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Don’t tell anyone from Botswana, but this has got to be one of the most boring countries in the world. I recently returned from a two-week work visit (my fourth) and have never witnessed so much inactivity in my life. Given the choice, most folks in Botswana would spend every day sitting in the sunshine, cooking some pumpkin with millet-porridge and bits of chicken, and then taking a long nap. If you read any books in the Ladies’ Detective Agency series by Alexander McCall Smith, you would also realize that page after page is devoted to much ado about nothing. The smallest incident can become the subject for an hour-long debate. This may make for pleasurable light reading, but the reality can drive you bonkers.
Botswana’s customer service makes Namibia look positively jumpy and that says a lot. My favorite story comes from a rural hotel along the Zimbabwean border where, as the restaurant’s only customer, I was given a menu for dinner. I asked for the vegetable curry, only to hear from the waitress ten minutes later that they didn’t have the ingredients. “Okay,” I said, “I’ll take the chicken salad.” Ten minutes later, the waitress came back with the same answer. Finally I offered, “How about a burger?” But sure enough, the waitress returned from the kitchen empty-handed. “We don’t have that either,” she said. “There isn’t any food from the menu.” With that, I marched into the kitchen and looked the chef in the eye. “So,” I posed, “what did YOU have for dinner?” The chef stammered a bit and then described traditional maize-pap with spinach that we often eat at home. “I’ll have that too,” I said firmly. Happily, the food was delicious (especially given the alternative). The next day, the chef explained that he had thought foreigners always want European food. Actually, I smiled stiffly, it’s just truth in advertising that we really want.
Why is Botswana this way? Perhaps the people are spoiled. Diamonds have made this country relatively rich, resulting in solid brick houses for almost everyone (even though many are small and still rely on an outside privy). Except for a single slum in the capital, Gaborone, I saw no signs of desperate poverty. The democratically elected government squirrels away its income during the good years to maintain their social benefits when times go bad, like now. Corruption is low and peace permeates the land. This part of Botswanan life is wonderful.
But with the government doing such a good job, there are few incentives for people to take their own initiative. Even where there is sufficient water, you see almost no gardens, very farm few animals (despite lots of open grassland), and almost no signs of private entrepreneurship. Whereas in my last e-mail I wrote about the benefits of giving very poor people in one Namibian village the equivalent of US$10 a month to stave off hunger and promote income-generating activities, here the pendulum seems to have swung the other way. By contrast: give the people too much, and folks would rather take a nap.#2. Dateline Namibia
I returned to Namibia on Friday night. Lucas cooked maize-pap and spinach for dinner, and everyone is doing well. On Saturday morning, I had plans to meet Jozefina, a brilliant university student we help support. Six years ago, while still in high school, Jozefina had tested HIV-positive at the largest government hospital in the north. Shattered, she felt isolated and alone for years. But as we slowly got to know each other, I noticed that – despite an increasingly hectic schedule – she wasn’t showing any of the usual signs and symptoms of HIV that usually show up after four or five years.
“The virus is either progressing very slowly with you,” I said. “Or something else is going on.” Although I didn’t say anything to Jozefina, I knew that about 1% of all people tested for HIV initially come through as false positives. Since HIV testing began in Namibia, protocols from the Ministry of Health therefore require that all positive-results are tested a second time, using the same blood sample but with a more rigorous and expensive regimen that snuffs out this margin of error. (There is no such thing as a false negative.) Thus, positive results may only to be announced to the patient after both tests are completed and both turn up positive. But what if that second test was never done?
So a few months ago, I suggested to Jozefina that she get tested again. She went with a friend and told me afterwards that she couldn’t believe the result. Jozefina tested “Negative,” but the counselor told her to come back in three months’ time to make sure that she wasn’t in the window-period, before the HIV anti-bodies take hold and show up on an HIV test. This time, Jozefina asked me to come. “I won’t believe it until I get the result after this test,” she said. “And I’m scared…”
Nowadays there are many places to go for an HIV test in Windhoek, and Jozefina chose the newest one that opened, just down the street from the President’s residence. The test is free and anonymous. When we entered the building, there were 8 people in the waiting room – all young and good-looking, including two couples who sat holding hands. The staff counselors took each person in turn – first for a pre-test counseling session, then for the blood-prick, and finally for the results.
Back in 2001-2003 when Catholic AIDS Action opened its three Voluntary Counseling and Testing Centers (while I was still the national coordinator), I remember that each one had a TV in the waiting room on which we were supposed to show various health-related and HIV-prevention videos. No more: After repeated complaints by clients that they were nervous enough awaiting their results, the Testing Centers complied and started showing comedy. So last Saturday, as the probability ratio suggested that 3 out of the 8 people sitting with us were likely to find out within the next hour that they are HIV-positive, we sat roaring with laughter at the silly antics of Rowan Atkinson (aka Mr. Bean) on screen.
Finally, it was Jozefina’s turn to hear the results of her test. She trembled. “What if it is positive?,” she whispered. “I don’t think I can take this any more.” She went into the counselor’s room by herself, and a few minutes later asked me to join her. Then, her face impassive, she silently handed me the file. I looked inside and saw the stamped results in large black letters: “Negative.”
Whew!
I suggested we take a walk, and slowly Jozefina began opening up. “I guess I have to believe it now,” she said. “I know it’s good news, but I don’t feel happy. It’s like my whole identity has been changed. I don’t know who I am any more.”
In a way, my own reaction was equally tempered. While the news was great, I began to feel a huge anger swell up inside my gut. For six years, Jozefina’s life had been practically destroyed by the apparent failure of the government hospital to undertake the back-up test, simply because it is more complicated and expensive. Seeing how Jozefina fit the demographic profile of most new infections in Namibia in those days (i.e. young, black and female), some lazy nurse probably just said, “Why bother?”
Jozefina was also mad: “You know, I almost killed myself after hearing those results six years ago.” She said. “Just think: it would have been for nothing.”
Additionally, because the tests are done anonymously, no one can go back and prosecute. She just has to look forward and accept what’s done is done. I’m convinced that Jozefina will find her way: she is a strong young woman and is thinking about writing a letter to the local newspaper encouraging others in a similar situation to get tested again, just like she did. But we are also left to wonder, how many other people have been wronged in this way and may never find out the truth?
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P.S. My colleague Marika Matengu drew the picture in this entry for a new guide we are writing for managers of programs for orphans and vulnerable children. More on that, soon.
