Thursday, November 29, 2007

A Clown Show with a Serious Message

Community Health Promotors Doing Their Part

A 40 year old man:
¨Vamo Amigo, ¿solo uno? Necesito otro¨
Translation = ¨Come on friend, only one? I need another¨

A 10 year old boy:
¨Por favor, quiero traer una a mi madre¨
Translation = ¨Please, I want to bring one to my mother¨

What it means...

Reproductive and sexual education is having an affect on people when the issues are brought to them and resources are provided.

I had the priviliege today of watching the younger generations of Nicaraguans attempt to change the future of their country by reaching out to teach their community. After a 20 minute program, adolescents came to get the free phamplets and condoms. Middle aged men followed asking for extras, and lastly the women approached slowly and quietly asking for some as well. By the end, over 200 condoms had gone out, 150 Awareness phamplets, and 100 larger cartoon style booklets.

As we walked through the streets people stared at the brighly colored faces of 10 teenaged nicaraguans. The stares continued as we entered the dimly lit market that welcomes you to the bus terminals. Along with the market comes the smoke and smell of fried food and the street children from 8 to 11 selling oranges or asking for a cordoba (1/18th of a dollar). I turned to see the line of intrigued people of all ages follow our crew of clowns. We settled in the middle of it all and the show began.

Sí!!! or No!!!! That is what was yelled in unison after short skits about how HIV is transmitted. Props like plates and cups showed that HIV is not transmitted through sharing forks, cups, or through saliva. Sneezing, handshakes, and using a public restroom were among the skits that followed. The Sí concentrated on sharing needles (see side bar slideshow) and the use of condoms to pratice safe sex. I was pleasantly surprised at the response after the show ended. In the face of poverty free things are either eagerly grabbed for or hesitantly accepted or denied. However, having a 40 yr old man ask me for a second condom, a bus driver asking if he could have 25 phamplets for this passengers, an elderly woman ask me for two condoms for her daughters, and then two teenage males asking me how they can join the clowns, it left a mark that shows how even the most serious of conversations and causes can be done in a creative and imaginative way.

Wednesday, November 28, 2007

First Impression is Impressive

Lots of Progress in 16 Months

I entered the office I sat in 16 months ago. The feel was the same, the atmosphere was the same, but it was evident that things have changed. For starters, in the past it was myself, Martha, and Ingrid talking and working on two out dated computers that were not connected to the Internet. Now the same room was filled with 7 people and 4 work stations; 3 of which boast computers connected to the Internet. The next thing was the people. They have added paid staff and their numbers of volunteers has increased, both in terms of locals and forgieners. 7 people in room that used to be 3 - 2 from Germany, 1 from Spain, 3 from Nicaragua, and 1 from the USA. All speaking spanish and planning different programs, flyers, and activities to promote health in León and in the rural communities.

Tomorrow I will go along with community health promotors who will be handing out condoms, awareness phamphlets, and putting on a clown show about the methods of transmission. A common misconception among some Nicaraguans is the transmission of HIV through public restrooms, which is an area I have been told is incorporated rather comically in the skit. When I last departed this group of promotors and ´clowns´were beginning their training, so it will be extra special to see how they have come full circle.

The progress at CISAS has also had its effect on the HIV Self Help Group. Today I had the chance to talk to one of the ladies I had originally met at the start up of the HIV Self Help group. The shy woman I had met in the past was gone. She had been transformed into a leader, a spokeswoman, and she spoke about the changes that have come over the last year with pride. Although they have lost some members due to the virus and some even because of arguments, the group has grown significantly and even has a second group in the city of Chinandega. Chinandega is a more rural city that is notorious for its poverty and garbage dumps. On Dec 6th the self help group will be opening their new office, which is a room upstairs and connected to CISAS. She was very excited about the new room and the phone line being put in to establish a HIV hotline for people to call with all kinds of questions or concerns. Something as simple as a phone number to dial can make a world of difference, especially in a place where the fear of discrimination and isolation runs so high.

Tomorrow: Promoting HIV Awareness in the Streets of León

Tuesday, November 27, 2007

2nd Stop - Nicaragua

An Experience, A Catalyst, A Return

The international leg of the project will begin with Nicaragua. I will be volunteering at an non-governmental organization (NGO) based in Leon called CISAS (Centro de Informacion y Servicio de Asesoria en Salud). 

This is the organization in which I interned two summers ago for a month working in two different projects. The first was drug prevention through sports for street teens. The second was aiding a newly formed HIV self help group. It is also where the bulk of my idea for this book arose. I was conducting a service learning project that would allow me to understand how NGOs are run, funded, and some of the services they provide. The stories I heard in my daily conversations with one of the projects stayed with me upon my return. These stories were very different and yet similar to the ones I heard in Connecticut or Newark while volunteering at soup kitchens or doing HIV awareness campaigns. One day in my car after a long discussion with Fr. Ric Rsycavage SJ, a lightbulb went off and the project was born.

When I set up this project I looked forward to coming back to CISAS and capturing the spirit of the people and the story of their lives. It is with much anticipation that I return. 

Tomorrow's Blog:  Returning to CISAS 

Friday, November 23, 2007

Giving Thanks and the "Power of a Pet"

Before anyone can begin to eat a morsel of thanksgiving dinner, my family goes around the table to say what they are thankful during the year. My family members give thanks for the support of each other and a clean bill of health over the last year. Family and health - two vital components that everyone would be thankful for. As the plates were getting smaller and smaller, the talk at the table changed to my time spent in San Francisco. I had already shown photos of Open Hand and explained what I was doing but in light of Thanksgiving my mind floated to what the people I met would be thankful for. 

The more I thought about it, I began to think of the interviews and conversations I had throughout my time at Open Hand. There seemed to be a reoccurring theme that flowed through much of those discussions. Volunteers, staff, and clients alike were all thankful for Open Hand and the reasons varied. Volunteers were thankful to an organization that made them feel as though they are making a difference. It is not difficult to understand, every facet that volunteers take part in is tangible - you are cutting mushrooms for a sauce that will feed people, you are peeling cabbage that will be placed in the free grocery store, or you are assembling hot meals that will be delivered to the front door of someone who needs it. 

The staff repeatedly mentioned how this is the best job they have had because they believe in the mission and the objectives. From the clients services to the kitchen staff or janitors, I either ate lunch and picked their brain or worked along side them and did the same. They understand the need and the services provided. One person pointed to the noted difference she sees in the clients that inspires her every day. It is easy to see that these people are thankful for finding a place that they believe in and doing a job that gives back to the community in visible ways.

The clients carry perhaps the most unique and varied perspective. The simplest of answers illustrates the profound effects that come with receiving a hot meal, quality food, or being treated with dignity and respect. Some responses that resonate now in my head highlight the conversation and handshake that takes place at the grocery store counter. "How are you doing today?", "How was your weekend?", "Are you sure you don't want eggs?!" it all fits under the notion of solidarity. Everyone walks together, no one is ever alone. Another area of thanks was the high quality and level of treatment that occurs in the Bay Area. People mentioned how they would be terrified to go visit or live in Texas or Oklahoma because they've heard about the levels of stigma that hinder a person's life experience. One called San Francisco the Globe's Mecca of HIV care and for this reason they will never leave the city. 

"Power of a Pet"

The last topic of thanks I put aside in it's own paragraph because it struck me by surprise and afterwards made a great deal of sense. In a conversation that occurred while bagging frozen chicken legs, I learned about the power of a pet. It was something that came up in a couple of later discussions and each time the transformation was the same. The constant is a person who is in the depths of a dark depression contemplating existence and not feeling motivated to maintain the healthy lifestyle or keep up with the daily regiments that can save and prolong their life. The variable is a kitten, a dog, or an animal that bonds to the person. The results are a transformed person who is highly motivated to stay healthy in order to care for the animal. The reciprocal value is the love and affection the animal shows no matter how tired, upset, or depressed the person is.  I call this the power of the pet because the lasting impression the animal has on the person is nothing short of amazing. 

Saturday, November 17, 2007

Odds, Ends, and Observations

Out for a Walk - Reality sets in

A few days ago I accompanied Robin and Sarah on a "route" to hand deliver hot meals to people in the program. These people get one hot meal a day - 365 days a year. The route was 10 stops in the Tenderloin district, considered one of the lower income and impoverished districts of San Francisco. It is actually the surrounding blocks around Open Hand, and after being given the safety run down, I was told that this would be quite the experience -they were right.

To begin, the streets of the Tenderloin have at least 3 homeless or very close to homeless people per street.  I am accustomed to seeing homeless people from my days in Jersey City and taking the train into NYC, but never to this extent. After asking around it seems like there is a need for shelters and organizations that aid the homeless. That said, it was difficult to walk into nightly hotels to deliver a meal and pass by so many people who could use one as well. Although I had been warned that the living conditions would be adequate at best, I was taken aback when one lady opened the door and the room was simply an old lazy boy chair, a small coffee table, and a dresser. The phenomenon that I was completely unaware of is called - SROs (Single Room Occupancies). At best it's a room with a bed, private bathroom, and a TV to escape reality or pass the time. At worst it's a bug infested room, with no bed, and a bathroom shared by the entire hall. One place had carpets torn and full of stains, a stagnant smell of cigarette smoke, and an electrical box with exposed wires awaiting a potential life threatening tragedy. 

The deliveries are met with a polite smile and thank you. Some talk of how much the meal means to them, others are too shy or embarrassed to open the door enough to see their face. After giving a warm meal of beef stew with rice and steamed broccoli to a Spanish woman in her late 50s, I was left wondering what circumstances had led her to this path? My personal pursuit to understand wanted to ask 20 different questions or somehow express my solidarity and concern, but in the 15 seconds it takes to hand a meal over I could only muster a touch of the hand and a "I hope you have a good day" in Spanish. On the walk to the next stop I kept thinking about what I would like to ask her, like was she aware of the different organizations that could help her, but in the middle of my thinking it was already time to ring the next door bell.

It does appear though that something is finally being done. The city of San Francisco is now slowly buying the privately owned SRO hotels and is giving up to 50 year leases to non-profits and church groups to set up SROs that have social programs. We went into one, and it had signs for free TB tests, $10 Flu shots, an eating healthy seminar, as well as a birthday board. These places at least show concern for the person and attempt to address pertinent health issues. In my opinion it is certainly a step in the right direction. 


One of the great things about Open Hand is the amazing amounts of volunteers that allow the organization to run as smooth, efficient, and effective as possible. I have met people, like John from the slide show, who have been volunteering here for 20 years! This seasoned veteran is a fixture on the assembly line and brings an open mind and friendly smile to all who come to volunteer or utilize the services of Open Hand. Many of the volunteers have been there over 10 years and all comment on how much a difference the place makes in the community.  Also, many of the volunteers are a wealth of knowledge regarding HIV in San Francisco. Whether its discussing their personal stories, such as of losing a partner or why they volunteer, or how the perceptions have changed over the last 10 to 20 years, I gain invaluable information simply talking or being around them. I thank them for their candidness, honesty, and interest in my project. 

Interview Completed

I am very satisfied and excited about the interviews. My first completed interview was not only inspiring, but it provides a very realistic and insightful perspective on what living with HIV is like in San Francisco. As I have been told several times, San Francisco is the best place in the world to live if you are HIV +, yet there are still hardships that are endured that can be avoided. For instance, the manner in which this man was told by his doctors of his status had lasting effects - no preparation, no counseling, just an "oh by the way..." and then a silent exit out of the room. Also, something that really stayed with me after the interview was the discussion on how faith is involved in this person's life and the changing issues over the last 10 years in San Francisco. This gentleman is a prime example of how non-profits can really help a person through  battling not only a "terminal virus" (as he put it) but also the shock and depression that follows testing positive. Furthermore, the depth of the responses attest that HIV is still a vital issue in the United States.  With the advent and accessibility of Antiretroviral medication, those with the virus can live typically healthy and longer lives. As a result, the mindset of people in this region, and the government of the US, has relegated HIV to the back burner. It is thought of now as a chronic and treatable disease and not as threatening to society, which is reflected in the gov't's budget cuts for NGOs and NPOs that provide HIV care (specifically, lowering the amount of money provided by the Ryan White Care Act). These issues and more are voiced in the interview, and intriguingly by someone who is both HIV + and works for Open Hand.

Thursday, November 15, 2007

The Beauty of Lunch

Lunch. For 8 years in grammar school I had it at 12 noon sharp. We would file in, sit down, eat and laugh.  In high school, I had it at 12:25pm, and the discussions centered on sports, class work, and how people were going to get home. In college, lunch become a matter of convenience -whenever or where ever best fit the schedule. However, lunch time now has taken on a new meaning. It is a time to learn, listen, and attempt the process of understanding.

For starters, the lunch room at Project Open Hand and its atmosphere is a prime example of what one of my mentors would call "a beautiful thing". But how should it be classified or described? Everyone, including staff, volunteers from all different origins (developmentally disabled, retirees, college students, and people who are HIV positive), and administrators, comes together in the same room to break bread and discuss whatever topics that come to mind; what is the mayor doing? did you catch the Raiders game? how is so and so?. Furthermore, all the food choices are the exact same as those provided as meals for the "clients". Is this a small window into Marxist communism where class is not an issue and just the good of the whole prevails? Is this what politicos call an egalitarian society where everyone comes to the table with the same respect, rights, and dignity? Perhaps, it's the best example of the Christian moral doctrine that stresses how each of us is made in God's own image and therefore are united, equal, and together in solidarity. 

My lunch conversations are where a great deal of my understanding about how HIV, both past and present, has impacted the lives of those in this city. For instance, a simple question "how did you guys hear about this place?" led me into a world I had never really attempted to place myself into. All three men at the table had lost a partner to AIDS, and all three men recounted the pain and sorrow of watching a loved one pass with an inability to help. They spoke of a time where HIV was still horribly misunderstood and long term treatment was not an option. One recalled the plight of his partner and simply stated, "I wouldn't wish that on my worst enemy". They then recounted how being a caregiver consumed their lives as their partners worsened. One was lucky enough to stumble onto a simple support group for AIDS Caregivers run by a Jesuit who had left the society. He spoke of the group as a life line that granted him a peace of mind and de-stressed his daily routine. This conversation lasted less than 10 minutes, but it put on display the impact this disease has had on this community and the toll it has taken on the psyche of homosexual men in San Francisco.

Tuesday, November 13, 2007

Open Hand, Open Hearts

A Perfect Fit

After volunteering two full days at Open Hand, I completely understand why they came so highly recommended as a great place for me to consider. I understood that their mission was to provide nutritious meals for people who have HIV, critically ill, or elderly, but, after spending three hours cutting fresh peppers of all colors, picking rosemary, and then cutting Oyster mushrooms for a sauce to top roasted chicken breast, I soon realized that this place was serious about providing quality, wholesome, and healthy meals.

The wholesome mentality is reinforced in everything they do. They compost everything possible, which brings tens of thousands of dollars back into the organization, and they save energy with two donated solar panels on the roof. But let me get back to the food! Some items that caught me off guard were Wolfgang puck soups, flavored yogurts, raw frozen chicken, yams, tomatoes, and 4 different types of milk! The absolute majority of the food contains no high fructose corn syrup and is full (and i mean full) of grains, oats, and heart healthy choices.  Oh and talking about choices, they provide: Regular, bland (low sodium), Vegetarian (yes Tofu is a choice), diabetic, mechanically softened and Low Fat/No Diary (mostly for people battling Cancer). 

All this is done by amazing management and organization. Teams of volunteers come in to work one of two shirts. The morning cuts and preps all the food and the afternoon works the assembly line to pump out over 1400 sealed, deliverable meals. I should mention I am much better scooping peas then Brussel sprouts and also that I still can't manage to keep my 1940s style ice cream vendor hat tightly on.

One of my favorite parts of the day is the conversations that take place while doing work that could otherwise seem tedious. On my first day I was stationed next to a lovely elderly lady with a quaint proper British accent who quickly commented on my 'better than average' skills with the knife.  I later confessed that I had an advantage - growing up in a household with a grandfather who was a butcher in Argentina and a mother with favorite hobby of gourmet cooking. I asked about her pleasant accent and found out she was born and raised right outside of Capetown. She was delighted to find that my project has me visiting South Africa. Beautiful and scenic were the words she used to describe Capetown and the surrounding farming country. My next question led to a discovery that gave me a better understanding of the organization. She was going on her 18th year volunteering at Open-Hand! As I went around the room asking the volunteers - 18, 16, 8, 5 - it became clear that this is more than a 4 story factory or a place to volunteer when you have the time, this was a family where volunteers become close friends and most importantly believe in both the organization and the cause. Man or woman, old or young, heterosexual or homosexual, everyone has the same thing in mind and the the numbers also depict this concept. A self proclaimed "rookie" can see and learn that the most important thing about cutting bacon, mushrooms, and peppers is preparing the meals with an open heart; after all, the slogan of Open Hand is "Meals with Love". 

Coming Soon - Working in the Grocery Store and Going on Home/Site Deliveries

Monday, November 12, 2007

National FACEAIDS Conference

The Perfect Plunge

There is something about being in a room full of students who have come from 25 different universities across the country to discuss the AIDS pandemic in Africa. Whether it is the passion and drive that is reflected in the discussions or the common belief that access to preventable and treatable diseases is a basic human right, the energy in the room depicts a piece of a movement that fosters a human quality much needed in the light of so much tragedy,  inequality, and oppression - this quality is simply hope. 

In small group discussions, the beauty of FACE AIDS comes alive. Big state schools (such as Michigan) and little Jesuit school (like Fairfield and Gonzaga), large established chapters (like Texas) and brand new budding chapters (like University of Wyoming).  It is a testament to the drive and beauty of activism and solidarity. Also, fundraising $850,000 for the Partners in Health Clinics in Rwanda demonstrates the merits and influence of such activism and unity.

I got the chance to ask Dr. Farmer (who by the end of the evening shook my hand and for better or worse jokingly called me a character) one of the questions I will be using when interviewing managers/directors of HIV organizations in the different regions. The question asks people to comment on what is needed most in this fight against HIV. Jim Kim, the former WHO director and co founder of PIH, stated at the first national FACEAIDS conference that political will is the key to large scale change. This was then echoed by Stephen Lewis, Kofi Annan’s special envoy on AIDS in Africa, at the 2nd National FACE AIDS Conference. The Dali Lama, in a documentary that featured Dr Farmer, placed the strongest emphasis on human compassion, and lastly, many say the biggest gains will be made through enhancing infrastructure of clinics.

Farmer thanked me for my question and answered the way I knew he would. To paraphrase, one is not more important than the other. The pandemic is a multifaceted problem that must be resolved through several avenues. For instance, he used the example of food. He discussed how much nutrition plays a role in resource poor areas and how many people debate and comment on whether his clinics should and could sustain paying for food (which he said accounted for 20% of the Rwandan clinic budget). In his matter of fact style the sentences that followed embodied his most basic belief and approach to successful healthcare. It is the whole picture one must understand,  band aids don’t work to cover a severed limb, and barriers remain unless broken down or maneuvered around. What good is putting someone on ARV’s if they are starving to death? Food is part of the equation of a healthy life.

The successes of PIH in Rwanda has created a stir among those in public health, and yet the secret is not hiding under a rock in Kigali. PIH has created a model that is well funded through the donors (heavily in part by the Clinton Foundation) and that has a government that is willing to seriously take on a crisis and do everything it can to make PIH a success. There is a reason people in southwest Rwanda are living a little better than 5 years ago. There is a reason PIH is revolutionizing health care in resource poor areas. There is a reason PIH has been asked to scale up there efforts to the national level, and there is a reason for hope in Rwanda.

Wednesday, November 7, 2007

Blog Info - The What it is and How it Works!

What is this?

This is the project's blogsite, but more importantly this will act as a journal and "inside scoop" to what I am doing, where I am, and what the culture and community is like.

What Can You Expect?

Expect to read about my experiences abroad and what life is like where I am staying. I will make simple notes and observations about the culture, scenery, people, and organizations in which I am volunteering. Expect interesting links of articles or data that are relevant to where I am. Expect pictures I take to provide a mental image and allow you to visualize the world around me.

How Can You Get Involved?

Come by periodically and visit. I will post every 3 days! This blogsite is meant to be interactive and keep people interested and, most importantly, involved. Click the pictures, utilize the links, and stay a part of the project. I invite you to post comments, suggestions, or even simple responses to my posts.

Let the Conversations Begin...

Tuesday, November 6, 2007

Journey Begins . . .

1st Stop California - "Kick Starting the Project"

Weekend FACE AIDS Conference at Stanford University

I co-ran this national conference last year at Fairfield University and think it is a great way to begin the traveling part of the project. Dr. Paul Farmer, an inspirational and world reknowned doctor of social medicine, will be the keynote speaker and several other noteworthy and passionate specialists, public health officials, and media personnel will all be part of workshops and panel discussions regarding global HIV and cutting edge topics, such as microbicides and the "scaling up" of the very successful health programs run in Rwanda by Partners in Health. (To learn a little about Dr. Farmer and how Partners in Health is literally changing the world one community at a time read this brief article from Forbes Magazine )

Getting the West Coast Perspective

After attending this Conference, I will be volunteering in San Francisco at a non-profit organization that is dedicated to providing nutritional support to people who are critical ill or fighting HIV. The organization is called Open-hand, and to learn a little more about them their website is For the majority of the two weeks I will be in San Francisco I will be staying at University of San Francisco as a favor from the Jesuits. Again, I am lucky to have the support of St Peters Prep and Fairfield University, both have been extrordinary in aiding in whatever ways possible. It is exciting to think that 6 months of work and preparation will be realized in a few days.
The interview questions have been read over by infectious disease doctors, HIV volunteers, program directors, and several other keen minds. I have taken to heart suggestions and feel the questions balance both the humanistic perspective and the on-going struggle against HIV.