Wednesday, December 31, 2008

Looking Back, Looking Forward

A New Year's Reflection, Resolution, and Prayer

The New Year gives a person time to reflect on their past and perhaps set a plan for their future. In that light…

I would like to thank the many people who have made my work possible. Ranging from family to peers, priests to government officials to former teachers, and Indian to Rwandan, each has played their own vital role of support. Over the year I researched for 5 weeks at a time in Thailand, India, and Rwanda. Each location with faces, names, stories, and experiences that taught me the meaning of compassion, fellowship, and development. My tribute to them is witnessed in all of my presentations and the “Hope & Global HIV” DVD. Too often against seemingly endless odds these people, their stories, work, and struggle, go undocumented or unnoticed. They have taught me the power of the individual to impact their community and create change. Whether acting as individuals or in concert with others, we must never underestimate the power of the individual.

My New Years resolution is already underway. I am in the process of developing a self sustaining and reproducible model that links local communities to ones I have covered throughout this last year. A full post will be dedicated to the overview and logistics of the project in the coming month.

I will leave with this Christian prayer that I have said numerous times over this past year. In each country across language and cultural barriers, I found myself hoping that I was achieving these words. For it is in them that I found much of my motivation and direction. The words espouse a deep sense of personal responsibility and call to action by making the individual the channel, the enabler. With this in mind I wish all a Happy New Year. One in which they can embrace the truth that we all have the power to make a difference.

Prayer of St. Francis
Lord, make me an instrument of Your Peace.
Where there is hatred, let me sow love;
Where there is injury, pardon;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where there is sadness, joy.
O, Divine Master,
Grant that I may not so much seek
To be consoled as to console;
To be understood as to understand;
To be loved as to love;
For it is in giving that we receive;
It is in pardoning that we are pardoned;
And it is in dying that we are born to eternal life.

Friday, December 5, 2008

Coming Full Circle

Keynote at Fairfield University Highlights Hope in Action in Global HIV/AIDS Struggle

It is a presentation I have given three times in the last two weeks. The statistics, key points, and stories flow easily as they come from the research and work I have done over the past year. The names and faces forever planted in the fields of my mind. However, this time it is different. This is my alma mater and I am speaking as the keynote for AIDS Awareness week and as the inaugural speaker for the MLK Jr. Lecture Program. The cozy and tech savvy room is full of students, friends, and former professors.

The goal of the presentation is two-fold and centers on the broader concept of hope. To begin we must draw attention to two key factors that fall into the category of grabbing the attention of the audience. The statistics that come out of the global HIV/AIDS pandemic are more than alarming. They are mind numbing: 33 million infected and 25 million deaths. And if we look at who is getting infected it is frightening – the voiceless, the marginalized, married women and young generations. But attention has two sides. We must remember the long way from which the story started. Although treatment is still not a reality for the majority of people infected, over the past five years people put on treatment in sub-Saharan Africa has increased 40 times over. We are making progress, but it is not time to rest as for every TWO people of treatment FIVE are becoming infected. In every presentation the balance has to be kept in check to instill the second goal – inspiration.

It is usually a person, sometimes an organization, but always people looking to make a difference. It is the tangible sign that action can overcome and inaction is unjust. At each speech I show a clip from the DVD I have produced to give the audience an example of both real life people living with HIV/AIDS and people making a difference in their own way. The reoccurring theme that comes through my voice and the DVD is the power of the individual to impact their community.

This night I focused on the movement already started in Rwanda. A story underreported and seldom told. A movement that sees a government working closely with international and domestic organizations and US PEPFAR officials. My voice speaks to the witness of Partners in Health’s (PIH) work providing healthcare to hundreds of thousands in rural Rwanda who before had no options. It also highlights the combined efforts of over 190 different FACEAIDS chapters across the US to raise funds for PIH and awareness of HIV/AIDS in sub-Saharan Africa.

The presentation should show that hope is tangible but requires action. I want to inspire all people to see HIV/AIDS as a social justice issue where all can make a noted difference. I want to call attention to the issues, engender a link for advocacy, and inspire action. All people want to make a difference sometimes it is only the how, the confidence, or the first push that is needed.

The educational and motivational DVD is compiled mostly of my own photos and highlights stories of individuals and organizations creating hope in their communities. It is meant to challenge and inspire a viewer. Follow yellow texted directions on right panel to learn how to get a copy

Monday, December 1, 2008

World AIDS Day

I will write an entry about World AIDS Day after my presentation at Fairfield University this Wednesday. Details of the event can be found here on the University’s website. The Wednesday night keynote will be part of the University's AIDS Awareness Week. I will be sharing from my experiences abroad and focusing on the messages and tangible stories of hope in Rwanda. It is open to the public.

I have accepted an invitation to be on the David Smith radio show. It can be heard via the internet on this website < > or on AM600 if you are in the Connecticut area. It will be on Wednesday from 1:30pm to 2pm.

A very well written and insightful article commemorating the 20th anniversary of World AIDS Day can be viewed on It is titled "Much Done: Much to Do" and is by Dr. Anthony S Fauci – Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. It highlights the significant advances that have been made over this time but calls attention to the continuing struggle.

World AIDS Day is a time to remember, to reflect, and to pray. I hope you will join me in this day's calling.

After Note:

I have produced an educational and motivational DVD documenting stories of hope meant to inspire and challenge. The DVD is mostly comprised of my photos from each location and stories of individuals and organizations I have met along the way. Donate $20 or over to the Emily C Specchio Foundation, email me your address , and I will mail you a copy of the DVD. Donation is tax deductible less amount DVD cost to produce. These funds will support my work and the launch of a 2nd project called "Attention, Advocacy, and Action".

Thursday, November 13, 2008

Power of a Pin

FACEAIDS Pin Changing Lives and Inspiring Students

130 plastic beads and a safety pin are breaking barriers in rural Rwanda and inspiring students from across the country that they can make a noted difference. It is a simple beaded pin, but the message and power behind it is inspiring. Wherever and whenever I speak – the pin is on my lapel because this pin is changing lives in rural Rwanda and campuses across the United States.

As individuals we can feel powerless by seemingly overwhelming or daunting issues. Half the world's population live on less than $2.50 a day. Stats like this serve to inform us and even command our attention; yet, they often are beyond our comprehension. $2.50 – no matter how managed - can not provide sufficient food, basic healthcare, adequate housing, and educational expenses to lead a dignified life. In the face of such glaring numbers I try to stay grounded.

The truth is people have a great heart. They want to help or make a difference, but the difficultly is often the how., Partners in Health, and FACEAIDS all provide the elusive answer. Muhammad Yunus (the father of microfinance) and Michael Milken (the convicted wall street felon turned philanthropist) recently shared on Charlie Rose the 3 issues that they believe are key to eradicating poverty and giving all people an opportunity to lead a dignified life – healthcare, education, and a job.

Breaking down each of these necessities could fill volumes – instead I will focus on a woman I met in eastern rural Rwanda. She, like many in the east African country, has lost family members to the 1994 genocide and stands to lose more from HIV/AIDS. A few years ago a doctor – let alone HIV treatment - was not available near her village. Partners in Health has since built a clinic and now a full hospital – healthcare has become a reality for her. She made a living making and selling banana beer but struggled with the labor of the process and could not make enough to provide for her family the way she would want. She is now part of the FACEAIDS pinmaking cooperative. She takes great pride in her work. When I asked her what she does with the extra income her face lit up. FACEAIDS makes her save a portion so she will be able to purchase a goat. A goat that will provide milk in a land where protein is a necessary staple that many cannot afford. She wants what all parents want – opportunity for her children. Her FACEAIDS work provides the extra funds to afford the school fees to give her eldest son a chance to break the cycle of poverty. Healthcare, education, and a job gave this family the chance for a better life.

For the last three years every Fall at Stanford University sees a wave of college students from across the country come together on a mission centered on these pins. It is the National FACEAIDS Conference where students will brainstorm new ideas to increase advocacy and raise funds for Partners in Health’s work in rural Rwanda. Much of the focus will be on social justice, human rights, and development issues, but an underlying theme will be the power of a pin.

Saturday, November 8, 2008

A Speech for the History Books

Obama's Victory Speech - Full Text

Hello, Chicago. If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer.

It's the answer told by lines that stretched around schools and churches in numbers this nation has never seen, by people who waited three hours and four hours, many for the first time in their lives, because they believed that this time must be different, that their voices could be that difference.

It's the answer spoken by young and old, rich and poor, Democrat and Republican, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled. Americans who sent a message to the world that we have never been just a collection of individuals or a collection of red states and blue states. We are, and always will be, the United States of America.

It's the answer that led those who've been told for so long by so many to be cynical and fearful and doubtful about what we can achieve to put their hands on the arc of history and bend it once more toward the hope of a better day.

It's been a long time coming, but tonight, because of what we did on this date in this election at this defining moment change has come to America.

A little bit earlier this evening, I received an extraordinarily gracious call from Senator McCain. Senator McCain fought long and hard in this campaign. And he's fought even longer and harder for the country that he loves. He has endured sacrifices for America that most of us cannot begin to imagine. We are better off for the service rendered by this brave and selfless leader.

I congratulate him; I congratulate Governor Palin for all that they've achieved. And I look forward to working with them to renew this nation's promise in the months ahead.

I want to thank my partner in this journey, a man who campaigned from his heart, and spoke for the men and women he grew up with on the streets of Scranton ... and rode with on the train home to Delaware, the vice president-elect of the United States, Joe Biden.

And I would not be standing here tonight without the unyielding support of my best friend for the last 16 years ... the rock of our family, the love of my life, the nation's next first lady ... Michelle Obama. Sasha and Malia ... I love you both more than you can imagine. And you have earned the new puppy that's coming with us the new White House.

And while she's no longer with us, I know my grandmother's watching, along with the family that made me who I am. I miss them tonight. I know that my debt to them is beyond measure.

To my sister Maya, my sister Alma, all my other brothers and sisters, thank you so much for all the support that you've given me. I am grateful to them.

And to my campaign manager, David Plouffe ... the unsung hero of this campaign, who built the best _ the best political campaign, I think, in the history of the United States of America.

To my chief strategist David Axelrod ... who's been a partner with me every step of the way. To the best campaign team ever assembled in the history of politics ... you made this happen, and I am forever grateful for what you've sacrificed to get it done.

But above all, I will never forget who this victory truly belongs to. It belongs to you. It belongs to you.

I was never the likeliest candidate for this office. We didn't start with much money or many endorsements. Our campaign was not hatched in the halls of Washington. It began in the backyards of Des Moines and the living rooms of Concord and the front porches of Charleston.

It was built by working men and women who dug into what little savings they had to give $5 and $10 and $20 to the cause. It grew strength from the young people who rejected the myth of their generation's apathy ... who left their homes and their families for jobs that offered little pay and less sleep; from the not-so-young people who braved the bitter cold and scorching heat to knock on the doors of perfect strangers; from the millions of Americans who volunteered, and organized, and proved that more than two centuries later, a government of the people, by the people and for the people has not perished from this Earth. This is your victory.

"I know you didn't do this just to win an election and I know you didn't do it for me. You did it because you understand the enormity of the task that lies ahead. For even as we celebrate tonight, we know the challenges that tomorrow will bring are the greatest of our lifetime, two wars, a planet in peril, the worst financial crisis in a century.

"Even as we stand here tonight, we know there are brave Americans waking up in the deserts of Iraq and the mountains of Afghanistan to risk their lives for us. There are mothers and fathers who will lie awake after their children fall asleep and wonder how they'll make the mortgage, or pay their doctor's bills, or save enough for college. There is new energy to harness and new jobs to be created; new schools to build and threats to meet and alliances to repair.

The road ahead will be long. Our climb will be steep. We may not get there in one year or even in one term. But, America, I have never been more hopeful than I am tonight that we will get there. I promise you, we as a people will get there.

AUDIENCE: Yes we can! Yes we can! Yes we can!

OBAMA : There will be setbacks and false starts. There are many who won't agree with every decision or policy I make as president. And we know the government can't solve every problem. But I will always be honest with you about the challenges we face. I will listen to you, especially when we disagree. And, above all, I will ask you to join in the work of remaking this nation, the only way it's been done in America for 221 years _ block by block, brick by brick, calloused hand by calloused hand.

What began 21 months ago in the depths of winter cannot end on this autumn night. This victory alone is not the change we seek. It is only the chance for us to make that change. And that cannot happen if we go back to the way things were. It can't happen without you, without a new spirit of service, a new spirit of sacrifice.

So let us summon a new spirit of patriotism, of responsibility, where each of us resolves to pitch in and work harder and look after not only ourselves but each other.

Let us remember that, if this financial crisis taught us anything, it's that we cannot have a thriving Wall Street while Main Street suffers. In this country, we rise or fall as one nation, as one people. Let's resist the temptation to fall back on the same partisanship and pettiness and immaturity that has poisoned our politics for so long.

Let's remember that it was a man from this state who first carried the banner of the Republican Party to the White House, a party founded on the values of self-reliance and individual liberty and national unity. Those are values that we all share. And while the Democratic Party has won a great victory tonight, we do so with a measure of humility and determination to heal the divides that have held back our progress.

As Lincoln said to a nation far more divided than ours, we are not enemies but friends. Though passion may have strained, it must not break our bonds of affection.

And to those Americans whose support I have yet to earn, I may not have won your vote tonight, but I hear your voices. I need your help. And I will be your president, too.

And to all those watching tonight from beyond our shores, from parliaments and palaces, to those who are huddled around radios in the forgotten corners of the world, our stories are singular, but our destiny is shared, and a new dawn of American leadership is at hand.

To those who would tear the world down: We will defeat you. To those who seek peace and security: We support you. And to all those who have wondered if America's beacon still burns as bright: Tonight we proved once more that the true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals: democracy, liberty, opportunity and unyielding hope.

For that's the true genius of America: that America can change. Our union can be perfected. What we've already achieved gives us hope for what we can and must achieve tomorrow.

This election had many firsts and many stories that will be told for generations. But one that's on my mind tonight's about a woman who cast her ballot in Atlanta. She's a lot like the millions of others who stood in line to make their voice heard in this election except for one thing: Ann Nixon Cooper is 106 years old.

She was born just a generation past slavery; a time when there were no cars on the road or planes in the sky; when someone like her couldn't vote for two reasons _ because she was a woman and because of the color of her skin.

And tonight, I think about all that she's seen throughout her century in America _ the heartache and the hope; the struggle and the progress; the times we were told that we can't, and the people who pressed on with that American creed: Yes we can.

At a time when women's voices were silenced and their hopes dismissed, she lived to see them stand up and speak out and reach for the ballot. Yes we can.

When there was despair in the dust bowl and depression across the land, she saw a nation conquer fear itself with a New Deal, new jobs, a new sense of common purpose. Yes we can.

AUDIENCE : Yes we can.

OBAMA: When the bombs fell on our harbor and tyranny threatened the world, she was there to witness a generation rise to greatness and a democracy was saved. Yes we can.

AUDIENCE: Yes we can.

OBAMA: She was there for the buses in Montgomery, the hoses in Birmingham, a bridge in Selma, and a preacher from Atlanta who told a people that We Shall Overcome. Yes we can.

AUDIENCE: Yes we can.

OBAMA: A man touched down on the moon, a wall came down in Berlin, a world was connected by our own science and imagination. And this year, in this election, she touched her finger to a screen, and cast her vote, because after 106 years in America, through the best of times and the darkest of hours, she knows how America can change. Yes we can.

AUDIENCE: Yes we can.

OBAMA : America, we have come so far. We have seen so much. But there is so much more to do. So tonight, let us ask ourselves _ if our children should live to see the next century; if my daughters should be so lucky to live as long as Ann Nixon Cooper, what change will they see? What progress will we have made?

This is our chance to answer that call. This is our moment. This is our time, to put our people back to work and open doors of opportunity for our kids; to restore prosperity and promote the cause of peace; to reclaim the American dream and reaffirm that fundamental truth, that, out of many, we are one; that while we breathe, we hope. And where we are met with cynicism and doubts and those who tell us that we can't, we will respond with that timeless creed that sums up the spirit of a people: Yes, we can.

Thank you. God bless you. And may God bless the United States of America.

Saturday, October 18, 2008

The Movement

Student Global Health Conference Inspires Advocacy and Action

When citizens think about movements they generally recall the women’s suffrage, civil rights, and anti war movements. However, the world has shrunken with the advent of the internet, increased travel, and evermore accessible telecommunications. This has created the ability for larger movements but also allows for some to get lost in the fray. Facebook causes, mass emails, blogs, and twitters have created an overwhelming abundance of information and myriad issues to track. At times what is missing is the commitment to action – arguably the most important step.

It was in this spirit of expanding upon a movement that the Students for Global Health Conference (SGHC) achieved its objectives – increase attention, focus advocacy efforts, and commit to action. Held at Boston University School of Public Health the day after the Partners in Health (PIH) symposium, the conference offered a chance to both students and young professionals to network, learn, and be inspired at what can be achieved together.

The conference began as an idea by a group of PIH interns to run after their positions ended. The small and dedicated group planned, programmed, and ran the conference as students and young professionals volunteering for a cause they believe in. With over 200 students pre-registered and speakers from PIH, Harvard’s FXB Center for Health and Human Rights, and Physicians for Human Rights the days event were beneficial to all in attendance.

The final piece of the conference saw small groups of students coming together based on issues and producing tangible commitments in the given field. My group (Women’s Health Equity) chose to raise funds and awareness for (a highly effective and popular microfinance organization) and start a letter campaign to promote full appropriations for the PEPFAR reauthorization bill. Eleven students from seven schools can hopefully create a network that achieves what I call the AAA: attention, advocacy, and action.

Curtis Peterson, the conference leader, had much to smile about at the end. The conference proved yet again to him that the commitment and investment from people is out there. Movements require masses of people from all walks of life working in concert toward a common cause and goal. What I might add is that we are in the midst of the next great movement – rights based healthcare – and weekends like these have helped and continue to help rally different paths to the same goal.

If you would like to join our group (SWEET= Students for Women's Economic Equity Today) on, make a small microfinance loan, or simply view our goal - click here. Thank you

Wednesday, October 8, 2008

Addressing the Problems of Poverty

Partners in Health’s 15th annual Thomas J White Symposium

In the storied walls of Harvard’s Memorial Hall, Partners in Health (PIH) held their 15th annual Thomas J. White symposium and reaffirmed their commitment as an organization driven by a preferential option for the poor – a phrase and meaning developed by the Jesuit Gustavo Gutierrez during the liberation theology movement in Peru. From the first speaker to the last, the day’s agenda was clear – clarify the mission and build on the movement.

The founding of PIH and the story of their early work is best illustrated in Tracy Kidder’s Mountains Beyond Mountains, but at this symposium the characters leaped off the pages utilizing humor, sincerity, and a clear rationale that runs throughout the organization’s work. Ophelia Dahl, daughter of famed writer Roald and executive director of PIH, started by stating what may not be obvious to an outsider. Although PIH is internationally renowned for their HIV work – they are not an HIV/AIDS organization. The title would be limiting because the heart of their work is based on addressing the problems of the poor. These problems, which certainly include HIV/AIDS, are rooted in economic and social human rights violations. Is it a coincidence that people without access to clean water, adequate shelter, or jobs (let alone healthcare) are the ones most affected by the major diseases of our world? The PIH answer is simply no.

PIH has long held a rights based approach to healthcare that attempts to correct the root causes, such as poor housing or access, while addressing the symptoms, like malnutrition or HIV infection. At their core they are community builders and focus their attention and resources on the two pillars of any society – health and education. Fundamentally they profess the commonalities between all people and dispel “the accident of where we are born” should dictate who suffers, who is oppressed, and who dies.

On paper what PIH has accomplished is clear. They have established centers in 7 countries in 5 global regions. They see millions of impoverished or marginalized people as patients, and they have taught, trained, and employed the locals to effectively assume the majority of the operational tasks. However, a similarly vital success has been the overall movement – a word heavily emphasized throughout the speakers. PIH’s revolutionary approach changed the mentality that high level healthcare could not be achieved in poor settings. They are, dare I say, true mavericks. The ripple effect was best portrayed in the event’s four keynotes. The first two were former refugees who are now doctors. They have both returned to their homelands to start similar rights and development based clinics, Tiyatien Health in Liberia and Village Health Works in Burundi. The other two keynote speakers represented the student movement. First was Dave Ryan, the president of FACEAIDS (an advocacy and fundraising student group highly featured in this blog) who spoke of the importance of initiative, action, and results. A similar message was espoused by Matt Cone, a high school professor of contemporary issues at Rock Bride High in Missouri. His class has not only raised over 100 thousand dollars for PIH, but it has done so by incorporating a sense of attention, advocacy, and action in the curriculum of the course.

The movement has already formed and focuses people on the economic and social justice path to creating change, development, and dignified living. The tangible results are there – Adeline Mercon, a Haitian mother, spoke through an overqualified translator (Dr. Farmer) and stated I am the 2nd Lazarus and I am celebrating the 10th year of my second life. Her story started with her father asking Dr. Farmer for money to buy his daughter’s coffin and ended with her strong enough to work and care for her children. Somewhere in Peru, Gustavo Gutierrez is nodding his head in agreement because the movement is growing and the results are adding up.

Please refer to the photos on the sidebar and blog entries from April for my experiences documenting Partners in Health in Rwanda.

Wednesday, September 24, 2008

Commitment - The Key to Change

Clinton Global Initiative Places Change Makers, World Leaders, and Funders Together

Commitment [kuh-mit-muh nt]: involving yourself, pledging support, the most necessary step toward action. A college professor, and long time United Nations insider, once told me the General Assembly opening session speeches are a nice part of the United Nations, but the real work goes on in the small meeting rooms nestled in the nooks and crannies of the famous building. It represents one of the rare opportunities heads of states get to talk national interest agendas and weigh support of foreign policy issues face to face without the media or work up of official state visits. In the professor’s words, “It’s where the ball really gets rolling”.

Bringing these world leaders together is a great benefit unfortunately at times missed by mass media. Some reporters and news outlets focus attention on President Bush and President Ahmadinejad speeches billing the headline as “The Great Showdown”, as if Monday Night Football coverage translated to the diplomacy and international relations arena. These two speeches, though important, and excerpts of interviews with Ahmadinejad were ubiquitous across media channels as the only coverage of the day’s events north of Houston Street in New York City. Nonexistent is coverage for a four day conference this
week that takes advantage of the UN’s high ranking guests and gets the ball rolling on the critical issues that face our world.

“Over 80 former and current heads of state, hundreds of top CEOs and non-profit leaders, major philanthropists, and 10 of the last 16 Nobel Peace Laureates” will attend the Clinton Global Initiative meeting this year and focus on four of the great challenges of our time and world: education, poverty alleviation, global health, and energy & climate change. At this invite only conference leaders of the different sectors gain the ability to meet, view, and discuss concrete opportunities through panels, breakout sessions, and an internet platform that allows for a free flow of ideas, dialogue, and support.

What this conference seeks to build and guarantee is commitment. Since starting in 2005, “CGI members have made nearly 1,000 commitments valued at over $30 billion to improve more than 200 million lives in over 150 countries.” It places together innovative and highly effective change makers and non-profits with the people who are enablers. Nothing gets passed with more success through any government or corporation than a bill the president is moved to create or support. He or She will find the funds when they see results are attainable. Getting these types of members on board, talking, and part of the equation are fundamental to the creating the success the Clinton Foundation strives to develop. Former President Clinton established the CGI to “help turn good intentions in to real action and results.” He understands the essential nature of this link and his post presidential legacy will be cemented through the works and actions of his foundation and centered of the most important word – commitment.

The CGI meeting is viewable by internet. Schedule. Featured Commitments.

Thursday, September 11, 2008

A Game Changer in HIV Education

Culturally Sensitive and Scientific Approach to HIV Education

My question, “What would the reaction here in India be if schools taught a culturally sensitive science and fact based approach to sex education”. I had asked the question in all five countries to officials, doctors, and the directors of each organization covered. The responses always extolled the great impetus such an approach could have at removing stigma, creating understanding, and empowering a population with life saving knowledge. However what usually follows is the realization that such programs or practices simply do not take place in large scale. The reason is steeped in taboos stemming from culture, religion, or governmental bureaucracy and no example was more palpable then in India.

Although India is the world’s largest democracy and developing at a pace nearly unforeseen, it still has traditions that some interviewed referred to as “backwards”. Whether it is divorced or widowed women completely ostracized from the community, or raped women thought to be worthless and ill suited for proper marriage, women’s rights is a hard fought battle in India. Furthermore, premarital sex is almost unspeakable and “a big No-No”, which comes across slightly innocent given the provocative nature and displays of sexuality in the highly popular Bollywood scene. Of course it was with this reality that I awaited the answer from the director of the Community Care Center (CCC).

The response, “For god’s sake if you even utter sex education they will chase you out and throw you into the river!” Despite the taboos the organization pursues a course of action. “Call it health education or life education and then go in and teach them whatever you’d like. This is what we do and it works.” The need for HIV education is desperately there. In their 2006-7 “Needs Assessment Study” the Gujarat State Network of Positive People (GSNP+) reported 70% of the 766 people living with HIV interviewed knew nothing of HIV before testing positive. How does one protect himself or herself from a virus they have never heard of - let alone understand how it transmits?

It is corporations’ social responsibility programs, such as the CCC, and non governmental organization, like the GSNP+, that are left with much of the responsibility in educating the population on HIV/AIDS. Through awareness outreach, solidarity programs, and advocacy campaigns the state of Gujarat is slowly showing changes in levels of understanding on HIV. However there may be a game-changer. Whereas my question was only hypothetical, it has now become a reality through Stanford University and the hard work of Piya Sorcar. Their model teaches the issues through facts and a culturally sensitive approach. It absorbs the culture and integrates it into the material without sacrificing the essential messages. Their three point mantra is the foundation everything is built on. The HIV virus spreads from only three mediums: sexual fluids, breast milk, and blood. The beauty of the program is the simple and clear language and the utilization of graphics and media works to both engage the audience and reflect culture. Lastly, it even comes in Indian male and Indian female versions to address some of the hesitancies and sensitivities within the various religious orders within India.

Besides India my research has also taken me from the hills of Rwanda to the golden coast of the United States and the heat of Nicaragua to the temples of Thailand. The potential for’s programs can be tweaked and geared toward each of these countries garnering tangible results. Each country has its own culture and that is the beauty of the program; keep the facts and alter the dressing. Experts talk about the two sides of the HIV/AIDS epidemic as treatment and prevention. Both go hand in hand, especially in developing countries where costs of treatment can be a pressing issue for both patient and government. This computer based model can make a great difference in addressing one of the biggest issues concerning HIV – awareness, prevention, and understanding.

For more blogs about the CCC, GSNP+, or India please go to February and for photos see sidebar.

Wednesday, September 3, 2008

A Family Field Trip

Innovative and Interactive Exhibit Shows Future of Health Education

Seated in front of a large screen, my younger siblings grab hold of the controllers and attack the microbes and foreign particles that enter the blood stream. “Look Marco I’m a macrophage” - atypical words flowing from the mouth of a soon to be seven year old. Yet this is the future - both in HIV awareness and our population. Here at the Liberty Science Center’s “Infection Connection” children and teens get a highly interactive and stimulating approach to learn about the body’s immune system, various viruses that attack it, and social issues surrounding particular infections.

The video game lasts several minutes but it’s obvious their interest has been peaked. When the game ends they briefly argue as to whose role was more important – the macrophage who engulfs the pathogen and calls for the T-cell or the T-cell which does the “killing”. As we watch the brief 5 minute HIV video the real winner is revealed. Both children have a sense of how the HIV virus enters the body and can cause AIDS. As we see the T-Cells slowly wiped out, they know that the immune system is losing its “power” and defense mechanisms. The video focuses heavily on the science behind the virus utilizing clear language and visual effects. It also includes important statements which highlight the stark reality behind global HIV – highest percentage of infections worldwide are in sub-Saharan Africa, 11.4 million AIDS orphans in Africa alone, and 1.6 million deaths worldwide in 2007.

The video does not harp on transmission because the audience may be too young for so much at once, but the science behind the virus and some context of global implications seemed to stick with both siblings. Venturing by myself I found several miniature exhibits each one dedicated to noted diseases, such as influenza, lymes, and malaria. Of particular interest was “Bedroom Secrets”, which focused on sexually transmitted infections, condom usage, monogamy, and opening communication lines. Press a button next to one of the pictures and hear a teenager talk about a visit to the doctor’s office. The section uses accessible language, drawings of real life situations, and subtle tones of prevention, awareness, and responsible actions. Tucked away in a corner it gives a sense of privacy to absorb its messages from peers and professionals.

In each of the countries I have participated in awareness work through the organization documented. In India, I played a UNICEF board game geared toward harm reduction and HIV awareness. In Nicaragua, I passed out pamphlets and condoms as clowns gathered an audience for a show on HIV transmission methods. In these endeavors and pursuits the goal is to change the near future by educating and working in the present. The mentality in each location is linear and direct. Increase awareness of how the virus does and does not spread, thereby decreasing stigma, number of new infections, and thus reducing the number of people on treatment.

Discussing and explaining the issues and facts behind HIV in such an interactive and science based approach made the lesson come to life. In place of a lecture, a general understanding of the basic foundation is gained in an engaging and de-stigmatizing manner. I could not help but wonder what effect this type of programming could have in some of the resource poor settings where I have traveled - areas where displays of technology, such as a slideshow or PowerPoint presentation, generate crowds from intrigue or relative limited access. The potential for such programs is far reaching, especially when geared to specific populations and taking into account cultural and social norms. A future blog will be dedicated to one such model developed in the USA being tested in India.

Back at the Liberty Science Center I finish the infectious disease train ride which highlights interviews of people living with TB, Dengue, and HIV in countries of high prevalence. As I exit my train car a clear and powerful message is announced - “choices we make as individuals, communities, and governments weigh heavily on the lives of others. Are you part of the problem or the solution? The future is unwritten”. The future is unwritten and with more interactive and accessible programming and continuing the course of governments, corporations, and NGOs working together the complex problems presented by the global HIV pandemic can be reversed and addressed.

Tuesday, August 26, 2008

Project Update

I apologize for the silence. I have been drafting chapters of the book, applying to graduate schools, and setting up speeches in the Tristate (NJ, NY, and CT) area.

I am pleased to announce the International HIV/AIDS Alliance Ukraine will be the final research site for my book. They are financed by the Global Fund to Fight AIDS and will represent a harm reduction model that focuses on the relationship between intravenous drug usage and HIV infections. The organization is one of the strongest in Eastern Europe and is responsible for two of the largest HIV initiatives in the Ukraine. It will be a privilege to cover and document their work. More details will follow once logistics are finalized.

I will be posting at least one entry per week until further notice. I invite you to view the keynote speech I gave at the Emily C. Specchio Foundation on YouTube. The speech highlights successes and hope encountered in each country stemming from individual empowerment and personal action.

Friday, June 6, 2008

"Anchors Away . . ."

The Rwanda Women's Network and the Village of Hope

As I make my way into one of the offices I see a wall full of photos and immediately my curiosity is peaked – why so many mug shots of children? The board is sectioned into categories: both parents living, one parent living, and child head of household. With each face comes a different story – a painful reality of loss – mostly attributed to the genocide or HIV/AIDS. My questions are answered by two of the directors of the Village of Hope both of whom are Rwandan by ethnicity. Their paths are dissimilar yet they converge at this one organization and seek to create hope through action and empowerment. Peninah came back from Uganda a month after the genocide hoping to find any of her countless relatives alive, but her empty stare and heavy eyes alone foreshadowed the grim response to my question. Winnie grew up in Uganda and received her masters in social work in Britain. They say the change they have witnessed in the women of the Village anchors them to the organization. The omnipresence of the genocide and this anchor would soon become recurring themes throughout the day.

I started out in a room learning about the countless programs that are run through the Village of Hope. The comprehensive work done here delves deep into the cyclical nature of poverty, most often created as a product of the genocide or the HIV virus. I have come to learn poverty denies the access of three vital human needs - income generation, education, and health. The Village of Hope attempts to address these issues, and the sheer amount of area women (over 4000) who utilize its services speak to its success. As I step outside I meet a group of women from one of the Village-run income generation programs. They are the bedcover makers and they half-jokingly tell me I must visit the store before I leave. The materials, training, and sales location are all provided for by the non-governmental organization that runs the Village and only the cost of the material is subtracted after an item is sold. Generating income is perhaps one of the biggest steps toward empowering an individual and changing the life of a family. As I finish interviewing one of the women I make my way to a group of children who are trying on school uniforms (see photo). Although primary school education in Rwanda is said to be universal and free, Stephen Lewis states in A Race Against Time that hidden fees for uniforms and scholastic materials are the main deterrent to school enrollment in Africa; thus severely limiting individual opportunity and economic development. The Rawandan Women’s Network (RWN), the organization that founded and runs the Village, pays these hidden fees for over 100 primary school children. Furthermore, the Stephen Lewis Foundation and PEPFAR send over 150 teens to secondary or skills schools. In regards to health, the original initiative of the RWN is the Polyclinic of Hope, established in 1994. Here, women and children (and also some men) receive medical services including HIV testing, HIV counseling and nutritional support for HIV/AIDS.

When housing was deduced as one of the major threats to the post genocide women and orphans, the Rwanda Women’s Network sought funds to build the Village of Hope. In 2000, Japanese funds built the village center and the Clinton Foundation erected twenty houses. The RWN consulted with all the stake holders, from social workers to the women themselves, to select from the most vulnerable amongst them to live at the Village. These houses (see photos for details) are built for six but often house seven or eight – there is no shortage of street children or orphans. Alongside each house is a kitchen garden for which the women receive seeds and are taught the techniques of how to cultivate the various fruits and vegetables. The abundance of potatoes, cabbage, avocados, carrots, and onions plays an integral part in providing nutritional support and access to food.

The RWN established The Village of Hope in an undeveloped outer district of Kigali and many women who depend on it relocated or built small houses to live within walking distance. However, Rwanda’s new reputation as one of the hopes of Africa due to its good governance and safe atmosphere has created a land premium in Kigali as both ex patriots and foreigners build new houses. The Village now finds the bush that separated them from the main road into the city strewn with hundreds of US style mansions (costing approximately $150,000 US). Many of the women dependent on the Village are approached daily to sell their lots but must weigh the consequences of relocating further away. The RWN’s advocacy, networking, and educational awareness programs provide the knowledge base needed when it comes to vital issues such as property rights.

The success of the Rwanda Women’s Network can be directly linked to empowering the individual through programs that address basic human rights. Their Village of Hope is much like the famed roads of Rwanda. They have a plethora of programs that like the highways, which branch out to all corners of the country, cover key sectors for creating a just life – income generation, education and health. All major roads in Rwanda lead back to Kigali and all the work of the RWN comes back to empowerment and unity. There is no Hutu or Tutsi mentality. The mantra is “We are all Rwandans”. Women whose husbands were murdered have come together with women whose husbands did the murdering in the name of development for their children’s future. The approach and work of the RWN has won it accolades in the form of two prestigious international awards. Its success looks to continue forward as the process of scaling up and going nationwide has already begun. After a full day at the village I understand why it was recommended as a “must-see” by ranking government and UNDP officials. Moreover, after interviewing some of the women and teenagers who benefit from its services, I have seen why Perniah and Winnie have dropped anchor in a landlocked Village of Hope.

Monday, May 12, 2008

Shadowing an Accompagnatuer and Community Health Worker

Rural HIV Care House Visits

Whether you look left or right, banana trees consume your view. Intermittingly along the rough and rocky dirt road women will be walking with their cultivated produce balanced on their heads, children with their family’s yellow containers preparing to fetch water from the nearest well, and men with three bushels of bananas strapped to a bicycle that they are pushing. This has been the view for much of the 45-minute ride for rural HIV care house visits. This day I am shadowing an accompagnatuer and a community health worker – two mainstays and vital parts of Partners in Health’s (PIH) framework.

The idea is simple. A person in a community is trained to “accompany” another in their treatment of HIV/AIDS and their general wellbeing. It fosters a strong link in the community, acts as a referral process to the clinics, and has incredible results for adherence to treatment. It is a highly organized system in which accompagnatuers are responsible for their individual clients and then the community health workers monitor the progress with periodic joint visits. This day is one such visit. The accompagnatuer has six patients that she visits once a day at the same time to directly observe their morning antiretroviral dose and give them the medication for the afternoon. The furthest one lives 2km from her house, approximately a fifteen minute walk.

Our driver stops the creaking truck at a narrow path cut into sectioned off vegetation patches and at first I see no houses (see photo). As we continue down the path children begin to gather wondering what a “muzungu” is doing in their tiny and secluded rural community. A smile, a wave, and a greeting in kinyarwandan will be returned with brighter smiles, enthusiastic waves, and increasing curiosity. It is a recurring event that breaks initial barriers and reminds one of the simple beauties in life. We arrive at the desired mud house and exchange greetings, handshakes, and laughs at my attempts at the local tongue. The husband and wife give us the wooden bench and bring in a dried leaf mat for them to use on the floor. It is a simple gesture but it speaks volumes about the culture here and also the importance of the health workers in the eyes of the people.

The community health worker goes through a three page comprehensive questionnaire. The format is heavily geared for check marks and numbers therefore allowing me to follow along quite well. The husband and wife are both HIV+ and their first five kids have tested negative. There is a hesitancy to test the two-year-old child, which both workers attempt to address. The wife tested positive during a prenatal check up with that child, and the husband followed suit. This particular visit is evaluating the husband’s health. The questionnaire also contains other factors that are fundamental to health and are valuable resources for PIH’s social workers. Some of the alarming issues are that he eats one maybe two meals a day and that there are no mosquito nets over the three beds in the house. Positives are also noted, such as the house and metal sheet roof are in good condition and the cooking is done outside of the house. This last note is important because everyone cooks with coal, which when used inside living quarters can create numerous health risks. There are no complaints or illnesses reported and the community health worker neatly writes her findings and conclusions at the end of the last sheet.

After fifteen minutes the house visit is over. More importantly this family of eight in the deep rural areas of Eastern Rwanda has received attention that is potentially life changing. It is difficult for these people to get to a clinic so instead PIH branches out deep into the surrounding district in a proactive fashion. In essence they are trying to find the problems and bring the people in before they get worse. It is vital to understand that the mentality, which is common in many developing countries, is a visit to a doctor or clinic is only after ailment has become a serious problem. For instance the husband’s first CD4 count, the measure of the immune system’s strength, was 35 and he only got tested because his wife tested positive. To put this number into perspective HIV treatment starts at 200 and as high as 350 in malnourished populations. Less than two years later, his count is 1056, which is well within the range of an HIV negative adult. This is two more years that six children had a father and a family had a breadwinner – intangible positives that some times do not make it in statistics or reports.

The success of the accompagnatuers program has proven to be beneficial to the patient through varying areas – medical, social, and even psychological. The effect of the system and the relationship between the people in the room are highly visible. However, the meeting cannot go on too long because there are more houses to visit. After the thank yous we turn outside and are greeted by an even larger group of children. The path back to the truck is lined with string beans, bananas, and potatoes. A look around will show mud houses and endless cultivation. This is the setting, and this is the future of healthcare in rural areas of Rwanda.

Wednesday, May 7, 2008

Partners in Health

The Approach, the Vision, and the Results

It is difficult to explain everything that Partners in Health (PIH) does in Rwanda. The simple reason is their programs are too vast and comprehensive to fit in one, two, or ten blog entries. I think the better way to explain what is being done here – in the rural countryside of Eastern Rwanda – is through the philosophy and the approach that has made this non-governmental organization world renowned. PIH is an organization that functions under a human right based, development driven, and comprehensive approach. Now let me clarify that statement through tangible examples.

To call PIH a healthcare or HIV/AIDS non-governmental organization would be limiting. It is very true that they provide unparalleled healthcare, especially with treatment of HIV/AIDS, in research poor settings, such as Haiti, Rwanda, and Lesotho, but their real gains are in addressing the root of many of the problems they encounter – poverty. How do they tackle such a large yet critical component of the human condition? Of course the answer is through healthcare, but that is only the beginning. Healthcare is not only a basic human right in this organization because they don’t stop at the “standard” or the international expectation. Whether it is the successful chemotherapy treatment for pediatric Hodgkins Lymphoma (perhaps a first in the rural districts) or the mixed cocktail antiretroviral therapy that is criticized as not being cost effective, the standard here is that patients deserve everything possible just as if a member of the doctor’s staff where in the same predicament.

Of course there are other human rights that are vital in establishing a just life; education, a livable wage, housing, food are but a few. Many of these key rights are included in the practices and programs on the ground. It fits accordingly to the vision of development. If we talk about education, PIH pays for over a 1000 primary school fees for area children. If we talk about a just wage, the absolute majority of the paid staff (ranging from doctors to cooks) are Rwandan and paid above what the established wage would “normally” be (such as the same position with the Ministry of Health). The concept here is human capacity building. Above all, the over arching goal is to create a model and system that can be run completely by Rwandans in the future, much like PIH’s renowned Haiti program. To attain such a goal, training of local personnel becomes a high priority. It does not stop with medical training. They also run several income generation programs, such as teaching and providing tools for carpentry and sewing. When it comes to a dignified living space, PIH utilizes it many social workers to identify the most vulnerable or needy cases and then works to fill the need, such as a coagulated tin roof or an entire home from scratch. One doctor put it so bluntly that I had to write it down. To paraphrase - if some one has TB and they have a roof that is leaking then the TB is never going to go away. We go in, patch the roof or cover it with a plastic tarp, and now the patient gets better. So simple, yet unfortunately deemed “radical”.

The last example I will provide is perhaps one of the most essential of basic human rights – access to food. It is a topic of international importance and tragedy as the global food crisis continues to plague the world’s poorest. An extra 50 cents for a bagel gets a full page in a Connecticut newspaper, but the impact of the raising of prices effect in the developing world is the difference between eating twice a day to once or worse. In a country that is ravaged by malnourishment, PIH runs several food programs that are aimed at providing the life saving nutrients needed for survival. For instance, the pediatrics ward estimates half its patients are a result of malnourishment. The visible symptoms are so common they have a local name – “Kwashiorkor”. The eyes get puffy, the cheeks get overly chubby, and belly swells. The treatment – food of course – is two months supply and then revaluation after that period expires.

The comprehensive aspect is illustrated through the “accompagnateur” system that first made PIH “famous” in the public health world. It is best explained as a person who the organization pays to daily visit a set group of people in their community to directly assist and make sure the patient is taking their HIV or TB medications. This direct approach has many benefits. First, it accounts for an amazingly high adherence and successful continual treatment rate. Secondly, it creates a leader and a network within the community. Thirdly, it provides as a mechanism for referring someone to the clinic or hospital if they are having complications or other illness. This same practice, which started on the central plateau of Haiti, is now being used thousands of miles away in the rural countryside of Eastern Rwanda.

The Health Ministry has realized that the philosophy and approach of PIH is not only addressing healthcare needs, but in the process it is conducting development initiatives through empowering the locals. The two have partnered to scale up the rural health care sector of the country. It is a new endeavor and challenge for PIH, but not many organizations have the vision or approach to accomplish such a task.

Wednesday, April 30, 2008

Rwanda’s Fight on HIV/AIDS: Strengths, Challenges, and the Catalyst

Interview with Highest Ranking HIV/AIDS Official in the Rwandan Government

High level executives at the UN Development Program described her as a wealth of knowledge. A Senior Advisor for PEPFAR praised her for her detailed approach and drive. An administrator from Partners in Health said she is the exact person you want to talk to. In every one of these meetings I thought - who is this Dr. Agnès Binagwaho? Well, she is the Rwandan government’s highest official in the field of HIV/AIDS. Her title reads Executive Director of the National AIDS Control Commission but she is much more than that. She is personable and insightful in her speech, straight forward in her talk, and pragmatic in approach.

I got the chance to interview Dr. Agnès during the break of a conference on monitoring and evaluating international aid effectiveness. Every African country was represented at this conference as its importance is crucial for achieving sustainable development. Money wasted literally costs people’s lives for many of these countries. It was in this setting that I got to discuss three key issues with the foremost authority on HIV/AIDS in Rwanda.

In a previous interview, the UNAIDS Rwanda Director highlighted the decentralized approach of Rwanda as one of its greatest successes. Dr. Agnès reponse built on this foundation. “What I am telling you is the government vision – we want to harmonize, to align people behind one unique action plan designed according to the needs of the country.” Some foreign governments, above all France, have been overly critical of the leading party, and in the past, some painted them as a new dictatorial regime. But how was this national plan created? “We put together all the constituencies, like the civil society, the development partners, the new private sector etc, and we ask them to tell us their needs”. Identifying needs is important, but what about the decision making? “They each have their own priorities but we try to figure out what we can work on at that time. They also decide with us what to take and leave out of the plan. It makes sure people are working with less frustration when they are part of the decision.” I stop and can not help smiling at the wisdom of that statement.

The National Strategic Plan is the heart of the successful approach, but where are the arteries and veins that circulate the vision and action? In 2006, Rwanda went through an administrative adjustment. It restructured its many districts into 30 larger ones and created 5 provinces (named in their relationship to the fifth province – Kigali City). The strategic plan is entirely implemented through the district level. Everyone at the above levels are coordinators and managers instead of implementors. Each district has an HIV/AIDS committee that is comprised of a multilateral membership. The director of each district’s health program, hospital, education, and gender initiatives are included and the committee is rounded off by two vital and crucial members of “civil society”; a religious leader chosen by the different denominations (mainly Catholic, Anglican, and Muslim) and a person living with HIV elected by the local network of people living with HIV. This committee is led by two officials that report directly to the mayor (who has the authority to make decisions but in conjunction with the national strategy and policies). This approach has led to a remarkable level of success throughout the entire country. Many of the measures of success, such as testing and people receiving treatment, have more than doubled since 2005.

There are a plethora of successes, but what are the challenges? Rwanda after all is one of the poorest countries in the world, and is heavily reliant on foreign aid; now ‘there’s the rub’. Although Dr. Agnes agreed with the UNAIDS Rwanda director that evidence and data are needed to target at-risk groups, she focused her response on the issue of foreign aid. “The big challenge is what is going on in this meeting right here. It is alignment harmonization of partners in our true priorities and action plans. People come and say we have come to do statistics but okay. They don’t come in and say, ‘We have come and want to help you. We have this amount of money. Where do you need to put it.’ This is the support we need. That is how you may have some critical sectors that are not funded. Without this approach it will be very difficult to create sustainable development and you can not fight AIDS without sustainable development.” What she is really saying is that their officials understand and have worked diligently to access and prioritize the needs of their own country. The call is for budget support and not vertical giving that is targeted based on the funding organization's priorities.

Dr. Agnes singles out PEPFAR as an example of the good that can come out of foreign aid working within the framework of the government. “PEPFAR is one of the success stories because PEPFAR here is aligned to our national strategy. They don’t do a vertical program. They integrate where they have to be. We still don’t like the way they break down the money and the cost of everything because it is not totally clear but they do it within our strategy. This is only because we had the political will to oblige them to do so.”

It leads right into our most interesting topic – what was been the catalyst for this united vision and this successful program on HIV/AIDS? Her simple two word answer is one that has stayed with me from a FACEAIDS conference keynote by Jim Kim – political will. She emphasizes that programs and initiatives that will help reach the Millennium Development Goals and other goals will be implemented. Politics used to be a deadly game in Rwanda, but this is the new Rwanda. “Really we never go for pockets, we always go for national. This is important to note also – it is because the previous regime before 1994 was based on exclusion and discrimination. The new orientation is inclusion and participation, which means no place in the country is left out, no portion of the population is left out, and everything is national. What is good for the north is good for the south. What is good for me is good for you. This is a policy that is implemented for the community and that is the difference. There are no pockets.” “No pockets” is another way of saying – favoritism and ethnicity no longer apply here.

My interview with Dr. Agnès was refreshing. It was a reminder that vision is vital to solve any problem and that a pragmatic approach can create hope even in the depths of devastating tragedy. Rwanda certainly has many challenges that lay ahead, but it can point to its health sector as a symbol of success. A symbol of something designed and coordinated by Rwandans for Rwandans with financial aid coming from an international community that perhaps is attempting to literally pay for past indifference.

Postmark: This entry has been published onto Rwanda's National Government AIDS Website

Sunday, April 27, 2008

The Rwandan Genocide Memorial and Education Centre

A Range of Emotions . . .

You make your way up the steep hill on a road that looks like any other in Kigali – a dirt wall on one side and a beautiful scenic overlook of the city on the other. However this road is different because half way up you see a large modern white house with spacious terraces that is set a part from anything else in sight. It is Kigali’s Gisozi Genocide Memorial and Education Centre – the final resting place for over 250,000 Tutsi and moderate Hutus.

In an attempt to supplement this entry I would ask that you read this article to gain some of the historical perspective of what happened in 1994 and why. It is not thorough and is somewhat slanted but it at least covers a good deal of events. I will concentrate on the range of emotions that come out of the path set out by the exhibits.

Anxiety -
I knew the time to write about the Rwandan genocide would come, but I find it hard to explain in only a few paragraphs. The story is too complex to breeze over, too important to not do it justice, too recent a memory to be forgotten. Everything in Rwanda comes back to the genocide. How can it not? 1.2 million men, women, and children murdered with bullets, machetes, and clubs in less than 100 days.

Neighbor kills neighbor, friend kills friend, and family kills family. How can such acts take place? 300,000 children left orphaned. A UNICEF study estimating 99.9% of children witnessed violence (rape, torture, or murder). A youth militia death squad brainwashed, trained, and armed by the government to wipe out a piece of the population.

Sorrow -
Videos of mass graves, actual chains used to bury couples alive, skulls and bones of those murdered, thousands of photos of men, women, and children who lost their lives for simply being “Tutsi” or a “Hutu that was a traitor”. A traitor may be spared death, and was any Hutu who married a Tutsi (a very common thing) or helped/befriended Tutsis.

Mass killings took place at churches, even catholic churches. The church went as the priest did. Some accounts told of priests who died trying to make peace or hide Tutsis. Others depicted priests that rounded up their congregations in their church for shelter and then worked with the militias to slaughter their own people.

Anger over the amount of carnage and the sheer evil and vile nature of the organized killings of people based on their “ethnicity”. Anger at how easy it was to pre-register the Tutsi, block off the main roads, and then proceed house to house with death squads. Anger over the idea that one group should wipe out another. Women and children were excessively targeted as the most important aim was to make sure no new generation would emerge.

“The Tutsi and Hutu are one people, one history, and one language”. The first documented violence (occurring in 1959) between the two came as a direct result of European colonizers creating – I repeat creating – a racial division between them in form of identity cards. Historians and military call it indirect rule through divide and conquer. Despair over the fact that the French armed the extremist government after peace accords were signed in 1993. Despair over the countless eye witness stories of French soldiers getting those hiding to come out and then quickly leaving before the militia arrived. Despair over the international community disregarding eight ethnic massacres from 1990-1994. There were plenty of warning signs. It does not stop there. The United Nations refusal to acknowledge the term “genocide”, which would have legally obliged them to enter and punish the perpetrators, the withdrawal of peace-keeping troops, and the “never again” acknowledgment of their “sin of omission” all strike a resounding and familiar chord with the past year in Darfur, Sudan.

A funeral was taking place as the remains of two recently found and exhumed bodies were laid to rest at the memorial. Before the funeral the memorial became filled with Rwandans. Screams, heavy sobbing, and cries filled the rooms creating an intimate and pain filled atmosphere in which I felt like nothing more than an intruder. These were survivors. People who lost their loved ones in heinous acts and crazed ideology.

The use of the gacaca courts, a traditional tribal way to deal with transgressions. 250,000 local judges were given training on law and judicial ethics and the perpetrators of the genocide were given town hall style trials with at least 15 judges and 100 witnesses to make quorum. The most important stress is on identifying the victims (which many knew personally by name) and then establish the extent of the crime. A truly remarkable approach that has its critics but has led to starting the healing process. Click here to learn more about it.

No one in Rwanda is allowed to say the genocide did not take place. Since the genocide Rwanda has not backed down from its stance that the international community completely and utterly failed its country. It has focused on the fact that all Rwandans lived peacefully and together before the colonizers came and created the divisions. It is now known as one of the safest countries in all of sub-Saharan Africa and unity wins out over division. Moreover because it knows the chaos and pain of genocide, it has sent a piece of its army as part of the peace-keeping initiative in Darfur.

Thursday, April 24, 2008


Pre-visit Research Meets First Impressions

“The hills are alive…” but it’s not the sound of music. Instead we find many sturdy houses, mostly accessible roads, and hordes of people going to and fro. Kigali, Rwanda’s capital, is a city built on several hills marked by trees, greenery, and beautiful scenic views.(see photo) It is known as one of the safest cities in all of sub-Saharan Africa and it is a symbol illustrating the amount of change possible when leaders, organizations, and people are willing to work together toward a common goal.

When I started my background research on Rwanda I did not know what to expect upon arrival. The facts that I usually look into (recent history, life expectancy, health risk etc) were not too encouraging. Recent history focused on the 1994 extremist genocide that saw 14% of the population brutally murdered. For a perspective driven juxtaposition: 14% of the US population would be 45 million people and Rwanda is only slightly larger than New Jersey. Life expectancy read: women 45 / men 42 (nearly 66% that of India). Health risks were plentiful: a nasty form of malaria, an HIV prevalence rate of 3%, and a slew of warnings about cholera, meningitis, and yellow fever. Switch gears to providing care - are there enough healthcare practitioners to combat or address these needs? Well the figures show 3,900 people per nurse and 50,000 per doctor. These stats should jump off of the page, but the point I emphasize is what I am seeing in light of what I read.

One cannot glance over Rwanda’s status as a developing country (its 2007 GDP is 1/10th of New Jersey’s 2007 state budget). Needless to say the country is very dependent on foreign aid. Moreover, threats and struggles are realized in varying arenas, such as border tension with the Congo, the growing global crisis on staple food prices, and the everyday ills of poverty, that make Rwanda’s successes fragile. For instance, poverty in Kigali is not as visible, or “in your face”, as in Mumbai or Surat, but that certainly does not mean poverty is not a problem or it does not exist in large numbers. Perhaps it is better hidden or more likely a layered issue that takes some time to piece together? With only four days in country I can only comment on what I observe. What I see is many beautifully groomed main roads lined with trees, trimmed bushes, and freshly cut grass. More importantly, I see direct responses or positive steps toward addressing my previous fact-finding results. I see HIV awareness billboards all over the paved streets (see photos). I open the newspaper and read about the government launching an integrated health system through Partners in Health and the Clinton Foundation. A measure that will train 21,000 health advisors and rise to 40,000 as time goes on. It is a joint style that believes in high quality medical services for all people and focuses on holistic approaches (infrastructure, provisions of water, electricity for health facilities etc). Also of note is the daily public reminders of the genocide but the approach is meant to build unity not make excuses or deny the past, which are jailable offenses.

Many of the daunting facts that built an impression before stepping foot in Rwanda are present in the media and appear to be an issue that a plethora of organizations are combating together. In all my travels I have never seen such a presence by the international community as I do in Kigali. Visibility is of course enhanced by Kigali’s small size, but it does not dismiss the shear volume of organizations. There is still much work to be done, but there is a sense that the direction and ingredients are here on the ground.

Sunday, April 20, 2008

Setting the Stage

A Movement in Rwanda is Catalyzing Hope

The first piece of the three-stage flight to Rwanda is complete. I write from Amsterdam’s international airport with a looming 4 hour lay over. This gives me the opportunity to do something I normally do not – set a stage before arriving.

When I began planning this project I knew that the sub-Saharan portion would most likely be the most difficult. It would prove the most challenging to plan, the most expensive to price (an airline ticket is nearly double the cost of any of my other flights), and perhaps the most telling in the effects of HIV on a community, a country, a region. The efforts of Partners in Health in Rwanda has been something I have wanted to see, witness, and document since helping raise thousands of dollars for its cause through my FACEAIDS chapter at Fairfield University. We would get emails from the field and personal stories of success making Rwanda this intimate yet intangible part of our motivation. The culmination of why over 120 universities had FACEAIDS chapters was exemplified in Dr. Paul Farmer’s keynote address at last November’s national conference.

Farmer’s speech highlighted the unified efforts of the Rwandan government, the Clinton foundation, and Partners in Health (PIH) to develop a national healthcare system that maintains the model that has made the Boston based ngo the gold standard of HIV treatment organizations. It was the message of a combined effort that resonated with me during his talk. So many players on this stage, yet one clear mission – creating and implementing a healthcare system that brought health, development, and human rights together. The “story” is best explained in this recent article from the Boston Globe. It is full of insight and spirit and best explains why it is a privilege to document the work being accomplished. I only hope my writings from Rwanda capture the same vivid message of what I call a movement.
I was introduced to the “movement” through Partners in Health’s projects, but the more I researched about work being done in Rwanda I saw that many entities are invested in making a difference in the country. It is this movement that is bringing hope to the “Land of a Thousand Hills”. It paves the way for a bright future that no one could have predicted following the 1994 Rwandan genocide. In the aftermath of 800,000 Tutsi and moderate Hutu deaths Rwanda has found a way to reconcile and move forward with the goal of the whole in mind.

In two weeks time I will be onsite at PIH’s countryside hospital/clinic. Before that I will be in the capital of Kigali meeting with representatives of the United Nations Develop Program, the Rwandan health ministry, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) as well as other organizations, such as Orphans of Rwanda and FACEAIDS. The meetings will focus of how each of these entities plays a role in the movement. It is with great anticipation and over two years of “hearing, reading, and fundraising” that I embark on this leg of the Global AIDS Project.

Thursday, April 3, 2008

On the Hill

Two Days at the Capital give Insight into the World of the Public Sector and HIV

I have had the privilege to document some of the most effective models of providing HIV treatment and prevention around the world. I will soon be departing for Rwanda to cover Partners in Health’s famous model that addresses the HIV epidemic through development and working with local communities and the Rwandan government. The United States of America is responsible for much of the increased funds that support and foster the progress that has been made throughout the world in combating HIV. Both the public sector, through programs such as PEPFAR (The President’s Emergency Plan for AIDS Relief), and the private sector, such as the Clinton and Gates Foundations, have made great strides in addressing the vital components of treatment and prevention. However there is a startling rise that is calling our government officials to take a deeper look domestically and maybe learning from programs abroad.

The Washington Post ran an article covering a recent report, which in the words of government officials I ate dinner with, shocked the Hill. One would think the story was about an exposed affair or high level corruption charges but it was not – it centered on the alarming rise of HIV in Washington DC. When people think about an HIV epidemic and children infected during birth, their minds travel to “other” places, such as India and sub-Saharan Africa. However, the study reports DC in a “modern epidemic” and shows cases of infection through birth; something unthinkable in the states because of readily available drugs that can greatly reduce the transmission rate from mother to baby. Lastly, the report strongly emphasizes that there is a clear racial component to being HIV infected in DC – the subtitle reads “More than 80% of HIV Recent Cases were Among Black Residents”.

This Washington Post article on the rise in HIV infection was followed by a recent announcement by the CDC that "1 in 4 teen girls has at least one sexually transmitted disease". The core facts of the study show that there is a serious issue of sexually active teens who are at risk of dangerous consequences, such as infertility, cervical cancer, and HIV. Many factors play a role in the alarming figure. The taboo nature of discussing sex within families, schools, or churches, the inadequacy of many health education programs to cover the in depth issues of STDs and condom use, the sex drive of teens, and simple myths or misunderstanding create an arena where HIV and STDs can flourish.

Given these two reports that highlight HIV on the rise and the prevalence of sexually transmitted diseases, I posed a question to US Senator Tom Coburn of Oklahoma and Congresswoman Michele Bachmann of Minnesota if they would support universal sex education that approached the issues in an objective fact based scientific manner. Their responses spoke volumes. Coburn, an obstetrician by trade, acknowledged the reports as very serious and concerning. His response focused on the difficulty of presenting all the issues properly, such as that condoms do not always protect a person from HPV (the virus that causes cervical cancer) or herpes. Congresswoman Bachmann spoke of the role of family values and her strong support of science but did not delve into anything of substance. I attempted to push the issue and discuss the merits of empowering teens through teaching about transmission of STDs and the role of condoms in preventing HIV. However, her assertion that science has not shown condoms can completely prevent HIV transmission left me dumbfounded. Was she arguing that condoms do not have a 100% yield or did she simply not know her science; after all the CDC has hailed latex condoms as “highly effective when used consistently and correctly” for deterring HIV transmission.

The prevalence of STDs and the alarming fact that HIV cases are both rising in some cities and are heavily racially disproportionate depict the importance of the public and private sector to reassess how we address HIV and STD prevention. One non elected official spoke candidly how we can learn from the successes of the projects abroad and implement them here in the states. It caused me to think back to the various organizations that I have covered. Though differing in region, culture, and religion many of them maintained the approach that to affect change in a population you must start with the individual and community. Here the goal is the empowerment of the person through education and awareness and it is a concept that can find support in both the public and private sectors. Unless we expect our sex-sells culture to change or the biological sex drive of teenagers to disappear, then the answer for prevention has to be found in obtaining a level of understanding about STDs and the various methods of prevention, such as male and female condoms, abstinence, and faithful monogamous relationships. I would heed Senator Coburn’s advice on the challenges that sex education can present but I would assert that a comprehensive lesson plan can be achieved and should be achieved.

Friday, March 21, 2008

Famous Jesuit Challenges People

Keynote at Boston College Sees World Renowned Jesuit Challenge Christians for a Better World

If a Jesuit university is not being persecuted, then something is wrong!" Father Jon Sobrino made this statement at Boston College this past week at the end of his keynote address entitled "Jesuit Catholic Universities in the 21st century". It encompasses many of the virtues and beliefs espoused throughout his lecture. Father Sobrino is the renowned Jesuit theologian famous for his life long struggle against injustices and human rights violations in El Salvador. He was the spiritual advisor to the martyr Archbishop Oscar Romero. Romero who was shot dead by a right wing death squad on March 24, 1980 while celebrating mass and is heralded as the Mahatma Gandhi of Latin America. Father Sobrino narrowly escaped assassination at the university in El Salvador that he founded. He was away giving a speech abroad when six Jesuit faculty members and two lay workers were murdered by the army for teaching and preaching against the establishment (the government, the military, and people of privilege) on behalf of the poor who were suffering blatant human rights abuses during a vicious civil war.

Some people may think 'persecution' an odd choice of words but when you listen to Sobrino you cannot help but feel you are in the presence of a modern day prophet. In Catholic pedagogy prophets speak truth to those in power. Although his tone was softer than his written words, Sobrino's passionate discourse challenges the very core of American culture. He contends that consumerism and capitalism are flawed and that Christians (he believes the term Catholic is too narrowing) and especially Jesuit Universities should be attempting to come up with different or altered economic models. His argument is based on Jesus' preachings of the 'here and now' reign of God on Earth as stated in the Lord's prayer "…on earth as it is in Heaven…". Sobrino warns us that consumerism and the capitalism in practice today are overwhelmingly exclusive and wrought with injustices. He observes that consumerism causes people to extend themselves, live beyond their needs, and excessively use resources. The capitalism that he denounces preaches the accumulation of wealth and the building and building of capital often at the expense of others. Rather, he espouses a model that "rejects the accumulation of wealth and capital and is based on providing basic needs and the pure word of development".

While I believe both 'isms' have their positive aspects (e.g. helping to create and maintain the overall economy and support the private sector), each has the potential to be gravely misused. In the USA, whether we look at energy consumption, the role of corporations and corporate capitalism, or our foreign policy, it is evident that a disproportionate amount of our wealth and power is concentrated within the hands of the few. A recent CNN article notes "US income disparity reaches highest since 1920s". With all the excessive gains and wealth created by the US and world economies there are still billions living without access to clean water, dignified living space, or the rights to quality education or healthcare.

Sobrino challenges all people and especially Christian universities to have a mission of "influencing society in the right way". He speaks of the "crucified people". These are the overwhelming majority of the world population that live in poverty or face human rights violations that keep them oppressed. He challenges us to look at these people as Christ on the cross and to do two things. First, reflect on why these people are up there and if we did anything in anyway to aid in the process. Second, ask ourselves what are we doing now to help that person down.
How do we do this? Sobrino would say through solidarity and "a compassion that lights the dark spaces of the world". Some may dismiss him as a communist or socialist but they would be stuck in the past and not understand his message. He is talking about humanity and how the social institutions should have a mantra of "research with reason": Look at what is wrong with this system and tweak it or develop a new one. Perhaps instead of stressing accumulation of capital, the stress should be on pure development and basic needs. Perhaps multinational corporations that have long been accustomed to running rough shod over foreign governments and labor markets should have to take into account universal labor rights and environmentally friendly approaches. Perhaps instead of giving CEOs 50 million dollar bonuses the money could be used to create new jobs or run corporate social responsibility programs.

Sobrino's message brings hope but focuses on reflection, the courage of action, and social responsibility. It puts less stress for change on the institutions and large entities and more on the person and the individual. It transcends religion and is a cause that anyone can take up.

Monday, March 10, 2008

The Power of Individuals

Speech at UN Focuses on Two Women Who are Changing their Communities

“Can you link your experiences to give a speech about women peace builders?” The answer is yes, but how to do it became quite the internal debate. Who do I choose? How should I present the issues? All I knew is that the audience would be members of the International Movement of Catholic Students – Pax Romana and the location would be at the UN plaza. Hailing from all over North America and with representatives from Ivory Coast, England, India, and Bangladesh, I took my seat and began to tell the stories of Daxa and Maria.

In a perfect world I would have had an opportunity to show the audience the four photos I had selected, but then again in a perfect world their would be no story to tell. The first two photos were simple full body pictures. Maria is there in a plastic multicolored hammock with jeans and a t-shirt. Leaves from a banana plant provide shade and in the background one can make out the red metal sheets of her out house style bathroom. Daxa’s photo shows her in a beautiful white sari with her traditional gold nose piercing and dark red wedding mark on the middle of her brow. A mere glace at the photos would convey the differences between the two women. Religion, culture, appearance, even continent, nothing would lead someone to initially create parallels.

Pictures are said to be worth a thousand words, but rarely do they provide the viewer with the story. Everything that unites these women comes as a consequence of their status as HIV positive and what links them is their struggle. Both Maria and Daxa had “normal” lives in their communities. They committed to a relationship and remained faithful to their partner. However neither expected to become HIV positive from their spouse and neither expected what could come from such news. Maria’s church criticized her, her family disowned her, her employers fired her and the hospital, the place that should have understood the situation best, treated her as if she had the plague and did not keep her status confidential. Daxa too was not spared ill treatment at the hands of those who should have known better. She was provided no counseling when she tested positive as a pregnant mother and went through an abortion because she thought her baby would die soon after being born. Furthermore, the hospital attempted to overcharge her various services because she was HIV positive. Between the heavy stigma and the ostracization, Daxa and Maria could have given up or succumb to the depression that clouded their minds. Instead, we would flash to the last two photos and see what path they have chosen.

Maria and Daxa made a decision somewhere in this journey to stand up and be a pillar for those who were in similar situations. Both were instrumental in beginning HIV support groups and networks that have given HIV positive people a fighting chance to, at least, not struggle alone. The first picture is of Maria addressing the audience at the official inauguration of the city’s only HIV self-help group (see December "Inauguration" post). Her group does not have a working relationship with the government and finds it’s support coming from a local NGO and its funds coming from a German NGO. The group has had some difficulty recruiting members and had 15 members for the entire city last November. However with each public speech and awareness campaign the visibility of the group increases and, hopefully, any stigma maintained by audience members decreases. The services they provide run the gamut from hospital visits to group declamations for violations of rights. Daxa’s photo shows her giving the inauguration address at a TB/HIV Center that unites NGOs, the government, and India’s largest corporation with the positive people network that she heads. The group now has grown to over 3,000 members and has an office in one of the hospitals for counseling and testing. She wants no pregnant woman to go through what she did. Last year they were responsible for getting 2,051 people HIV tested and they still do house to house follow ups and awareness programs.

Within only four pictures and brief explanations the audience can see the power of the individual. Maria and Daxa have dealt with and lived through many hardships, and have responded with dignity, courage and an impassioned voice. Maria’s wildest dreams would include the success that Daxa’s work has achieved, but her access to resources does not allow it thus far. However, they both would agree that success is based on individuals and not raw numbers. The importance of providing a physical place to call their own, a place where there is no discrimination or stigma, has not been lost on either women. Both women are not professionally satisfied as the presidents of the groups and still face very real personal struggles. Maria struggles to find work to feed her family healthy portions and also to buy secondary medications for opportunistic infections. Daxa meets children who are HIV and relives the pain of aborting a child that she now knows could have been born HIV-. Her health is also an issue as her medications have been increased after adverse reactions to the previous ones. However, these women understand that life is about struggle and responding to it – if not for yourself, then for others – and this is why I label the presentation “Women Peace Builders”.