Ochas Pupwe is a Ph.D. candidate at Western Michigan University studying Applied Economics. Pupwe writes about his experiences working in the Zambian prison system promoting AIDS education, testing and counseling.

Ever since Camp Rising Sun (an international leadership camp) announced the ARISE PROGRAM ( a program for CRS alumni to fund community projects), it always kept bothering me that one day I should do a small project for my community. One day turned into tomorrow, and then tomorrow until the zeal would go. Thanks to the ARISE team for continuously encouraging people to be useful to their communities, and one night as I sat in my seat doing my night shift at one of the mobile communication companies, where I was attached for my internship, the common message came again from one of the coordinators” Apply for ARISE funding and make this world a better place to live in” At first I brushed it off, but because the night was quite long I decided to turn all those tomorrows I used to promise myself into a today, and believe me my life has never been the same.

Unlike the many other projects we get involved in, I should admit, going to do the project in the prison was a very intimidating thought. The first day of my endeavor was not easy, the bus I got on drove a number of miles to the outskirts of the city, and made a sharp turn into a corner of society most people live never to even imagine. The prison with all its stories of brutality, roughness, sodomy, seemed a wrong idea to me. But my true vision and will power to serve humanity revitalized my strength and as I stood before that big gate, almost looking that it’s dividing the city, I refused to give in to the trembling intimidation that had filled my heart.

“You may come in” ordered the prison guard. His tone not having any trace of tolerance, he seemed to be confirming my fears. With one gigantic step I moved into the prison premises, and though just at the reception I could sense that the aroma of the air had changed. This was indeed another world. To my surprise just after entry, there stood before me another equally strong gate, which I realized was obviously for enforced security.

The officer in charge was very nice to me and encouraged me to go ahead with the project, and pledged his support but as expected a good number of his subjects had their reservations when they heard the word VCT (Voluntary Counseling and Testing.) By this time I had started noticing the inmates, some in green who are convicted and others in plain clothes that are remanded.

A thorough insight of how the prison community operates helped me draw a program and before I could realize it on 23/05/03 I was moving in with Mr. Lalusha (Medical Officer) for our first AIDS education session. Mr. Lalusha for obvious reasons of his experience volunteered to carry out the first education session whilst I stood by as an observer, though his main mission was to carry out VCT.

When I looked at the inmates as I stood in front of them in the afternoon, I can confess that I have never spoken to a more attentive audience. Most of them looked frail from hunger, but despite this they were still very eager to learn.

We actually had problems in our first sessions in trying to convince the inmates that the program was ongoing as all of them where enthusiastic to come in at once, as none of them wanted to miss out on this one in a prison time experience. With the help of the prison chaplain we managed to divide them into 20 groups and hence conduct 2 sessions a week with 50 inmates per session. At the same time as the AIDS education sessions where going on the Medical officer was also carrying out VCT. Unlike the outside world, the response to VCT in prison was so overwhelming that at first we thought maybe they are just excited and would soon back out. But even after presenting and emphasizing the possible negative effects of VCT the inmates where still ready to go ahead. We further informed these prisoners that we had no medicine to offer but just the ability for them to know their statuses. The result of all this was the eager want for VCT from the prisoners.

After my first education session I should admit that I have never felt so good about something I have attained as I felt that first day of my project, their is indeed true happiness in serving others. I think Freddie understood that concept better and so did the funders of ARISE.  The education session went on well with inmates contributing and asking a lot of questions. The environment was relaxed and conducive for learning, no rough prison guards to intimidate the inmates where around, this was ensured with the courtesy of the officer in charge. With time we managed to finish all the male groups and just had one meeting with the female section. However we had to return to the female section because we had left some questions hanging, which needed the expertise of the doctor.

The most disturbing part of at the women’s section was the presence of children, who live with their mothers in prison. We are still yet to inquire what human rights implication that is .We however aren’t to dwell on this as it isn’t one of our objectives. Our focus in future maybe will be the risks these children in terms of HIV infection they are exposed to.

The peer counseling training handled by Rashida Bobb and Charles Lalusha was not only successful but also much appreciated by the inmates. About 5 months in the project, I had a different perception about the prisons, especially after having personal conversations with the inmates, despite the crimes they may have committed, the bottom line is “they are people” and like everybody else they need love. Far from what they are portrayed they are not rough barbaric animals from the moon, but some are our brothers, sisters and friends who have made mistakes in life, but despite this they are still a part of us, the human race!!!!

At the conclusion of the project we handed in reports to the government and Camp Rising Sun, but I would like to conclude that though a lot of work is being done in the field of HIV/AIDS, prisons are far from well served, and all well meaning organizations need to remember this neglected section of Society.

Thank you

Rwanda’s Public Health Care Option

With so much debate and controversy over providing adequate health care, one African country is setting an example for both “developed” and “developing” health care systems.

Doctors Without Borders utilizes World Cup to raise HIV awareness

Medecins Sans Frontieres (MSF) is working hard to bring greater attention to the serious cut in funding for HIV/AIDS. The US, especially, is taking heat for its decision to reduce the amount of funding. More:

• South African activists added their voices to the protest
• FIFA World Cup HIV campaign

UNICEF marks Day of the African Child with Somalia

The often unseen side of conflict is the toll it takes on health care systems. UNICEF has done well to raise more awareness for the greater need for investment in health care systems in the war-torn country of Somalia.

Zambia to be more Transparent with Health Donors

In a promising move, the Zambian President Banda told donors that more effort would be put into putting greater transparency and financial management in the Ministry of Health.

World Bank missed the boat on Tuberculosis

Thirteen years of funding a program tasked with advocacy and controlling tuberculosis has lacked serious evaluation and focus. The Change.org Global Health Blog offers greater analysis in how the World Bank has failed in the fight against Tuberculosis.

These are just some of the key highlights from the end of this past week. Follow on twitter: @scoutbanana to get up to date articles related to Health in Africa.

Nyala, Kalma camp, South Darfur - March 2007 (MSF Photo Blog)

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?