Stronger in Gambia, Despite HIV
May 11, 2009, —
By Lane Hartill
Abdulai tried to find Musa, but he'd already fled. That wasn't good. Not
good at all. He knew if he didn't find him soon, things would get bad. Really
bad.
Students in Africa create AIDS message costumes at school in an effort to raise awareness of HIV and AIDS. Photo by Sean Sprague for CRS
He knew Musa was somewhere in southern Senegal, knocking back traditional
elixirs that he hoped would kill the virus working its way through his body. As
a marabout, an Islamic religious teacher, Musa had always taught his
followers that reprieve was found in the bitter potions prepared by wise men.
But there was no cure. Musa couldn't wash it out, asphyxiate it or pray it
away. It had strengthened, and it controlled him now. He would have to return
to The Gambia. He would have to go see Abdulai.
For months Abdulai and other counselors told Musa that this thing called HIV
was in his body, and if he wanted the drugs that would save his life, he had to
tell someone he had it. That's the law in The Gambia if you want access to HIV
medicine. But Musa wouldn't admit what he had.
But now, given his condition, things had changed. He knew he'd have to do
the unthinkable: Tell his brother he had HIV.
Abdulai gets the call at night. Musa is back, they said, and things aren't
looking good.
He is lying on his side on a foam mattress on the floor. In the dark room
with only a single window, shadow and light caress his face and filter through
his graying goatee, aging him dramatically. A stranger would think he's in his
70s. But this respected Islamic scholar and father of two small children is
only 36.
The Catholic Development Office health team, which is supported by CRS,
tries to reach people like Tacko, a 20-year-old with a glistening gold tooth in
an otherwise perfect fence of white teeth. This gentle young woman will look
you in the eye, flash a smile, and in tender, halting English, tell you one
horrific detail after another about the last three years of her life.
She'll start with how her father forced her to marry a "bumster"
at 17. That's Gambian slang for a young Gambian man who prowls the beaches and
streets of Banjul, the capital, looking for female European tourists to charm
and seduce. The payoff ranges anywhere from dinner to tickets and a visa to Europe. Tacko claims her husband had been with two "white women." She was next.
She soon became pregnant. Then her parents died; her siblings moved away.
Shortly after that, she had a baby boy, who died two years later. Then the
diagnosis: HIV-positive.
Now she works for the Catholic Development Office, counseling people like
Khady. Khady is HIV-positive and mottled with a black, bumpy fungal infection.
Still, she tries to look nice with her double pierced ears and a collection of
beaded orange bracelets on her wrist. It's not just her health that's a
problem, it's her husband. They hadn't talked in two years and they recently
divorced. She's trying to raise three little ones, aged 5, 7 and 9, alone. Now
she's single, losing her hair and covered in something that looks like
ringworm. Will any man, she wonders, want to marry me?
That did it. In her bare concrete room, with her fussing 5-year-old
squirming on her sagging mattress, Khady's life got the best of her: The
ex-husband who sends their kids away when they go to visit him, the pathetic 58
cents she makes a day selling snacks at a school, the itching rash. Her eyes
freeze and a warm glaze of tears coats them. No wracking sobs. No wailing. Just
a 28-year-old mother trying to hold it together as her life falls apart around
her.
'It's Not a Curse'
Across from her, Tacko sits on a stool. Legs out straight out in front of
her, she's rocking back and forth, the memories coming back. She seems to be
waiting for the right moment. The room is quiet. A chicken pecks the dust
outside the front door.
"It's not a curse by God," she says, suddenly. "You are in a
much better position than me. Your mother is living. Your father is living. All
my people are dead. Me, after work, I go home and have to cook. I work all the
time."
Tacko's feet are now out of her sandals, elbows on knees. She leans into
Khady, like a coach consoling a distraught player.
"The greatest problem is to keep thinking about it," Tacko tells
her. "That causes depression. Join people in whatever activity they are
doing so you won't be isolated and discriminated against."
Khady wipes her eyes. She says it helps hearing Tacko's story, to hear
someone who has been in more pain than she has.
Tacko ribs her about her hospitality. They laugh. A connection has been
made.
In 15 minutes, Khady went from a distraught single mother covered in a rash,
to a woman who now sees her life in a different light.
When everyone leaves, Khady is standing with her family in the sun, smiling.
He's so thin his hands appear overgrown. His knees are as big as
grapefruits, his legs as thin as baguettes. He opens his mouth, but nothing
comes out. His voice disappeared yesterday, says his older brother, also a
marabout, who sits next to him acting as an interpreter. He says Musa hasn't had
food or water in three days.
A bad smell fills the room. Nobody says anything. Musa's wife will come and
change him soon. She will wonder what he has; he still hasn't told her. Men
rarely tell female members of their family they have HIV. Men say they're too
chatty, they gossip too much. Men confide in men; they say they keep secrets
better.
Caring for the Neglected
Abdulai deals with people like this every day. When Gambians' savings dry
up, when their friends don't stop by on weekends for tea, when the virus starts
to win and they start to give in, they turn to people like Abdulai. He, along
with a team of 11 others, works for the Catholic Development Office, a Catholic
Relief Services partner that works with HIV-positive Gambians and orphans and
children.
They do what few others are willing to do: pay attention to those with HIV.
They roll them over and teach their families how to clean bedsores; they push
needles into their arms and let IVs drip into their veins; they fill cups of
mouthwash.
Weekends are often given over to caring for others. They drive on the
washboard roads and sit in patients' dank rooms all day long. They counsel
them. They laugh with them. They tell them HIV is like any other disease; you
just have to manage it. They also pay for orphans to go to school; they even
buy them shoes. They also help those who are ill but not HIV-positive.
Villagers just know them as people who care for the sick. Confidentiality of
patients is a priority.
Abdulai and the others work in Bassé in the eastern end of The Gambia, a
country shaped like an appendix that worms its way into the side of Senegal, on
Africa's west coast. For many Africans, Bassé is just a stopover on their way
to someplace else.
The rusted buses that disgorge Africans into Bassé also bring HIV and
misperceptions. Many people here will tell you HIV is a two-step disease: You
get it. You die. While the HIV prevalence rate in the country is officially
only 2.5 percent, the rate in Bassé is almost certainly higher, say HIV
experts.
Impromptu Classrooms
That's why you'll find Sister Alexis, Catholic Development Office's team
leader, and the rest of her crew hauling speakers into villages, cranking up Youssou
N'Dour and Jaliba Kuyateh, popular Senegalese and Gambian singers. At a recent
music night, just as the crowd had swollen to 500, just as it had worked itself
into a lather, they cut the music. Then they pumped up the HIV messages. Come
and get tested for HIV, they encouraged the crowd. Couples, before marriage,
you need to do this, they told them. With several testing centers in eastern
Gambia, in 10 minutes, anyone can know if they have HIV.
That's not all. A touring question-and-answer game show also makes the
village circuit. They talk to kids and adults about HIV and promise prizes—cooking
pots, bed nets, soap—if they answer questions correctly. In this poor region,
free household items are much appreciated. People pay attention.
Community educators from Caritas, a CRS partner, use illustrations to explain how HIV is spread. Photo by David Snyder for CRS
The Catholic Development Office also has a monthly radio program in which a
panel talks about HIV. It's translated into three local languages. The outreach
seems to be working. In December of 2008, 127 people were tested, up from 19 in
February.
New Ways, New Lives
Back in the dark room, Musa is still in the same position, his hand
elegantly poised under his chin, like a sage considering a request. Abdulai
will return later this evening with an IV drip for him. They'll get him started
on medicine. Musa's strength will return. He will even start talking again.
"We are very compassionate," says Sister Alexis, sitting next to
Musa. "We bring ourselves to their level."
The care—the body powders, the sponge baths, the quiet conversations—are
essential. But more important is Abdulai's willingness to hold a man most
people won't go near, to sit in a foul-smelling room and not flinch. Gambians
see this. They appreciate it. They now are able to see themselves living to old
age.
Take Jawo. Not long ago HIV had shrunk his athletic body to 88 pounds. All
he could think about was his children, and who would take care of them when he
died. When HIV is with you, he used to think, you can't survive.
Now, with the help of Sister Alexis and the team, he's back driving taxi
again. He's regained that loose gait of a retired basketball player. He even
thinks about retirement: He will build up his herd of cows and milk them as the
sun sets in the evening. He will mix the milk with sugar and millet. Then he'll
sit back with his porridge and watch his grandchildren swirl around him.
Musa, Jawo and Khady are pseudonyms. Their names have been changed to
protect their privacy.
Lane Hartill is the West Africa regional information officer for Catholic
Relief Services. He is based in Dakar, Senegal.
