Stronger in Gambia, Despite HIV
By Lane HartillAbdulai tried to find Musa, but he'd already fled. That wasn't good. Not good at all. He knew if he didn't find him soon, things would get bad. Really bad.
Students in Africa create AIDS message costumes at school in an effort to raise awareness of HIV and AIDS. Photo by Sean Sprague for CRS
He knew Musa was somewhere in southern Senegal, knocking back traditional elixirs that he hoped would kill the virus working its way through his body. As a marabout, an Islamic religious teacher, Musa had always taught his followers that reprieve was found in the bitter potions prepared by wise men.
But there was no cure. Musa couldn't wash it out, asphyxiate it or pray it away. It had strengthened, and it controlled him now. He would have to return to The Gambia. He would have to go see Abdulai.
For months Abdulai and other counselors told Musa that this thing called HIV was in his body, and if he wanted the drugs that would save his life, he had to tell someone he had it. That's the law in The Gambia if you want access to HIV medicine. But Musa wouldn't admit what he had.
But now, given his condition, things had changed. He knew he'd have to do the unthinkable: Tell his brother he had HIV.
Abdulai gets the call at night. Musa is back, they said, and things aren't looking good.
He is lying on his side on a foam mattress on the floor. In the dark room with only a single window, shadow and light caress his face and filter through his graying goatee, aging him dramatically. A stranger would think he's in his 70s. But this respected Islamic scholar and father of two small children is only 36.
The Catholic Development Office health team, which is supported by CRS, tries to reach people like Tacko, a 20-year-old with a glistening gold tooth in an otherwise perfect fence of white teeth. This gentle young woman will look you in the eye, flash a smile, and in tender, halting English, tell you one horrific detail after another about the last three years of her life.
She'll start with how her father forced her to marry a "bumster" at 17. That's Gambian slang for a young Gambian man who prowls the beaches and streets of Banjul, the capital, looking for female European tourists to charm and seduce. The payoff ranges anywhere from dinner to tickets and a visa to Europe. Tacko claims her husband had been with two "white women." She was next. She soon became pregnant. Then her parents died; her siblings moved away. Shortly after that, she had a baby boy, who died two years later. Then the diagnosis: HIV-positive.
Now she works for the Catholic Development Office, counseling people like Khady. Khady is HIV-positive and mottled with a black, bumpy fungal infection. Still, she tries to look nice with her double pierced ears and a collection of beaded orange bracelets on her wrist. It's not just her health that's a problem, it's her husband. They hadn't talked in two years and they recently divorced. She's trying to raise three little ones, aged 5, 7 and 9, alone. Now she's single, losing her hair and covered in something that looks like ringworm. Will any man, she wonders, want to marry me?
That did it. In her bare concrete room, with her fussing 5-year-old squirming on her sagging mattress, Khady's life got the best of her: The ex-husband who sends their kids away when they go to visit him, the pathetic 58 cents she makes a day selling snacks at a school, the itching rash. Her eyes freeze and a warm glaze of tears coats them. No wracking sobs. No wailing. Just a 28-year-old mother trying to hold it together as her life falls apart around her.
'It's Not a Curse'
Across from her, Tacko sits on a stool. Legs out straight out in front of her, she's rocking back and forth, the memories coming back. She seems to be waiting for the right moment. The room is quiet. A chicken pecks the dust outside the front door.
"It's not a curse by God," she says, suddenly. "You are in a much better position than me. Your mother is living. Your father is living. All my people are dead. Me, after work, I go home and have to cook. I work all the time."
Tacko's feet are now out of her sandals, elbows on knees. She leans into Khady, like a coach consoling a distraught player.
"The greatest problem is to keep thinking about it," Tacko tells her. "That causes depression. Join people in whatever activity they are doing so you won't be isolated and discriminated against."
Khady wipes her eyes. She says it helps hearing Tacko's story, to hear someone who has been in more pain than she has.
Tacko ribs her about her hospitality. They laugh. A connection has been made.
In 15 minutes, Khady went from a distraught single mother covered in a rash, to a woman who now sees her life in a different light.
When everyone leaves, Khady is standing with her family in the sun, smiling.
He's so thin his hands appear overgrown. His knees are as big as grapefruits, his legs as thin as baguettes. He opens his mouth, but nothing comes out. His voice disappeared yesterday, says his older brother, also a marabout, who sits next to him acting as an interpreter. He says Musa hasn't had food or water in three days.
A bad smell fills the room. Nobody says anything. Musa's wife will come and change him soon. She will wonder what he has; he still hasn't told her. Men rarely tell female members of their family they have HIV. Men say they're too chatty, they gossip too much. Men confide in men; they say they keep secrets better.
Caring for the Neglected
Abdulai deals with people like this every day. When Gambians' savings dry up, when their friends don't stop by on weekends for tea, when the virus starts to win and they start to give in, they turn to people like Abdulai. He, along with a team of 11 others, works for the Catholic Development Office, a Catholic Relief Services partner that works with HIV-positive Gambians and orphans and children.
They do what few others are willing to do: pay attention to those with HIV. They roll them over and teach their families how to clean bedsores; they push needles into their arms and let IVs drip into their veins; they fill cups of mouthwash.
Weekends are often given over to caring for others. They drive on the washboard roads and sit in patients' dank rooms all day long. They counsel them. They laugh with them. They tell them HIV is like any other disease; you just have to manage it. They also pay for orphans to go to school; they even buy them shoes. They also help those who are ill but not HIV-positive. Villagers just know them as people who care for the sick. Confidentiality of patients is a priority.
Abdulai and the others work in Bassé in the eastern end of The Gambia, a country shaped like an appendix that worms its way into the side of Senegal, on Africa's west coast. For many Africans, Bassé is just a stopover on their way to someplace else.
The rusted buses that disgorge Africans into Bassé also bring HIV and misperceptions. Many people here will tell you HIV is a two-step disease: You get it. You die. While the HIV prevalence rate in the country is officially only 2.5 percent, the rate in Bassé is almost certainly higher, say HIV experts.
Impromptu Classrooms
That's why you'll find Sister Alexis, Catholic Development Office's team leader, and the rest of her crew hauling speakers into villages, cranking up Youssou N'Dour and Jaliba Kuyateh, popular Senegalese and Gambian singers. At a recent music night, just as the crowd had swollen to 500, just as it had worked itself into a lather, they cut the music. Then they pumped up the HIV messages. Come and get tested for HIV, they encouraged the crowd. Couples, before marriage, you need to do this, they told them. With several testing centers in eastern Gambia, in 10 minutes, anyone can know if they have HIV.
That's not all. A touring question-and-answer game show also makes the village circuit. They talk to kids and adults about HIV and promise prizes—cooking pots, bed nets, soap—if they answer questions correctly. In this poor region, free household items are much appreciated. People pay attention.
Community educators from Caritas, a CRS partner, use illustrations to explain how HIV is spread. Photo by David Snyder for CRS
The Catholic Development Office also has a monthly radio program in which a panel talks about HIV. It's translated into three local languages. The outreach seems to be working. In December of 2008, 127 people were tested, up from 19 in February.
New Ways, New Lives
Back in the dark room, Musa is still in the same position, his hand elegantly poised under his chin, like a sage considering a request. Abdulai will return later this evening with an IV drip for him. They'll get him started on medicine. Musa's strength will return. He will even start talking again.
"We are very compassionate," says Sister Alexis, sitting next to Musa. "We bring ourselves to their level."
The care—the body powders, the sponge baths, the quiet conversations—are essential. But more important is Abdulai's willingness to hold a man most people won't go near, to sit in a foul-smelling room and not flinch. Gambians see this. They appreciate it. They now are able to see themselves living to old age.
Take Jawo. Not long ago HIV had shrunk his athletic body to 88 pounds. All he could think about was his children, and who would take care of them when he died. When HIV is with you, he used to think, you can't survive.
Now, with the help of Sister Alexis and the team, he's back driving taxi again. He's regained that loose gait of a retired basketball player. He even thinks about retirement: He will build up his herd of cows and milk them as the sun sets in the evening. He will mix the milk with sugar and millet. Then he'll sit back with his porridge and watch his grandchildren swirl around him.
Musa, Jawo and Khady are pseudonyms. Their names have been changed to protect their privacy.
Lane Hartill is the West Africa regional information officer for Catholic Relief Services. He is based in Dakar, Senegal.
