Letter to Shelby Davis

Dear Shelby,

It is the day after thanksgiving in the US. I am not in the US. However, the boss I am working for at the Ministry of Health is a short term consultant from the Maryland and she reminded it was thanksgiving. It is only right to write you then, to once again, say thank you!

The name of my boss is Jeanne Cushing and she is an amazing near seventy year old lady. I have the privilege to work with her on a census of all the health facilities in Namibia. She is employed by an agency called MEASURE, which is funded by USAID. MEASURE does surveys all over the world to evaluate health services and collect demographic and health information. I am now working on the evaluation of health services part – I was the data editor for our census. From Jeanne, I am learning the software language, the programming language, which allows for data to be collected, entered and analyzed. Challenging. But then again, I am glad for it.

When I first came back from the US, I had trepidations. I was not ready to just live outside of school. Now my fears are gone. The Lord is helping me day by day. As I wrote earlier, about one year ago, I want to enter the field of public health. I cam back here a molecular biology bachelor’s degree holder. I was psyched by the messages at graduation, by general Patreus who said that a career in the public service is worth it. Katie Kurik, our class day speaker, said for once Princeton students have to work for the government and so that is what I am doing. I had my CV and I had my interest. So I went to the directorate of special programs (HIV, Malaria and TB) of the Ministry of Health. I spoke to one of the public health workers there – Mr Dumeni – who works for monitoring response and evaluation. I told him I was interested in prevalence and incidence of HIV and TB as well as learning how it was collected. I spoke about high risk groups. Basically, I was throwing whatever I was interested in at him. I told him I was a molecular biology graduate who wants to transition into public health. I sent my CV and the next day (a Saturday), he calls and says “We are doing a census on health facilities, would like to be considered as a reserve interviewer?” I accepted and I went for the training. There I learnt a great deal about health and how information is collected and even more from actually doing interviewing for the first week of the census.

It has been five months of work, but it has been worth it. In the process, I have discovered my love for medical anthropology, through the ethnography “Will to Live” by Joao Biehl (he is at Princeton, but I never took his class).

I have created my own “Princeton in Africa” fellowship. My work in the census has really taught me a lot and now the funds from it will be used to pay for my public health masters here in Namibia. I am lucky. Just this year, the Center for Disease Control (CDC) gave $500 000 to the University of Namibia to improve the public health program. So I will benefit from that grant and the co-operation with Washington University. I plan to do an awesome thesis. The challenge for me is to learn as much as I can. This is what I wanted and boy did I get it.

I feel really powerful. I am working and I know I can make a great contribution to our public health improvement through research.

In addition, I am volunteering at my Catholic Church. I organized the youth members and so far we have gone on two volunteer trips at non-profits that provide care to orphans and vulnerable children. I wrote a letter advocating for more condom access to the youth and it was published. Now, after Princeton, I discover I can write! Reading my thesis again, I see that I really can.

I still dance, but I started hip hop now. I am enjoying it, it is a challenge, especially the break dance. I will come back to contemporary (what I did at Princeton), but now I need to at least perform once as a hip hopper. I have met extraordinary dancers, instructors and artists. By knowing them and myself through dance, I realize again how I would never be content as a professional dancer/choreographer. I need to research. But I need to dance too. It is a healthy tension between the two that I aim to live. I accept that dance is my cherished pastime.

Princeton is far physically, but in my mind it is near. You too are near, because I think of you often. So now you know, I am doing something different from what I majored in. Princeton was a learning experience, where I found myself. As you know, in Namibia, young people are pressured to enter fields of study that are most urgent: medicine, law, pharmacy and engineering. There are no liberal arts colleges here or South Africa, where most of Namibians study. Now, how many of them are unhappy with it? I have a friend who studied biotechnology in India, but now she is a full time Evangelist. Another one of my friends from high school is leaving pharmacy, because he feels it is a “dead end job”.
I pray the Lord will guide them and everyone in the right direction. Thank you for this opportunity!

I am also a valuable resource for Namibian students who want to do undergrad studies in the US. I have volunteered at the American Cultural Center and plan to do so again. In addition, I want to take part in the United World College selections.
However, my thesis work comes first.
I am tired now. I will go to bed before I lose more coherence in this letter.
It is Friday the Shabbat – Shabbat Shalom. There is no Center for Jewish Life here, but I still remember the songs I sang there on many a Sabbath with my friends.

Shelby, I hope this letter finds you and your family in good health!

Yours faithfully

Pancho Mulongeni, ’09, Namibia

HIV and KSHV

I yesterday attended a meeting by the HIV Clinicians society called "Towards Universal Access" and it was about HIV/AIDS in Namibia.
I went there with baggage - my interest in finding out whether the ministry of health follows the number of diagnoses of Kaposi Sarcoma patients.

So the meeting had lots of percentages. There was the global perspective and there was a Namibian perspective. The percentages were always observed over expected times 100. Simple enough. The number of people that are observed to receive XYZ over those that we expect to receive XYZ.

The indicators included patients on ART (anti-retroviral therapy), adult and children, access to PMTCT (Prevention to Mother and Child Transmission of HIV).

The presentation about Namibia was given by Dr Martin Odit, who is the UNAIDS technical advisor for HIV/AIDS in Namibia. He is an epidemiologist and a phycisian.
He said the data was collected via ePMS, an electronic database for managing patients who go to the ART/CDC clinics all over the country. The ART/CDC clinic records information for patients who are HIV+ but not do not yet need ART (pre-ART), patients who need ART.

The ePMS system collects information in the registration boook, pre-ART register, HIV patient care booklets, ART registers, lab request forms, amongst other referal forms (Ministry of Health and Social Services, Supportive Supervison and Mentorship Visit Checklist for M&E at programme level). However, it is not sure that all of this information ends up in ePMS.

Surreal Annaul giving

I picked up the phone and on the other end, I heard the voice of an American young woman.
Slowly she started the conversation "Hello, is this Mr Mulongeni?"
Was she calling from the CDC or USAID office, what would they want from me now on Sunday evening, just after dinner.

"Yes it is, this is Pancho", I replied in hope of some like job offer (even though I am going to be a fulltime student next year, its good to be wanted).

"I'm from Princeton".
Junior, Tigercall, annaul giving. This was the content of our exchange. I asked her what class she was and she told me that she was a junior.
The accent. I noticed it now.
I could imagine her calling from Princeotn, where the sun is just about setting, from a cubicle in the housing buidling (is that where they do Tigercall).
Now I am off to donate my $10 (I can't donate less than the cost of the call!)

I meant to write Success, in any case

So that is it guys. I wish I could post more, but I am of to watch the Namibia : Struggle for Liberation series, which inspired my bread article.
I hope my blog has not become inspid.
I hope so.
Please read the bread article it is revised.

So what will I do now? On my schedule it says I watch the liberation series and then what?
I will write a letter to my grandmother! Yes, because I wont be there this Christmas so I need to write her a letter. Today she sounded really emotional on the phone "We picked all these "musmuhli (bulgarian fruit - i don't know what it is in English) and they are your mother's favourite, but we can't send them over, you are very far, very far away".

So guys, some of you reading this are near physically. Others are distant,
Comunque siate tutti vicini al mio cuore.
Vi adoro
(In any case, you are close to my heart, I adore you)

Take care!

Sucess

There were success this weekend.
Finally, we made it. We went to the Catholic AIDS action center, where we played with the orphans. We had no choice but to improvise - we arrived to find kids already in motion playing soccer. We could not stop them. So we asked those seated under the thornbush trees that characterise our landscapes to play with us. We played on the yellow and brown coloured fields.
It was real fun.
Though we outnumbered the kids at least 3:1 (most of them were inthe other game, where the center co-ordinator was refereeing when we arrived).
Next time I will plan accordingly and in advance schedule with Mary Beth.
Amaizing woman, how does she do this? American of course (the name) , she is not just any other volunteer. SHe is an adult about 30 something and she is doing this work ! So she doe snot fit the profile of a recent college grad from an Ivy league institution who wants an African experience as a peace coprs volunteer.

I will arrange for us to go again give that the kids want to go.
The teachers of the kids (who are students of the Holy confirmation) praised me somehow during our reflection. Mr Pandeni, who also taught me confirmation classes, said that now the fruits of the Holy Spirit were beginning to show.
I want to post the pics.

Bread and Health

Preface: The brown bread I baked today flopped, but this article should go down nicely. Enjoy!

Today, the main types of bread that Namibians purchase are white, brown and whole wheat. Brown is the least the cheapest and least desirable of the three; one will always find it when all the white has run out at the local grocery store. White bread is bought by virtually everyone, while whole wheat is consumed by a select, mostly white, health-conscious stratum of society. Brown bread is the mutt, being neither white nor whole wheat, it looks like white bread dirtied by bits of dark wheat bran.

I just learnt that before Namibian independence – during apartheid days – white bread was for whites only. I saw a vivid representation of this in the film based on the autobiography of Sam Nujoma – the founding father of the Namibian nation. The scene I am referring to takes place in the late 1950s, when the anti-apartheid movements were just crystallizing. A young boy goes into a small shop (our word for grocery store) to buy a loaf of brown bread. Though he sees there is only bread left, he delays his purchase by looking at the other wonderful eats in the shop. When his eyes finally wonder back to the bread shelves, he notices the bottom brown bread shelf is empty. So he takes a white loaf instead. Immediately, the shop owner apprehends him and informs him of the status quo: “Don’t you know that white bread is only for whites?” before he sends him off with a warning to never set foot in his shop again.

Of course, the irony of this apartheid policy is that brown bread is actually healthier than white bread. There is a great deal of literature dealing with the health benefits of eating brown and whole bread. Organizations such as the Heart Foundation of South Africa can provide one with detailed information surrounding this fact. For our purposes, it is sufficient to note that since brown bread flour is less refined that white bread flour, it contains nutritional value that is lost during the refining process.

But in the eyes of most black people today, brown represents the inferior food they ate back in the days of the struggle. Akin to the, substandard Bantu education they received at schools, brown bread is part of all that was of no worth to whites and so it was allocated to the blacks. It is therefore no surprise that black self esteem in post apartheid Namibia is tied to the bread black people buy: “I think it is something subconscious, but I go for the white bread and not the brown… its probably because white bread was only for whites then and brown bread was all we could buy” tells Selma, a black medical doctor. It is ironic that even a medical doctor (who is fully aware of the fact brown bread is healthier than white bread) will consistently choose white bread. But Selma is aware that her purchasing choice underlies a deep, psychological desire to attain self worth through the consumption of ‘best foods’ – that which was reserved for whites.

Now I do not mean to belittle the point that certain people may just dislike the taste of brown bread. Individuals will have their preferences, irrespective of their race. What I am asking is that we examine the prevailing assumption in Namibia that black people will prefer to eat white bread if they are given the choice. The aggregate of individual distastes for brown bread produce a collective distaste amongst our black communities. Indeed, when we look at aggregate, we realize how individual preferences are dependent on collective representations. A dislike of brown bread is not just arbitrary, but is influenced by the culture one lives in; a culture that transmits untouchable values from one generation to the next.

The field of study which deals with the cultures of people is called anthropology.
In the case of black of black people who avoid brown bread, this culture is a product of racist laws of the past. This law was certainly a barrier that prevented black people from buying white bread and so anthropologists refer to it as a structure. This structure ensured that brown bread was the only bread black people could eat. Though this structure was dismantled at independence, it engendered a collective representation of brown bread as something undesirable.

As a result of independence, educated black Namibians became socially mobile and moved out of places such as Katutura, which were for blacks only. Accompanying the move from Katutura to former white-only neighborhoods, brown bread was exchanged for white bread. Here, social emancipation crossed the path of cultural construction and as the anthropologist William Dressler said, it left its mark on the human body.

Therefore, the anthropological perspective would be useful to understand the nutrition problem in Namibia, which is perhaps our biggest public health challenge. According to the United Nations, about 400 000 Namibians suffered from hunger and inadequate nutrition.

Given this startling statistic, how does Namibia engage with the international community in the fight against hunger? At the recent World Food Summit in Rome, the Namibian delegate called for our country to be reclassified as a low income country. He claimed that the reality on the ground shows that we are wrongly categorized as a middle income country. To what extent is this true? The anthropologist would be adept at tracing out the several realities people face in this land of contrasts. Indeed, through an ethnographic work the anthropologist would illuminate abstractions such as “middle income country” with true life accounts. Thus, we can fully capture how some people at the grassroots prevent hunger, while others are caught in a daily struggle for nourishment.

Through my discussion of black peoples’ choice of bread, I hope to have illustrated how health is influenced by the way individuals construct meanings about what they eat. Moreover, I hope to have shown how the anthropological perspective can uncover the nature of hunger and survival in Namibia . This idea has already been demonstrated by anthropologists internationally, such as the works of Joao Biehl about life on the margins in Brazil. In Namibia, anthropologist Debie LeBeau has done research on the roles of alcohol consumption and patterns of sexual relations in HIV transmission. LeBeau found that HIV transmission is exacerbated by the exchange of sex for food. Yes indeed, issues of food are central to understanding human health.

Recovery

I was really very sick.
I lost pools of water in diarrhea. My ears were ringing and black strobe light flashing before me. It was gradual, from Tue I lost my appetite and became weak.
Thursday night, I was bloated, like a toad, could not vomit, just croaked. Then the diarrhea.

But now I am ok. I saw a doctor that thursday night, at the wonderful private health care clinic, the pristine Paramount Health Care. The doctor I saw was this petite woman with short black hair, dressed in a black sleaveless shirt. Dr Serfontein. She looked Bulgarian, my mom said, who drove me.
Dr Serfontein oozed professionalism. She just listened and made conversation. She asked about me where I worked while she palpate my tummy, while listened for my blood pressure. Smiling. She put me at ease. Her hands on my pulse, I could feel I was in trustworthy hands.
In short, she was badass, just like a doctor should be.
But she did not know I would have diarrhea five hours later. So she did not give me anything for rehydration. She did not give me the wonderful medicine against bloating that I received the next day from my general practioner, my family doctor, Dr Star.
The funny thing is that initially, Dr Star saw me on Tuesday, but she did not even touch me.
We kind of lost faith in her then, when I got worse on Thursday. What type of doctor was she? She just prescribed me vitamin supplemnt and that was it!
Then Serfontein, seemed so good. Race seemed to play a role, since Serfontein is white and Star is black. But then when Star gave me a drip to rehydrate me Friday and she gave me antibloating medicine and rehydration sachets, I regained my trust in her.
So, that is that.

Today

I wonder Pancho, what is your life like?
So someone may ask me. I wanted to just keep on living, but I needed to write this.
I woke up from the floor where I sleep, on top of two concentric duvets that offer comfort. The flatness I like, its good for the back
At 06:20 I went jogging to the local service station where I bought a loaf of brown bread and a milkshake in a bottle for my brother. He took it before driving off to school. He usually does not drive himself, but this time my father was away and he instructed my brother to just take the car (dad's) and drive.

I listened to RFI and I heard about the fall of the BERLIN wall.
Went to work, by foot. Arrived five minutes late, but it was not big deal.

Spoke to my bosses about what needs to be done in the health facilities census we are concluding. Spent much of the morning swapping roles with my colleagues. Now I had to enter the data from a stack of questionnaires that assessed the laboratories of health facilities. They were relaxing and enjoying it. Entering data is not easy. Here I was entering data about labs and diagnostics for health, rather than being in one. This was my choice. I did a bit of that and enjoyed my time with colleages. When I got stuck or entered something wrong into CSPro I would call them and ask "Lavinia, what do I do here?" or "Katrina, please come". They are in the same avocado flesh green colored room. They did what I usually did, tell them how to move in case the questionnaires has not been answered correctly.

Later I called up health facilities "Good Afternoon, I am calling from the directorate of special programs in Windhoek on behalf of the health facility census, I would like to know about the following clinic....what is the managing authorit, is it a state or private clinic?"
I spent about an hour calling all over the country to investigate the managing authorities of different facilities which were thorns for us, because the interviewers in the field said one thing and the people who compiled the list of facilities say another.

I would at this point give a typical college alumni account of my job and what I learnt, what are the pitfalls and strong points. But I'll save it. Suffice it to say, I am learning alot about collecting information about health in questionnaires.

Afterword, I walked home. I had a quick dinner and started writing an article about bread, white bread and brown bread in Namibia. My thesis is that the preference for white bread of black Namibians is due to the legacy of apartheid and the inferiority complex it engendered, which results in a collective representation of brown (semi-whole wheat) bread as undesirable resulting in the loss of health benefits of brown bread.
I am going to speak about how collective representations are cultural constructions that William Dresserly speaks about in his article "Medical Anthropology: A third movment in the social sciences" and how these cultural constructions are a result of the institutionalized racism of apartheid, a social structure. Basically the objective, the structure of the past has engendered a collective representation of today.
It will be my way of introducing medical anthropology to general readers of the newspaper.

Then I went for a run, here and I and danced on the road. The tar road is warm in early evening, at twighlight. I ran by the open space that is set to become a park. Beautifull and breathtaking. As I was running, I was loving it and loving my time here.
I came back to my place my home, cooked a healthy dinner for my brother and came to write this.
I am here with my family, living a life.
What does it mean to live like this?
How am I a different Namibian, apart from the fact I have a different accent, not really American, not Namibian?

Short

Ohh no! Ahh!
I lost it all, that I wrote

Poem

I used to be a poet
did I really know it?

From my vision,
there came a flood of questions
to which I aimed to answer with no precision

Questions remain,
but will I
should I
refrai from answering them all

People caught in their common webs of meaning
that construct and destruct
a world where goats and people are killed
because of witchcraft

Then my own quagmire,
where to read about prisoners or wicked stealth
of people lurking
to kill one
for their body parts
or because their girlfriend broke their heart

O Lord, save us, I implore your Sacred Heart
and thank you Lord for the Arts.

What is a public health problem?

There are so many things that could constitute a public health problem. Usually I think of infectious and chronic diseases of the body. What about
- Killing of people for their body parts for muti (whitchcraft)
- The murder of women by their jaded lovers (violence against women)

The above problems involve people dying and their are imbedded in both the ways people contstruct meanings in their lives and the social structures that impinge on their lives, which result in deaths.

What about:
-Doctors who work in the public sector and are underpaid for the work they do: Does this cause a deterioriation the quality of treatment and care? For instance, if doctors that work part time for the government are paid at the same level as full time practioners, how does resentment on the part of full time workers affect the lives of patients?

All of these are public health problems and