MEETING

After the camp, I had 3 days of AMREF meetings. A pretty drastic change in energy levels and activities, but interesting nonetheless. One was a community mobilization meeting designed to inform communities of the importance of Adolescent Sexual and Reproductive Health programs and education. For perhaps the first time here, I actually felt like everyone in the meaning was on the same page, was committed to the small job the committee had at hand, and competently represented the department from which they came. It was exciting, in a dull-meeting sort of way.

The second meeting was with the Council Health Management Team. Doctors, nurses, in charge of STDs and VCT and PMTCT [prevention of mother to child transmission of HIV], and antenatal clinics – all the bigwigs were there. Even the head doctors of the District and Region were there. Big potatoes.

The meeting was again mostly uneventful. We were discussing Youth Friendly Services in health care facilities here. Man do we take things for granted in the states. AMREF is collaborating with the TZ government to try to teach health workers things that I would take for granted: not demanding bribes for services, not being judgmental towards youth [YOU want birth control? You’re too young to have sex!!], keeping confidentiality and privacy [BIG issues here], etc.

There were some interesting English/Swahili language issues in the meeting, a few mistranslations, and somehow the African nation of Mauritius was assigned the characteristics of being #1 in the world for tourism and for condom usage [huh?! Someone will have to do research on that, but I highly doubt both attributes. Mauritius does, however, have a much lower HIV infection rate than Tanzania, which is what brought this discussion about].

By far the most interesting part of the meeting was when one of the research presented findings on a ‘Simulated Patient’ exercise. Basically, the took 4 young people from Mwanza town and taught them how to act out 3 basic situations: 1) a young man wants condoms 2) a young schoolgirl wants birth control and 3) a young schoolboy is afraid he has an STD and wants advice. They were then sent to various health facilities with hidden microphones to see how they would be received and what services would be provided. INTERESTING!! Oh man, I can’t remember the last time I’ve been so fascinated by something I’ve read here! These young people had all kinds of experiences – some places they received great treatment, confidentially, privately, by health workers who knew their stuff. Other places – oh man. They were charged excessively for services that are supposed to be free, they were asked in front of 10 village elders what their problems were, were denied condoms because they were uncircumcised [but first they had to STRIP in front of a nurse to ‘prove’ if they had been circumcised or not!], etc.

I spend all my time teaching young people to go to the health center to get advice, get condoms, get treatment [so many young people here with STDs! as high as 1 in 3!]. They roll their eyes sometimes, but typically agree. I can see why it’s easier said than done. However, there really are some FANTASTIC people here who are doing TERRIFIC work and making a difference in a system that, all things considered, has come a long way in recent history from what I can tell. It’s just the few bad seeds that really spook these young men and women from getting services that could be life-important.

On a similar note, after leaving my meetings I met up with some of my fellow AMREF co-workers, who work in a mobile VCT [voluntary counseling and testing unit]. They basically drive around all over the region to set up and do HIV testing. It is incredibly popular, especially since people do believe that confidentiality is low and are afraid to test for HIV and the health center close to them.

They were in town, and decided to go to the high school. The students went nuts!! So many of them listened attentively to advice [much more so than when they listen to me in the classroom, received counseling, read materials on nutrition and protection and the like. And around 50 or so students actually got tested. I stressed to them that this isn’t a game, it’s serious, and they should only get tested if they are ready to accept the possible outcomes. Statistically, of the 500 students at the school [300 boys 200 girls], probably a handful of boys [3-8] have already been infected with HIV, and even more girls [maybe even 10-15]. It’s terrifying. A study done in Misungwi in 1998 found that 5% of 15-19 year old girls had HIV. And the numbers go way up when you look at both men and women between 20-34.

So some of the students tested, which is great. Even more importantly, I think, is that they ALL saw the testing unit come, saw some of their friends testing, and confronted it as something that is important in their lives and is reflective of some of the major issues they will face as they begin exploring and entering adult life.

I’ve kind of become hopelessly dependent on the youth here, emotionally, in terms of having a prayer of changing directions and reducing HIV infections in Tanzania. There are lots of middle-aged men and women with shit behavior – they sleep around, they don’t use condoms, and especially older men: they really like to have sex with young girls still in school. It’s disgusting. But even though these youth are growing up in this environment, I have hope that things are different, that this generation is different, they’ve grown up in the era of AIDS and have seen it’s effects, and they can and will rise to the challenge and start turning things around. I really, really need to believe this.