Dessert with no dinner

The way HIV/AIDS-related programs are executed in Mozambique often reminds me of the episode of M*A*S*H in which Major Winchester donates gourmet chocolate to the Korean orphanage, only to learn that the head of the orphanage has traded the stuff on the black market for food staples like rice and beans. "Forgive me," he says, when he's realized his mistake. "I have given dessert to children who have had no dinner."

You'll see what I mean when you read this. When the magnitude of the HIV/AIDS epidemic became known, the international community flocked to the aid of affected countries, pouring money into programs for prevention, treatment, and impact mitigation. This is most definitely a good thing: helping sick people, and preventing people from getting sick, is a valid goal, particularly in the case of AIDS, which affects people of the age who otherwise would be earning money for their families and taking care of children.

But whether it's because of these ties to economic development; or because of the threat of AIDS spreading from Africa to our own safe and cozy homelands; or because of the ability of this disease to capture the imaginations and hearts of donors, AIDS has unfairly taken top priority on the international aid agenda. It's not uncommon to visit a hospital in which the beautiful, new areas dedicated to AIDS care sit beside the other wards, which are overcrowded, crumbling, and understaffed. Or, teenagers' curricula on STIs and sexual health, often NGO-run, are fine-tuned based on international best-practices -- but the students have had no adequate preparation in areas like the germ theory of disease or population biology, which are essential to their understanding HIV's transmission and spread through populations.

Or, like in the article linked to above, people with inadequate nutritional intake are given expensive and potent medications to treat their illness. I work in HIV/AIDS research, and I believe that it is indeed an international emergency. But we in the international development, research, and health communities need to ensure that dinner is provided before dessert.

Validation; or, The Next Level

It might be that it's Friday night, and that I get to hang out with some old Peace Corps friends later, and that I get to spend some lazy, pampered days in New York soon, but I'm happy right now.

I had an extremely validating conference call this afternoon. For the past two weeks or so I've been poking away at my computer, forcing myself to generate code that might work to turn out numbers that might be vaguely relevant or useful or correct. If this sounds like the wrong way to do research, welcome to data triangulation. We look at lots of numbers and try to pull out something meaningful from them.

Problem is, I've never been trained in triangulation -- I'd never even heard the word in this context before my first meeting with my thesis advisor. I figured someone would clearly explain to me how the process works in time for me to present the findings of said triangulation to a high-level group of researchers here.

So far nothing has become a whole lot clearer, and I'm on my own for the presentation, which is next week. The main higher-up on the project, though, R, always seems to have something in his head. He's said several times that we'll need to "take it to The Next Level" with the help of analysts at UCSF, which drives me crazy because this project, as my master's thesis, should mostly be done by me. Which is why it was so nice to speak to said analysts today, in a call that R missed, and learn that "The Next Level" appears to be a nebulous area existing only in R's head. The first few minutes of the call went something like this:

UCSF: "So, did you and R get a chance to talk on Wednesday?"
Me: "Yeah, we went over some scheduling issues and he gave me some tips for the presentation, but I was hoping he'd be on this call. He wants your help in taking it to the Next Level."
UCSF: "Yeah, so about that Next Level... do you have any idea what he's taking about? Because, the level you're at now... that's about the level we can work at."

Which is so great to hear. Because after 2 weeks of battling it out with Stata (and constantly checking friends' blogs and celebrity blogs), it seems that maybe I do have good instincts in this whole data analysis thing. Not that a trained professional couldn't do it 10 times faster, but I think I'm coming out with about the same results that an MPH on the project might, via the same logical routes that my thoughts have been taking over the past 2 weeks. I may not have the organization or confidence or refinement of a seasoned professional, but at least I feel that I could someday.

So I'll let you know when I've reached The Next Level, but for now I'm happy on this one.

Procrastination, the brain, and celebrity fluff

So it's down to the wire in my time spent working in Mozambique, and all I can do is watch bad romantic comedies and compulsively update my useless celebrity expertise on perezhilton.com. What I should be doing, and what I can press myself to do for vast, uh, minutes on end, is analyzing the 9 datasets that make up the material of the triangulation project. But it seems that my brain has become overwhelmed. With each passing day spent staring at the computer screen, my fingers are getting clumsier, my mind slower, and my capacity for concentration shorter.

I put a romantic comedy on as I fell asleep last night, because my brain's craving for them is like a late-night ice cream craving. There was a moment when I drifted off to sleep and was only conscious of a stream of numbers.... 40.0, 11.1, 12.5 -- of the type I'd been endlessly keying into an excel spreadsheet earlier that day. The number streams seem to be causing stress on my neuronal connections, causing these poor cells to beg for Jennifer Aniston and her sister's wedding. I've even started watching the second-rate American shows that a Brazilian channel here broadcasts; shows I had never heard of and would never watch in the States, but which make it here maybe because of low syndication fees, because they give my mind the idiocy fix it needs.

I've never had such severe concentration problems, but then again I've never required such heavy, numbers-oriented concentration before. Another problem may be that I'm on my own with the work here, and I'm never sure if what I'm doing is productive or even correct. So there's probably some fear of failure mixed in with the cognitive overload, conspiring to put my mental output at about zero. I don't know whether to push on or give in and raid my roommate's DVD collection.

Onde está a coração

Yesterday I went to another home -- I think I've probably blogged about at least two other "homes" by now. This home is where I stayed during my two month-long Peace Corps training: a cozy, woman-headed household in a little town about 45 minutes outside of Maputo.

It's remarkable how much it did feel like home: the kids ran out to greet me, my mom scolded me for not keeping in better touch and told me I should get married soon, and I was fed a big, greasy plate of spaghetti. I had brought a lot of toys for the kids, so we all played in the yard after lunch and got our hands covered in the red dirt that characterizes the village. I let the kids take some pictures with my camera, which they couldn't get enough of. They were too excited and impatient to learn the rules well, so there are a lot of pictures of torsos with no heads and ground with no figures, but there are a few that are surprisingly poignant. Here are 3 of mine followed by 2 of theirs.


In case you were trying to figure it out, frisbees, Silly Putty, and harmonicas all make great gifts for rural African kids. Trust me on this.



Mozambican girl plays frisbee: the dream realized!

+ Jovem!

A colleague at the National AIDS Council invited me to his TV show, a talk show for youth, because this week's show would be about multiple concurrent partnerships -- the topic of my current research. Fantastic! I thought -- though I made sure he meant *in the audience* and not *as a guest speaker* before I accepted. Him being what I thought was your average beaurocrat, I assumed "+ Jovem" was a toned-down, government-run show. I was envisioning Charlie Rose set in Mozambique and focused on HIV/AIDS, with a live audience who would get the chance to ask some questions.

Well. So last night we arrived at the studio, I and a colleague from UNAIDS whom I had invited. The guard waved us in the front door, past a long line of young people; VIP treatment! A few other production aids walked us through the halls to the set, where we climbed onto the risers where the audience was seated. The youth started rolling in, raucus and excited, many dressed to the nines for their opportunity to be seen on TV. Jorge, the National AIDS council beaurocrat/TV host, started describing to all of us how the show would go. The special invited guests were the second-in-command at the National AIDS Council, and a representative from N'weti, an HIV/AIDS communication-oriented organization. There was also a woman from the Ministry of Health who would make a plug for a good hygiene campaign that was to start the following week. And, a DJ and a rap group... and two groups of Marrabenta singers... and another duo of scantily-clad female singers... and there would be T-shirts given out, and there was a large display of "Klin" detergent and two girls wearing Klin t-shirts which would have some camera time as a sponsorship deal. So, as with all things Mozambican, there were surprises, there was chaos, there were things happening which it was better to just take in and not question.

The show started with Jorge and a group of guys wearing sparkly blue vests doing a little choreographed dance, which completely cracked me up. Imagine yourself meeting a work colleague to discuss contacts and resources useful to your project. Then imagine that same colleague, a few days later, breakin' it down with a posse of sparkly-vested dancers. Classic.

The HIV-related conversation wasn't fantastic, especially because of the straight-laced, academic tack taken by the interviewees. The kids in the audience were more concerned with gossiping with each other and sending text messages. But they did have a chance to share their thoughts about multiple partnerships -- always poorly defined, but in their context meaning having more than one boy- or girlfriend at once -- and they seemed to be getting into it. I hoped the youth watching at home would have similar conversations with their families and friends.

One of Jorge's assistant approached my UNAIDS colleague, Katia, and I, and told us we would be asked questions. Despite our impassioned protests to not have to speak on national TV, Jorge insisted. Katia almost forgot the name of the special guest, but pulled it together to make a point about how we are trying to bring what have been private conversations into a public debate in order to confront the HIV emergency in Mozambique. Then the question came to me, as a foreigner, what were my impressions of what was going on here with all of these multiple partnerships?

Putting the question like that, there was really one answer I could give: Well, this isn't just Mozambique, and it isn't just Africa. It happens everywhere in the world, and it's a problem that the global community will have to tackle together. Despite this being the in-vogue theory as to why AIDS has taken such a hold on Africa (previous theories being unsafe blood supply and high rates of STDs), I do believe it happens everywhere, and, moreover, I believe it creates a culture of inferiority when the debate is framed as, "what is wrong with these Africans?" I've already met a sort of cultural defeatism when, as a Peace Corps volunteer, I told people that I had friends who were virgins at 23 because of their strongly-held beliefs. The answer I got was, "Well, maybe in America you can do that. Here, among us Mozambicans, it's not possible."

So, that's the story of my 15 minutes of fame in Mozambique. A statement about global unity on + Jovem, and I think the Portuguese grammatical errors were minimal!

I was a lonely teenage broncin' buck....

These were anonymously left at my doorstep last night... Thing is, there are three women living in my house, and none of us has any idea who they might be from. At least it provides us with some entertainment.

Points if you can sing the line following the title!

Update: spontanous cure!

Good news: As of this morning, my phone is demonstrating complete, spontaneous cure! All the names are coming back. Phew. Old age will be put off for awhile yet. No word as to what triggered it, but perhaps it was the certainty of knowing its diagnosis. :)

And, just to make sure I haven't offended anyone, this wasn't meant to trivialize dementia, which is no doubt an extremely difficult thing to deal with for patients and their families and loved ones. It was more to demonstrate how warped a med student's view of the world is, when she looks at a phone and thinks neurology.