All That Is Bitter and Sweet (25 page)

She was from the Meru tribe and one of seven children. Her mother died in an accident when she was twelve, and when she was fifteen her father died of tuberculosis. Her father’s relatives took their land, and three of her siblings vanished. She had no idea where they were. Shola said she’d had six years of school, with a little sex education in the fifth year, but she’d had to drop out to look after her siblings once her mother died. She got pregnant at fifteen and again at eighteen, at which time her boyfriend left her. Two months pregnant, hungry, and unable to feed her toddler the increasing amounts he required, she began taking the bus to that street to sell herself between five and nine o’clock every night while a kind neighbor watched her child. She worked until her eighth month of pregnancy and was back at it a month after delivering. She said the baby had an infection in his umbilical cord and ran up a 16,000-shilling bill—the equivalent of $216 U.S.—only a part of which she could pay, and she was now even more desperate.

Kate, Papa Jack, our PSI team—all were mesmerized, horrified, as Shola spoke. She seemed so innocent and fragile and ashamed of what she was doing. She said the work was difficult at first; she was very shy and would only hitch up her skirt. She would not perform oral sex, saying it was dirty. She was obviously still lactating.

“I don’t let the men touch my breasts, because that’s the food for my baby,” she said. She could not stand to go home to breast-feed with the grime of strange men on her as she held her son.

“What would you do if you weren’t doing this?” I asked. She said she would want a small business, selling secondhand clothes.

Kate looked at me and I looked at Kate, and suddenly all her warnings from Thailand went out the window. We had to help this teenager right away; no NGO programming, however expertly designed and administered, was an immediate enough intervention for Shola. We knew the nature of PSI’s work was not to rescue women out of prostitution, and gestures like these rarely worked without an established support mechanism. For Shola, we made an exception. She was too compellingly tragic. We dug into our pockets and came up with about $250 U.S. It was enough to pay Schola’s rent for two years. We explained how much it was, admonished her to tell
no one
she had the money, and gave her the number of the local PSI office with the plea to call us to check in, explaining that they could help her convert the dollars to shillings and keep it safe for her. She rolled it up in a tissue and put it in her bra. Our local staffer told her the name of a modeling agency and how to look it up, something that irritated me and I disagreed with but had to admit that in the short term, while she still had no skills, might help her generate income apart from outright sexual exploitation. We gave her a lot of love and encouragement, then drove her to the bus stop.

When I think of Shola and that foul blue room jumps to mind, I blot it out with the memory of her pressed into me, my arms wrapped around her, in the backseat of the car, that ephemeral moment when she was safe, surrounded by people who had rallied to her defense. But it was a brief moment indeed; I never heard whether she followed up with our office, and there was no way to track her down in the transitory vortex of Nairobi’s slums.

In countries like Kenya, where HIV/AIDS, malaria, diarrheal diseases, poverty, and all manner of social problems plague the population, life can be very, very cheap. But the value of a woman in such societies is cheapest of all. That afternoon I had paid 800 shillings for flimsy sunglasses on a Nairobi street; all the women I had met earned 100 shillings for a trick turned on their backs, 200 shillings for one on their hands and knees. Now, that’s cheap.

Back at the hotel, a perky tourist from Texas recognized me in the business center and asked me if I was on safari. I let her blithe obliviousness and her expensive khakis irk me, and I blurted out bitterly, “No. In fact, I am on a HIV/AIDS prevention trip and have just been to three brothels.” I hoped I had ruined her evening.

In the morning, we drove several hours on ridiculously bad roads through the countryside to see a malaria program at a rural clinic. On the way, I received full immersion education about malaria, at that time the world’s biggest killer of children under five.

Because malaria is carried by female mosquitoes that feed on human blood at night, NGOs battle the disease by making it possible for hundreds of millions of people to sleep under nets treated with insect repellent. This works best because entire families often sleep under a single net together, and if it isn’t treated, those whose arms and legs are touching the net will still be bitten unless the repellent is present. The repellent has the added benefit of chasing the mosquitoes out of the room, thereby offering protection to those not under the net almost as well. In this way, multiple huts with long-lasting treated nets in a village can have the wonderful benefit of providing some protection to those who do not yet have nets.

The challenge has been educating folks about the cause of malaria and the need for every household to have and sleep under a net, the distribution of the nets, making antimalarial artemisinin-based combination therapy drugs available, and teaching those infected to seek treatment. These are the kinds of obstacles NGOs specialize in overcoming and on which good progress has been made.

It costs $6 to manufacture nets, which are sold for the heavily subsidized price of 150 shillings, or less than $2 in the villages. In 2008, this price was reduced to a mere 50 shillings. We deliver the nets to Kenyan health facilities at which we implement community behavior change communication, while selling the nets at these reduced prices, which can increase a sense of prideful ownership and use of nets. (By 2011, a happy confluence of political will and funding would allow PSI and other NGOs to undertake massive campaigns to distribute nets for free.)

Most rural Kenyans know about their clinics and women aim to go to them for ante- and postnatal care, even though it is sometimes a two-day walk to the clinic. Knowing the arduous journey will also yield malaria protection, they are more motivated to make the trip. A pregnant woman is highly susceptible to malaria; it makes her extremely sick and can cause a world of ills to her fetus, such as early termination or low birth weight if she is able to deliver. They constitute the highest risk and most vulnerable group and are a core focus of malaria campaigns.

From what I had observed, it made little sense to confront each condition—AIDS, malaria, unsafe drinking water, malnutrition—as a separate threat to the health and well-being of women and children. This old, siloed approach to health care and development aid was already on its way out. Now PSI Kenya integrates reproductive health, maternal and child health, and HIV prevention communication and services on every level.

One of the behavior change communication challenges in Kenya is teaching women and caregivers the value of mosquito nets and how to use them correctly. And this was what I was going to help demonstrate at a rural clinic.

A large crowd of nearly two hundred was gathered for our outreach event. Women sat on the grass, either pregnant or holding babies, and everyone was very curious and attentive in spite of the equatorial sun at midday. There was the usual pomp and circumstance in the form of repetitive welcomes and some fabulous singing to compensate for the stultifying protocol, then I demonstrated how to use and treat a net. I was given a typical plastic basin and showed how to use the gloves and dissolve the repellent tablet in water and saturate the entire net. Wonderfully, even though the event was fun, new technology means such steps are now obsolete, as pretreated nets are standard. And this was only five years ago!

Afterward, I interacted with my audience and felt confident of our day’s success: None, when they arrived, used nets. Now all would go home with both a net and information about malaria, how it was transmitted, how not to become sick, and treatment seeking behaviors if they were infected. They also said, when asked, that they would reach out to other families with their new empowerment, and last but not least, they said they would stand up to their husbands, who often insisted on sleeping under the family’s sole net alone, even with the knowledge that the mothers and children needed them the most.

To wrap up the demonstration, some wild, boisterous women sang for me again, becoming quite carried away when I joined them and basically creating a mosh pit where they knocked me from hip to hip like a little bouncy toy until I escaped, laughing, into the calm of the van.

I had one more appointment before I departed Nairobi. Before I left home, I had asked Gloria Steinem, a mentor and friend, “Who is the one person I simply must meet on this journey?”—something that has become a tradition on my trips. She has thrilled me every time with her introductions. Her referrals have connected me with heroes who have become friends and with organizations I now support that powerfully supplement my engagement with PSI.

Thus I arranged to meet the two women who ran Equality Now’s Nairobi office, but because of my crazy schedule, the only time to see them was in my hotel room, the night before I was to leave for Madagascar. When I opened my door in my bathrobe and saw two gorgeous Kenyans, Agnes Pareyio and Faiza Jama Mohamed, one in full formal cultural dress, I ushered them in and hurried to pull my act together so I would give them the same honor they had obviously afforded me. I put on my favorite nightgown that passed as a day dress, ordered them coffee, and prepared to be schooled. I was not disappointed.

Equality Now is a global NGO dedicated to ending discrimination and violence against women; its emphasis in Africa is on property ownership and female genital mutilation (FGM). In their animated, musical voices, the two women described the campaign against FGM, the brutal tribal custom of cutting a young girl’s genitals. Sometimes euphemistically called “female circumcision,” the practice is so widespread that an estimated six thousand African girls are threatened with it every day. In some tribes it is a ceremonial nick, but usually the clitoris and labia are sliced off by a traditional circumciser, usually without anesthesia or any regard to hygiene. A tremendous amount of blood is spilled when a girl is cut (many girls hemorrhage to death), and circumcisers often use the same filthy tools on more than one girl in succession, spreading disease. The resulting damage to the genitals makes girls more susceptible to STIs and HIV. It happens at various ages, but invariably, it happens. The desired result is a girl with reduced sexual function, who will remain a virgin until marriage and a faithful wife thereafter. It is an exceedingly grotesque example of pathological attempts to control female sexuality. FGM is so difficult to stop because it is an entrenched and pervasive practice, and women are conditioned to believe that they can never marry without being cut. Because every woman in the group has been mutilated, the peer pressure to conform is enormous. In many places, a mythology has evolved around female genitalia to reinforce the practice. In some tribes, it is believed the clitoris will hurt a baby upon delivery, and that it will kill a man. (Well, of course it does, but it’s a delicious death men love and from which they recover!
La petite mort
, as the French would say.) FGM is so important that should a woman in Tanzania die uncircumcised, she will be cut postmortem, or it is believed she will not go with her ancestors.