place. In Zimbabwe, there are currently 1.8 million people living with HIV/AIDS (that’s a 2003 estimation according to the Center For Disease Control). Since most of these people belong to the poor half of the population, they cannot afford to get the CD4 count in one of the expensive private chambers, which results in a hopeless overload of the few public hospitals.

Anna belongs to this group of people who cannot bring up the money for the luxury of an instant blood analysis. She signed up for the CD4 test on 10th of June, 2005. Her appointment is on 12th of June, 2006. When she looks to the calendar on the wall behind me, her eyes speak of the desperation with which she hopes to survive until that day. But even if she makes it till then, how will she finance the test? Currently it costs 1.6 million ZIM dollars (about 16 US$), huge money for someone who doesn’t have an income in times of inflation. Usually she sells soft drinks in her house – Coke, Fanta and so on. But just a few days ago, Coke shut down its Harare branch because due to the inflation it wasn’t profitable enough anymore. All that earns her some money now is the sale of Maputi, salted popcorn for 10,000 ZIM dollars a bag.

Anna’s family knows about her infection and she says that they cope quite well with it. When I ask her how she comes along with it, she shrugs her shoulders and says that she cannot change her situation. She is just making the best out of it. What bothers her most is the continuous up and down. One day she feels wonderful, then she takes off the curtains, washes them along with the rest of the laundry, irons everything and hangs them up again. The other day, she is in such terrible pain that she can hardly stand up in the morning. She tries her best to hide her condition from the neighbors. If you have AIDS, you are treated like a leper. People point at you with their fingers and make jokes about you.

After about one hour in Anna’s living room, Natasha softly pushes me to leave. We want to see yet another family and the Sunday workshop, in which she is participating, too, starts at one. I write down Anna’s phone number and promise to call her soon, then we say good bye and leave. After a short walk, we reach the house of Sarah and her brother Joseph. Natasha knocks at the door and we step inside, into a small, narrow living room. We take a seat on a ragged couch and Natasha introduces me again. The difference between Anna’s house and this one couldn’t be bigger. The whole building is as big as Anna’s living room and it’s divided into four rooms. Attached to the room we are sitting in is a kitchen and two sleeping rooms. Apart from the moss green couch set, there isn’t much more than a small shelf with a tiny black and white TV and a little table with some plastic fruits in a wrought iron basket on it. Sarah is sitting next to me on a seat, holding a plastic bottle, and opposite of me, Joseph sits on a chair which he got from the kitchen. Both have been knowing about their HIV infection for some years. Sarah instantly signed up for a program called DART (Development of Anti-Retroviral Therapy), a study of some western nations that supplies 3300 HIV positive people in Uganda and Zimbabwe with drugs. The program guarantees her five years of treatment with ARVs. Joseph was less lucky. When he was tested, the program was already running and didn’t admit anymore people. Just like Anna, he’s now waiting for a miracle to be able to pay for the CD4 count.

Sarah tells me about her disease. Recently, she had a heavy meningitis and therefore, she’s currently taking antibiotics on top of her ARVs. Since no one in her family has an income, she has to swallow more than 15 pills a day on an empty stomach. She is turning the bottle in her hands that she sips from occasionally. It contains a milky substance, consisting of maize flour, water and some other ingredients. This is her only meal today, 500 ml diluted maize porridge, and she has to share it with her brother Joseph. She looks at me wearily and smiles. Her eyes are warm and kind. The medication doesn’t work properly when it is taken on an empty stomach, she explains to me.

During the whole conversation, Joseph sits relatively silent on his chair, saying only a few sentences every now and then. While Natasha is talking to him, Sarah takes my hand and leads me into one of the rooms attached to the living room. She rummages through a mess of blankets, bags and other stuff on her bed and finally produces a transparent plastic bag. It contains two small, white containers with red lids and a folded piece of paper. It’s her DART “membership card” and her drugs. Sarah hands me the paper and I unfold it. Written in a printed table are dates, in four week periods. Those are the days when she gets checked up, and more than three quarters of the table are already filled up. When I ask her what happens when the table is full, she shrugs her shoulders and answers – a bit hopeless – that she will then be referred to the government. We look into each other’s eyes for a while – silently, but meaningful. The government won’t do much for people like Sarah. In this moment, Natasha enters the room and informs me that we have to leave. The workshop has already begun half an hour ago.

I spend the next days mainly with Anna, since it is easier for me to reach her and make an appointment. In her family, two people have a mobile. I don’t know why, but encounters in foreign cultures often become intensive more quickly than normally. At home, it often takes months or even years until you trust each other enough to open up completely. When traveling, this process only takes weeks, days or sometimes even hours. Is it because you know that the time you spend together is limited? Or is it because you know that the other will soon be thousands of miles away, taking his knowledge about yourself with him? Whatever it is, for me it’s one of the reasons to go out into the world again and again and again and search for new encounters. With the people of Mbare it was the same, and after a few days, Anna and me were as familiar as if we had known each other for years. Sometimes, when I was at her home, we just sat there silently and looked at each other, something that is very uncomfortable for people who don’t know each other very well. Saba and me came to have lunch with her, and we went to church together. From the very first day, our relationship didn’t have anything to do with work, it was never stiff or constrained. Although I always carried my camera with me and used it a lot, neither Anna nor me ever felt uncomfortable with it.

After a few days, Anna introduced me to a friend. Her name is Noma, she is in her early forties and has a nineteen-year-old daughter called Mariah. Both are HIV positive and have been knowing it for about four years. Of Noma’s six siblings, five have already died from AIDS; only her elder sister is not affected by the epidemic – that is, if you do not consider it as affected that she is caring for the nineteen children her siblings left behind.

Noma and Mariah’s father were divorced, but they still had a friendly relationship and he regularly came to see his daughter. Then, four years ago, he suddenly became sick and died after a short time. The symptoms clearly indicated AIDS. Then fifteen-year-old Mariah, who had always been a sickly child, convinced her mother to do the HIV test. They went to the hospital where they were separated by the nurses and led into two different rooms. Blood samples were taken from both of them and their status confirmed in an instant test. The doctors asked them to appoint a trusted person who could be notified in case of emergency, and both named each other. When they met again on the hall, with tears in their eyes, they threw their arms around each other and promised to accept their destiny and to give each other strength on their shared way.

Four years later, we are sitting together in their living room, in front of us a glass of Fanta – Coke still doesn’t produce cola – and they tell me this story. The fan blows a slight breeze into the blazing heat of the noon. The more I get to know these two women during the next few days, the more my respect and my esteem for them grows. They support each other in such a unique way, they radiate such a confidence and contentedness, that I have difficulties to believe that they suffer from a fatal disease. Their shared destiny raised the relationship between this mother and her daughter on a completely new level, and together with Anna and some other people that I meet in these days, they teach me a unique lesson in hope and joy of life.

During the next days, I’m coming to Mbare almost daily now and spend my time with Anna, Noma and Mariah. We watch TV together, we go on a walk through the ghetto together, we drink Fanta together and talk about all the world, his brother and AIDS. After about three weeks, I’m going to see Sarah and Joseph again. I feel bad because I didn’t get in touch with them for such a long time. When I enter the small living room, Sarah welcomes me with sorrowful eyes, and when I turn to Joseph, who sits in a seat with the back to the door, I understand why. The whole left half of Joseph’s face is disfigured by a devastating infection that literally eats the flesh from his bones. Joseph tells me that it all started completely harmless with a pimple on his left cheek, just three days ago. While we are talking, he takes a sip of tea from his mug on the table in front of him. He trembles so heavily that only with big effort he can avoid spilling. I watch as he drinks slowly and then puts the mug carefully back on the table, and I realize that Joseph doesn’t have much longer to live if he doesn’t get treatment soon. I ask his sister Sarah if she has time to go to the hospital with Joseph and me to get his face treated and his CD4 cells counted. I’d rather go now, since the infection spreads rapidly, but it is Friday afternoon and all the hospitals are closed. We have to wait for two days.

The next Monday at ten in the morning, Saba and me come to Joseph’s place. Sarah isn’t there, yet, so we wait in front of the house in the shadow. The infection in Joseph’s face spread indeed, but not as bad as I was afraid it would. When Sarah finally arrives, we hit the road to the hospital. There again we have to wait, more than one hour, until a nurse tells us that we are in the wrong place. The blood is tested here indeed, however the sample is taken in another hospital. Again we set off. After half an hour, we reach the Mbare polyclinic. In front of the entrance there are some benches under a canopy top and we take a seat, just shortly, because some workers are cleaning the roof and after I got a full load of leaves and dust swept into my collar, we decide to rather wait inside.

Joseph disappears into a treating room, a nurse examines his face and prescribes some antibiotics and an antiseptic cream. When he comes back out in the waiting room, it is one and the doctors and nurses have lunch break. Again we have to wait for an hour, and we use the time to take some food and get the prescribed drugs. At two o clock sharp, we are back and Joseph goes straight into the treating room where his blood sample is taken. However it is not for the CD4 count, but to define his blood values and liver functions, which is also necessary for the ARV treatment. The nurse hands him over the phials and tells him to bring them to the other hospital as quickly as possible, as long as the blood is still fresh. To get the CD4 count, we have to go to a third place, a private laboratory which opens only after two days. Tired, but satisfied we make our way back to Sarah’s and Joseph’s house. The CD4 count on Wednesday is a matter of two hours, and then there is nothing left between Joseph and his ARV treatment. The fact that the laboratory conducts the CD4 count instantly, for the same price as a public hospital, is also a great relief to Anna. Unfortunately, Saba and me cannot witness the beginning and the first results of Joseph’s and Anna’s treatment, since one week later we are already sitting in our plane back to the UK.

The encounters that I was allowed to have in Mbare opened a completely new view of the things to me. The strength, the endurance, the joy of life and the dignity with which Anna, Sarah, Joseph, Noma and Mariah faced their destiny, put us to shame who always complain about the slightest problems. Through the way they handled their disease, these people showed me the true priorities in life. Vice versa, through my friendship and impartiality in a society that treats HIV positive people like lepers, I had the feeling that I also gave them something back. All the more difficult it was when Saba and me had to leave Zimbabwe. Sarah wasn’t in Harare at this time, so we couldn’t even tell her good bye in person.

Two days before we are leaving, we meet Anna, Noma and Mariah in town and invite them for lunch. They put on their best Sunday dresses and they look absolutely gorgeous. Saba has her diary with her in which she lets the people she meets write some personal words. We sit together, eat grilled chicken and talk about the time we spent together. When it is time for us to leave, we all take each other’s hands and Noma says a prayer in Shona. I don’t understand a single word, but the emotion and the fervency she prays with don’t need any translation. When she has finished, we just sit there, silently, and hold each other’s hands. After some time, we finally let go and prepare for leaving. Before going, Saba and me promise to come back as soon as possible. Noma looks into our eyes, smiling, and replies: “That is, if we are still alive then…”

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