Ten Dollars a Day

Photo from an American Soldier in Afghanistan's collection

In Afghanistan, the American Soldier in this photograph, per the US Department of Defense, wears and carries US$17,472 worth of gear. On average, the family of the rural child in this photograph makes approximately US$1 per day. If this girl's family makes $1 per day, and she lives to her life expectancy, of 44 years (UNICEF)-- her family's lifelong earnings will be less than the value of this single soldier's uniform.

* * * * *

42 children, like the girl in this picture, will die this month in Afghanistan by stepping on or encountering a land mine.

That's more than one child a day.

Do you remember being a child, running aimlessly through that field by your house, perhaps chased in a game of tag, or running after your dog? Can you look out the window of your house right now, and see your child -- or your neighbor's child -- doing the same?

What if scattered about your front yard were buried explosives, dropped 25 years ago from a Soviet airplane...multi-colored, shaped in the form of butterflies. Intended to be a curiosity to a child. Designed to be picked up by a child...to maim or kill a child...in a sinister act of all out war. Because a disabled child, or a dead child, is a distraction to the family of a rebel soldier. And, a disabled child -- and certainly a dead child --is unlikely to grow up into an effective future soldier

So, 25-year-old butterfly bombs lay buried in the fine dust that migrates around the arid desert that is your front yard... to be found by your curious child, after a wind or rainstorm, which reexposed its deadly form.

"Hey," says your daughter, turning to look at your young son. "Look at this," she says, as she picks up the mysterious, pink-winged thing...

And then, in an instant, she is dead.

It could happen today...if you lived in Afghanistan.

What if you were a rural Afghani goat farmer, with no interest in politics at all. And last night, unbeknownst to you, your neighbor down the street -- who is jobless, hungry, and cannot feed his family -- decided he would join the Taliban...

Because they said they would pay him $10 a day.

Not because he really understands the conflict. He has not read about it -- because as a rural Afghani man, there is a 91% chance he is illiterate.

No, he joins because he understands that $10 a day is more than abject poverty.

$10 a day is $2 a day more than being a state police officer. $4 a day more than working for a cash-to-work program funded by the international relief community. $8 to $9 a day more than the average daily Afghani wage -- if you are fortunate enough to have a job. And $10 a day more than his current condition..of having absolutely no income at all.

What if your neighbor is now tasked, in this complex fight against the Americans, with burying IEDs (improvised explosive devices) randomly in the dirt road that runs in front of your house -- the street that you walk daily to the market, or into town -- because the enemy might drive down the road.

Will you -- as his neighbor -- have any idea that he buried explosives there? Will you know exactly where? Will your little girl? Will he tell you where he hid them? Or is this secret one of the many conditions of his newly acquired daily wage?

Will you discover his actions because you hear an explosion, and come running out of your house, to find the decimated body of your child splayed lifelessly in the road, or in a nearby field? Your child -- an incidental casualty in this confusion known as war. Your child -- reduced to a black tic of ink on a bureaucrat's statistical log.

One in 42...this month.

Tic.

Your dead child.

This happens more than once a day to a child -- to a family -- in Afghanistan.

* * * * *

If the girl in this photo is 10 years old, then all she has ever known is war.

In the days that she was conceived, so was al Qaeda's plot against America. And so, the American conflict in Afghanistan, that began in Kabul on October 7, 2001 -- in response to the attacks on New York's Twin Towers and the Pentagon -- has been waged her entire life.

Now suppose this girl is 2,339 years old. It's less likely, I admit. But, at 2,339 years old, it would still be true, that most of what she has ever known is war.

Alexander the Great marched in here in 328BC, followed by the Scythians, White Huns, then Turks. In 642, the Arabs came, and introduced the religion of Islam. Then came the Persians, then the Turkic Ghaznauds. A man named Gengus Khan stopped by with his Mongols in 1219, and occupied the area till his death. Local Princes took the power back, till Tamerlane -- a descendant of Khan -- came through for another enduring visit. The story of warlords and factions and power struggles continues here through modern history -- seeking a trade route or a political buffer between north and south, east and west, in this sandy, mountainous interspace of cultures known as Afghanistan.

In 1839, the British came, and during their ongoing colonial quests, made three attempts to rein in the locals -- in the form of First, Second and Third Anglo Afghan wars. Then there was Russia, from the North, who also savored a piece of the pie. It was, in fact, the Russians and the British, who, in 1880 -- in the semi-random way that imperialists do -- took out their Sharpies and their maps and sketched the modern borders of Afghanistan.

If our girl is 2,339 years old, then something very hopeful happened to her 92 years ago, in 1919 -- the year the 19th Amendment and women's right to vote was introduced to Congress in America. In Afghanistan, the new King Amanullah -- who took power when the British finally threw in the towel -- sought to modernize Afghanistan. Amongst other advances for women, he advocated for female literacy and education. He removed the mandate of the public veil from women -- making it a choice instead of an obligation. In 1919.

These were, for many tribal leaders of the time, unpopular decisions. A clash of religion, culture, conservatism and change. So, the rights of Afghani females to gain an education, to choose a husband, to learn a profession, to run for public office -- all slowly sputtered forward, and sometimes back -- for decades. In 1959, women in urban centers again were given the choice to publicly unveil. In 1964, women were given the right to vote and were allowed to enter politics. In 1978, under the influence of the Soviet Union, communists came to power. Girls' education became compulsory, marriage age was raised to 16, and brideprice was abolished. Unfortunately, along with these changes, the overt practice of religion -- Islam -- was banned. And understandably, ensued a popular revolt amongst Muslims across the countryside.

Our ten year old girl wasn't alive during the occupation by the Soviet Union, which lasted until 1989 -- more than a decade before her birth. But the legacy of that era of war lives on for her, and children like her, to this day. It is estimated that 1 million Afghani's died during that conflict. Many of the casualties were children, caught in the crossfire, or more unthinkably -- injured or killed by those butterfly-shaped bombs.

When the Soviet military finally withdrew from Afghanistan in 1989, a power vacuum ensued. Once the Mujahadeen, who tenaciously fought off the Soviets (with American military aid), took power, the result was nearly a decade of infighting and clan wars. A radical Islamic group called the Taliban, slowly rose to power, occupying the capital Kabul in 1996, and 90% of the country by 1998. And implemented an ultraconservative interpretation of Sharia law -- the moral code of Islam -- that some call "Talibanization".

Five years before our girl's birth -- when almost 50% of urban professionals in Afghanistan were women -- came a decree that would ultimately change the course of her human rights, her health, and her very life. The Taliban Decree of 1996.

The decree begins:

"Women, you should not step outside your residence."

And so began a new era of women's rights (or lack-there-of) in Afghanistan.

If you were a professional woman in 1996, imagine a declaration from your new government that you are no longer allowed to leave your home. Imagine they have also declared that you must paint the windows of your home black, to prevent anyone from looking in, and glimpsing you pacing around frustratedly inside.

Imagine they declare you are no longer allowed to go to work. Nor school. Ever. Ever again. You, nor any of your female children.

If you must leave the house for, say, emergency medical care, you must wear a burqua, which covers you from head to toe, with a small vent at the eyes to allow you to see. And you can only go out with a male family member. If you do not have a male family member -- as happened to 400 female orphans after the decree in Kabul-- then you are not allowed to go outside at all; the 400 orphan girls were kept locked inside for over a year.

If you are a widow, with no male relatives, you and your children will likely starve, due to your lack of access to the outside world.

In an emergency, your male doctor is not allowed to see your entire body -- only the perceived affected body part, and only if you are accompanied by a male relative. Your female doctor (40% of the doctors in your city are female), is the one female professional still allowed to work. She could treat you, if she could safely find a way from home to work. But like you, she now requires a male relative to escort her through town. You will soon discover only 25% of them can safely make the trip. The other 75% of female physicians remain imprisoned in their homes -- like you -- creating a crisis in women's access to health care.

You (and all persons of Afghanistan) are forbidden to listen to music, dance, sing, fly kites, raise birds or own a mirror. You cannot take photographs of loved ones, and must destroy all photos of people you have, because this is considered idolatry. If you violate these rules, you will be punished.

And what will be your punishment? It depends upon your crime. But, it is possible you will be led into a soccer field in your home community, wearing your burqua. In front of the crowd -- who are no longer allowed to clap or cheer at public ceremony -- you might be flogged, or stoned, or possibly shot in the head at close range with a rifle. As a lesson to others to obey.

The Taliban were driven from official power approximately one month after the US invaded in October 7, 2001 -- in response to the 9/11 attacks, and "Talibanism" was replaced with an elected democracy. But today, 10 years later, the Taliban continue to fight, and influence, and intimidate. And the war that rages in response continues to devastate the people and development of Afghanistan.

So, what about our girl of ten. What happens when a country is in a constant state of war, and cannot (or chooses not) to properly invest in the development of its people? How have these ten years of war, and all that has gone before, influenced her life and her future?

She beat the odds when she turned one -- because 11% of infants here die before 12 months of age. She beat the odds again when she turned five, because one in every five children in Afghanistan die before the age of five.

One in five.

Even under Taliban rule, the women of Afghanistan did not fail her. When female education was banned, women risked the punishment of death to run secret schools for girls within their homes -- understanding the value of her education, and her future. Nevertheless, today, only 18% of girls here are enrolled in school, and a mere 6% actually attend. (Boys rates are not much better -- with 38% enrolled, and 15% attending.) Only 13% of females in the country are literate.

If she marries, legally it will be at age 16 or older-- although it is estimated that 50% of girls are forced into arranged marriage before 16 years of age. If she gets pregnant at 16, or 15, or 12, her youth and small size -- enhanced by poverty and malnutrition -- puts her at risk for a small pelvic opening, and birthing difficulties. With only a 14% chance of having a skilled birth attendant at her side, she has a 10% chance of dying each time she gives birth.

And today, while I, an American female, am expected to live to 81 years of age -- her life expectancy is 44.

I have to smile, though, when I look at the picture again. This little girl in bright pink. No fear. Unhidden. Hands folded quietly, staring with bold curiosity at the foreign soldier. Does she represent the shrewd, historical strength of the people here? Yes. Is her courage a glimmer of hope for the future of Afghanistan? I hope so.

At least for the next 34 years, which -- if she survives war and land minds and childbirth -- is predicted to be the extent of her life.

* * * * *

Why does this conflict continue? It's an exquisitely complicated question. But here's one of many things to contemplate:

Food. Shelter. Clean water. Health care. Education. Literacy. Security.

What would you do if you didn't have them?

What would you do, for $10 a day?

Map: Areas in dark maroon have a life expectancy of less than 45 years. Can you find Afghanistan?

The Longest Night

Photo from Internet: Generic Antarctic Octopi

I had the happy experience of stumbling across this letter home amongst my things this week. A fabulous memory of a few years ago when I lived in Antarctica, where seasons are opposite of ours in North America, winter blackness goes on for months, and a crazy annual tradition is undertaken every June 21st. In a divergence from all things hot and humid and sandy and sunburned, I am delighted to share this memory with all of you who kindly read my occasional ramblings. Happy Solstice, particularly to my iciest of friends.

****

June 21st, ANTARCTICA

Midwinter Greetings from Antarctica!!

They say that today is the longest night of the year. Not to be confused with yesterday, and our 24 hours of darkness, nor tomorrow, and our 24 hours of darkness. This longest night has been determined with meteorological specificity. We are tipped farther from the sun today than we have been tipped all year. After this night, the sun will start her slow trip back to our horizon – a journey of another 61 days.

In fine human form, we celebrate this longest night with a bit of pomp, a bit of circumstance, and a fine tradition of human stupidity. We pull out our shovels and chainsaws, and dig down to the depths of the sea, 15 feet beneath the snow and ice. We stop to stare into the shallow depths of the re-discovered liquid ocean, through a six by six foot square window in its solid surface. Illuminated by a submerged light, the sea laps gently at its new icy frame. And we strip down to our skivvies -- some, in fact, down to nothing at all -- because, dammit, its summer (somewhere). It’s June, for God’s sake. And, yes, it’s time for a swim.

Our pale, fleshy bodies glow eerily in the foggy moonlight. No need for sunscreen on this beach today. Bare-bodied, defiant, we walk one-by-one down to the hole. This is, perhaps, a keen and wondrous example of the powerful emotion “denial”, and the eternal battle of the logical mind and its rebel nemesis. The rebel mind fails to acknowledge that minutes prior, its body was bundled in down, silk, fleece, wool and complicated polypropylene. It fails to question why it is now walking, defiantly naked, towards this newly opened window to the sea. Outside. In the -40F ambient air, made ever more frigid by the presence of a katabatic wind. It instead snickers with barely hidden delight. The logical mind wonders, “Why am I wearing sneakers, but nothing else? Isn’t this odd?” The rebel mind grins. It knows why**.

(**Previous attempts to perform this feat sneakerless has left people with the skin of their feet literally torn off, frozen permanently to the sea ice.)

It is the rebel mind that guides the body down the icy path to the hole in the mid-day darkness. It guides the hands that grab the dripping, icy harness and wrap it around its torso.

“What is this harness for?” asks the logical mind, cringing at its acrid frigidity on the flesh of its body’s warm back.

“Why, it’s a safeguard to prevent your body from getting sucked under into the ocean’s 300 foot depths,” whispers the rebel mind.

The logical mind contemplates this for a moment, suddenly catching on. The hole. The harness. The inappropriate nudity. Dear God in heaven! The body’s pulses surge with sudden panic-impregnated awareness. The logical mind prepares to mount a sudden protest. But, alas…the rebel mind has already directed the knees to bend, the calves to contract, a lateral jump into the air, and then….

Cold.

No, not cold. There is no description for this sensation. It is cold and wet and suffocation and pain and panic and fear and bright light and hair-standing-on-end and muscles contracting and blood vessels constricting and eyelids (and, yes, other orifices) clenching. Perhaps this is what it is like to get struck by lightning, or fall from an airplane with a great splat onto the earth below: a sudden, body-consuming, brain-flooding sensation of transient life.

This sensation is perhaps made worse by the rumor of octopi.

Yes, there are things living down there under the ice. One wonder of this newly-opened window to the sea is the life it reveals teeming in the waters below. We are not alone here in our Antarctic wilderness, on our dark Midwinter’s Day. Two years ago, one plunger was intimately greeted by the warm mammalian nose of curious weddel seal. This year, as we stare down into the sea, hundreds of small eyes stare back at our warbling forms. Bright orange krill swim at the surface, perhaps holding their own mid-winter celebration? Are they challenging each other to jump out of the ocean into the frigid air above, for a momentary glimpse of our waterless world? If I look closer, will I see the small harness that they attach to each other, to prevent them from floating away in the Antarctic winds? Beyond the krill, one can spy giant yellow starfish, clinging to the rocks of the sea floor below; and foot-long white worms, squiggling hideously just below our ladder in the hole. These worms are not dangerous, we are told. Just hideous, slimy, disgusting, necrotic foragers. They eat only dead things. They are the recyclers of the sea. So, what brings them here on this day, the mind has to wonder, to loom in wait beneath our hole -- these eaters of dead things? Would their presence make them optimists? Or pessimists? That, I suppose, depends on your perspective….

But, yes, an octopus had been spotted, feeding on krill just below the surface of the water. Certainly, this was quite the unexpected opportunity for him. He’d been swimming about in the dark depths of the ocean for months now, blindly groping about for dinner, not a glimmer of sun in the sky. When, suddenly, the illumination from our underwater lamp brought enlightenment, and with it, the fantastical and alluring dance of krill. Dinner. And he had swiftly scooted by, just in time for my turn at the plunge hole.

“Watch out for the octopus,” my Kiwi friend warned flatly, as he stood beside me at the mouth of the hole. He was the dive tender. I was standing beside him, nearly naked, save my sneakered feet, tankini, and fine layer of goosebumps. It was not a choice moment for a lecture on marine biology.

“The what?” I asked with pseudocalm, a hint of poorly veiled trepidation in my harsh whisper. “Watch out for the what?”

“The octopus,” he replied, with an unblinking challenge, a stoic stare. At that moment, he extended to me a band of icy, dripping cloth attached to a rope. “Here. Put on your harness.”

“Funny,” I said, with poorly-feigned nonchalance. “You think you’re sooo funny. There isn’t any bloody octopus in that water!”

“Don’t worry,” he reassured with a calm stare, pausing for dramatic effect. “It wasn’t a big octopus.”

Right. As if the size of the octopus had anything to do with my trepidation. As if I should have been un-alarmed by the presence of any hungry, multi-legged, suction-cup encrusted, beak-faced being that had been blindly flailing tentacled appendages for months in the frozen dark sea, seeking even a single morsel of food. As if I should have been unconcerned by the prospect of his octopus family, who might have been lurking just on the other side of the ice, in the shadows, out of sight, emaciated, drooling in anticipation of their next meal. And how big is an octopus family, anyway? Ten? Twenty slithering beasts? How many legs does that make? How wonderful that they had been alerted by the plunging humans before me -- a virtual dinner bell. These creatures, who’d been eeking out their survival in the dark Antarctic sea for months, barely subsisting on a diet of microscopic krill, now attracted to the light, now drooling in the darkness. And who would, in a moment, be presented with a rather large, tender, warm, fleshy morsel known fondly to me as... my body.

“Fantastic,” thought my logical mind. “I am bait.”

“True,” acknowledged my rebel mind. “Bait.” And then my body was hijacked.

Unexpectedly, my breath sucked in deeply and my toes pushed off forcefully in the icy slush on the side of the hole. As I flew through the air, muscles tensing, eyes clenching, my logical mind repeated the mantra of my shoremate. “No worries. It isn’t a big octopus. It isn’t a big octopus…”

Kaplunge…

Cold. No, not cold…

The first one-millionth of a second of cold-water immersion -- when the first molecule of toe hits the water -- initiates the cascade of a massive adrenaline dump. A giant internal air raid siren begins its deafening scream. The fight or flight response ensues. As the first tinkling-bubbling of ocean migrates down the auditory canal, the mind has already formulated its frenetic plan, and screams commands like an angry drill sergeant. “Left leg push! Right arm grab the ladder! Climb, climb, climb! What the HELL are we doing underwater? Don’t you know this is Antarctica?” And on the heels of that, “Worms! Big carnivorous worms!” And finally, to motivate, “Octopi!”

Yes, the brain is in full flight. So, when the dive tender at the surface starts screaming, “Octopus!! It’s the octopus! Look out!! My God, look out!!” there’s not a whole lot more for the body to do, except accelerate its escape. And imagine tentacled arms gently brushing against frigid legs. Hands grip the icy rails of the escape ladder, ignoring the frozen paralysis of muscles. The body climbs. And in moments, it is standing once again on the icy ledge, above the window to the sea, dripping wet, now convecting any remaining body heat off into the windy darkness. A leg gives a shake to dislodge imagined remnant tentacles. Eyes quickly turn back to stare down into the icy hole.

“You saw the octopus?!” I cried, wide eyed with horror, dripping like a wet rat, staring into the abyss. “Was it after me? Really?!” my voice squeaked in a frigid whisper.

Then came the laughter -- a loud uproarious eruption. He was laughing at me, the dive tender, a look of exquisite glee in his eyes. “No,” he said, chortling with obvious amusement. “Not really.”

I glared at him silently. Warm air steamed visibly, flaring from my nostrils. He would never know. How close that man came today to a sudden swim in that hole -- big down thermal body suit, boots, hat, gloves and all -- for a better look at that octopus. If only my hands were not frozen at that moment into frigid claws. If only I weren’t dripping wet, hair freezing in place in a tangled mat on my head. If only my muscles would respond to something other than a fierce command to run away to the warming shelter. Down he would have gone to commune with the octopi. The worms might have found their meal, as well. But, lucky Kiwi. In the contest of fight versus flight today, flight won. Just barely.

And my rebel brain grinned in preening satisfaction, while my logical brain sighed, urging my frigid legs towards the warming shelter.

“Come now,” urged the rebel brain. “That wasn’t so bad, was it?”

“I’m not talking to you,” grumbled the logical brain, effectively masking its unsurpressable elation, and the virtual sparkle in its eye.“Not bad at all,” it whispered silently to no one.

So, the plungers plunged, then donned their down, and slowly walked away. With the sea light gone, the octopus family groped their way into the darkness. The carnivorous worms squirmed along towards a more hopeful site, mild frustration in their slithering gaits. And the starfish remained, seated quietly on their rocky thrones, peering up through the skylight in their icy ceiling to the night sky above, towards their sister stars in the heavens. Golden star shining upon golden star…

On this Midwinter’s Night.

Goodnight.

Two Scratches of a Pen

The crumpled piece of yellow paper at my foot caught my eye. I bent over to pick it up. Then halted.

A flimsy piece of trash. Worthless. Discarded. Smudged. Walked upon. Crumpled. With the vague ink stamp of our clinic visible in the bottom left corner.

And above the stamp...a life altering scratch of an ink pen. A plus sign. Positive.

HIV positive.

With two scratches of a pen, a life altered for its duration.

I picked up the paper, quietly folded it, and stuck it in the back pocket of my scrubs.

Of course, I know this patient. I know this paper. Discarded trash from yesterday. That was my writing. A lab order for the cachectic, febrile twenty year old girl from a tent city. I'd ordered that test. I'd passed the paper to Sister Gloria, our nurse, and requested her to run it. She returned to me thirty minutes later, and with a stoic, kind-yet-grim look in her eyes, handed me back the slip. I'd met her eyes in silent, knowing, communication.

Two scratches of a pen. A life altering diagnosis.

Positive.

The twenty year old girl, skin and bones, laid curled on her side in the next room of the clinic, staring blankly at the wall. A resident of one of Haiti's semi-permanent post-Earthquake tent cities. Mother of a 6 year old child. A quick calculation revealed she therefore became pregnant at 13 years old, and gave birth at 14. She breathed rapidly. She was fragile. Like a small bird, fallen from her nest.

I walked into her room, and through a translator, revealed her test results. "Your HIV test is positive," I explained. "This means you likely have HIV, the virus that causes AIDS. We need to confirm this with another test. But I am very concerned."

She stared blankly at the wall.

"Do you have a sexual partner?" I asked.

"No," she replied. "Not since I got pregnant."

Another simple calculation. Last sexually active at age 13. Therefore, HIV positive at age 13.

Now, likely, AIDS. At 20 years old.

"Did you get tested for HIV when you were pregnant?" I asked.

"No," she replied. She got no prenatal care at that time. At 13 years old.

"Did you breastfeed your baby?" I asked.

"Yes," she replied.

Another mental calculation. Untreated HIV positive mother, never diagnosed or treated, subsequently breastfeeding her infant. Means child at risk for "vertical transmission". Transmission of HIV from mother to child, either at birth, or subsequently through breast milk exposure.

"We need to get your daughter tested for HIV, too," I said quietly. Mother stared blankly at the ceiling. The implication, and subsequent palpable self-accusation, was strong. The risk to her daughter's health. A mother's guilt. Finally, as the information was slowly absorbed, a quiet nod. Empty staring eyes.

I flashed mentally to the World Health Organization recommendations for HIV prevention. The "ABCs" of HIV prevention in sexual relationships:

A = Abstinence

B = Be Faithful to your Partner

C = Condoms

I suddenly remember the semi-angry rant of one of my Tropical Medicine professors -- an HIV and TB expert from India, who spent many years as a physician in the urban public health trenches before becoming a professor at Tulane. To paraphrase her highly-educated and evidence-based rant, in response to the ABCs:

Don't think that women of the developing world aren't aware of how they get HIV and AIDS. They know. They are not ignorant. They know about AIDS and know that it is sexually transmitted. The bigger issue is the ability of a woman to say "no". In many parts of the world, due to imbalances of power in the role of men and women, women have no power in a sexual relationship. Whether it is through physical dominance, or financial dependency. They do not have the social power to refuse sex. They do not have the social power to say no, to demand condom use, nor to demand monogomy of their husband/partner.

I look back at my patient, pregnant at 13 years old.

Infected with HIV. At 13 years old.

Was that sexual relationship an educated choice? Or any sort of choice?

At 13 years old?

In Haitian post-earthquake tent communities, where some estimate HIV rates could, in some, be as high as 15%, rape is on the rise. One recent news article reported on the experience of a middle aged woman, who came upon a teenage girl being raped by a group of young men behind a tarp dwelling. She began screaming at the men, physically trying to pull them off the girl. The men turned upon her, and gang raped her as well.

"Why did you try to help this girl?" asked the reporter. "Weren't you afraid?"

"I have a daughter her age," replied the older woman. "All I could think was, if it were my daughter, I would want someone to help her."

Emergency surgery was required to save the older woman's life...from hemorrhaging....from the injuries sustained during her gang raping. Trying to save an even more powerless woman from sexual assault.

I stared back at my patient.

Like the paper I found at my feet today...

A crumpled, discarded, treaded-upon form. A tragedy.

Haiti has the highest rate of HIV in the Western Hemisphere. 2.2 percent of the population -- more than 1 in every 50 persons -- has HIV.

How do we stop this epidemic?

Increase access to healthcare.

Reduce poverty.

Promote safer sexual practices.

Empower women, first through education. More power naturally follows.

Fund education for all.

Work to remove the social stigmas associated with the diagnosis of HIV.

Is this an impossible task? No.

Start with you.

And not just in Haiti.

Start with you. Start with your community. Your children. The young women and young men in your life. And the older women and men in your life. Teach abstinence. Teach faithfulness. Teach condom use. Teach respect. For self. And for others. Encourage the education of girls. And boys. Encourage the human rights of girls. And boys.

Get tested for HIV. Encourage others -- especially those you love -- to get tested, too.

.

There are 33 million people in the world with HIV today. Nearly 2.5 million more will acquire HIV this year. And an expected 2 million people will die.

.

Lives transformed, with two opposing scratches of a pen...

Riding the Bus

As I sat, going on hour number eight, plastered against the Haitian stranger to my left in the very back of the bus to Santo Domingo, I was reminded of a joke I heard while living in the former Soviet Union years ago. There, too, bus rides were intimate affairs of stranger on stranger body contact, wherein the rules apparently state that the physical contact is to be tolerated, but not acknowledged with eye contact nor spoken word.

The joke was told to me by a Russian colleague, after a particularly sardinesque trolleybus journey, wherein most passengers are standing, and pressed into each other lengthwise like standing matchsticks in a can.

The story, made all the better in the low, monotonous tone of a large Russian woman's broken English accent, goes something like this:

"An 18 year old girl, riding a tightly packed city bus with her mother, decided -- as her mother could not move, and therefore could not beat her -- that this was the perfect opportunity to make a confession.

'Mama,' whispered the girl. 'I have something I must tell you.'

'Yes, darling,' her mother whispered back cautiously, alerted by the concerning tone of her daughter's voice and the shameful downward glance.

'I...I...Oh, Mama. I'm pregnant.'

'No!' whispered the older woman harshly, in a mix of growing anger and horror. 'How can this be?!'

'I'm sorry, Mama,' returned the girl. 'I'm sorry!!'

'Who is the father?!!' demanded the older woman.

'I don't know, Mama,' whispered the girl. 'I don't know."

'What?!' the angry woman whispered angrily. 'What do you mean you don't know?'

'I don't know, Mama,' she cried, 'I cannot turn around.'"

Yes. Exquisitely politically incorrect. Yet, an apparently well loved and popular Russian joke.

And, oh, so true.

You know it. The truth of the overpacked, oversold, overwhelmingly anonymously intimate third world bus experience.

If you have ever ridden a public bus in a developing country, you are smirking irreverently at the uncomfortably too-close-to-the-truthiness of this story.

I know I was grinning, as I contemplated my situation, pinned intimately against the side of my anonymous Haitian seat companion by yet another bump in the highway. I attempted to turn and make eye contact with him, thinking that perhaps an "uh, sorry" sort of look, with a small smile to lift the corners of my lips would ease the social discomfort. He refused to look my way or acknowledge me.

I suppose pretending that the other person in the human sandwich doesn't exist makes the intimacy less traumatic -- or perhaps less potential for an emotional commitment -- if one does not acknowledge the spiritual presence of the other. In the five components of the human sandwhich making up the back row of our bus, if the two window passengers were the bread, my anonymous Haitian companion was the lunch meat, I the mustard, and my American friend to my right -- the pepperjack cheese.

Pepperjack sat semi-apologetically half on and off my lap -- thankfully a petite and slim young woman. My right leg was long-since dead, having become tingly then completely numb approximately four hours prior. I imagined blood clots forming threateningly in my lower calves, as my arms compressed rigidly against my chest by my backpack into the useless appendages reminiscent of a tyrannosaurus rex.

I hope we're on the right bus, I thought briefly to myself. How can I be sure we're not going to a secret work camp, on a sugar plantation or some other site. I can't, I thought. I'm here on faith alone.

I turned to Pepperjack. "If this bus were to bring us to a slave camp," I began cautiously, "would you rather hammer rocks with a sledge hammer, or hoe fields under the blazing sun?"

She glared at me quietly for a moment with piercing blue eyes. Then declared firmly, "Hoe."

"Ok," I replied. "Then I'll hammer rocks."

I noted that there are no seatbelts on this bus, but that, of course, would be redundant and unnecessary. As passengers, we are wedged solidly together like blocks in an igloo. Together, we -- like individual cells -- form a strange, immobile, membrane...like the cell wall of a strange organic creature. If this bus were to flip and roll on this dark, rural highway through western Dominican, I know for certain that not one of us would budge a millimeter. Even upside down we would hang, unscathed, as the tyrannosauri that we appear to be. Silently staring forward. Wedged. Inverted. Wondering if, upon rescue, we would finally be released and allowed to seek a place out on the roadside to empty our soon to rupture bladders.

There is a baby girl one seat up on the right held by its anxious mother. She appears to be a month or so old. We have discovered that this child does not have a passport. We know this because every ten to 30 minutes, our bus is stopped at yet another wooden roadside shack, and is boarded by a man -- sometimes in military camouflage, and sometimes in traditional Dominican dancer-bling of jeans encrusted with shiny faux diamonds and decal-emblazoned black t-shirt. Each man carries, in a show of power and intimidation, a big pistol tucked into the back of his waistband. These men -- sometimes immigration officials and, I suspect, sometimes bribe-seeking impostors as faux as the diamonds on their back pockets -- command us to hold up our passports. With intimidating glares, they slowly wander their dark eyes in inspection over the captive passengers.

By now, we have discovered that if we tuck our passports into our bras, accessible to our tyrannosaurus hands via our front collars, we are able to repeatedly comply with the gun-toters' demands with minimal effort of our largely useless upper extremities.

"Lift your passports," snarl the men as they stand in the doorway of the bus.

Everyone holds up their passport, except the small infant to our right. Of course, developmentally, she has not sufficient neurological wherewithal to find one of her own hands with another, let alone grasp and hold up her Haitian passport. Which is perhaps why she chose not carry it with her on this trip to the Dominican.

Unfortunately, her non-compliance repeatedly and predictably raised the ire of the different immigration officials/disco dancers (hard to differentiate their identity at times) who appear in the bus doorway.

Myself and my two American companions -- overtly white faces glowing palely from the back three seats of the darkened Haitian bus -- attract attention on these stops as we hold up our American passports. Repeated commentary at the door, involving pointing, chin gestures, glares, and the words "tres gringos" is not hugely comforting.

Do our white faces draw attention to the woman in front of us, then to the wiggling, passportless infant in her lap? Does the stopping of the bus, and subsequent absence of rolling/humming/rocking stimulate the infant into its unhappy wails? Or, as a predictor of the young teenage girl she is destined someday to be, is she just trying to give her mother a hard time?

"Hey, Mr. Angry Passport Checker," cries the infant in her secret language. "Look here! Look at me! I've infiltrated your country...without a passport. Nah nah..."

At the first passport check, five minutes from the Haitian/Dominican border, it was first established that the baby had no passport. The first intimidating man who boarded the bus grabbed her papers -- apparently a birth certificate and a shot record -- then berated the infant's frightened mother into tears. In Spanish, he ranted at the mother that the child's documents were not sufficient, that the baby needed a passport, that she couldn't enter the country with such worthless documentation, that she should be ashamed of boarding this bus to begin with, that he didn't care if even the president of Haiti himself had approved this paperwork; that this was the Dominican Republic, the child was Haitian, and she was entering the country in an illegal and unacceptable act. Et cetera. Et cetera. Et cetera.

Brown Haitian eyes nervously meet each others across the bus. The mother's welled with nervous tears. Mine meet those of my companions to my right.

This must be the drama that replaces the en-route movie, I imagined. Not really sure if I want to be a spectator at this event.

This bus trip is taking an infinity, I then note. I wonder if this baby was perhaps conceived and given birth to on this very bus. Is this, perhaps, why she has no passport?

Strangely, however, despite repeated immigration rants, neither mother nor child was ever actually asked to leave the bus. Were these men showing compassion to this baby's fate?

Unclear.

Unlikely.

They had no problem throwing an elderly woman off the bus at one of the first rural stops due to insufficient paperwork. Her elderly eyes stared in horror at the bus's departing tail lights as she stood solo on a grassy roadside embankment. Her horrified family, inside the bus, pressed disconcerted hands against the glass from the inside. All eyes inside the bus, mine included, reflected her horror as we drove away from her bent elderly silhouette that became smaller and smaller in the distance as the bus slowly rumbled away.

.
Granny, it seems, was not immune to immigration's ire. So, what about baby?

Perhaps fearing a similar fate for the baby, with the setting of the sun and the arrival or rural darkness, repeated cajoling negotiations were audible from varied passengers with the arrival of the next impatient, gun-toting immigration official.

"It's nighttime," called one slightly sensual female Dominican passenger in Spanish, batting her eyelashes towards the bus door in the darkness as one of the gunmen stormed from the bus with the baby's insufficient paperwork. Immigration stop number eight, I believe. About six hours now from the border in the middle of rural farmland. Nine o'clock at night.

"Please, sir. Don't throw her off the bus. Have mercy, sir. She's poor. She has no money. No place to go. She has family in the capital city. You can't throw a newborn baby off the bus. She has nothing. She has no place to go. You don't need this burden. Please, sir."

Did the negotiation save the child the elderly woman's fate? Or was it a carefully slipped bribe? Or the very real perceived inconvenience, on the part of a rural immigration official, of the prospect of, "if I yank this Haitian child and mother off the bus, then I have to figure out what to do with them in the dark nothingness of this rural night." i.e. nocturnal bureaucratic laziness out-trumps immigration policy.

So, recurrent ranting immigration lectures about incomplete paperwork, all met with confused non-Spanish speaking tear-filled Haitian mother eyes, ultimately ended in... well, surprisingly... absolutely nothing. Except the recurrent departure of the random immigration official, the hydraulic hiss of the closing bus door, the grinding of gears, and the puzzled realization that we were once again departing with mother and baby intact and an immigration official glaring at the rear side of our departing bus.

I believe we were stopped 14 times on this nine-plus hour journey by various "immigration" officials as we made our way across the Dominican. Several times, in the pitch blackness of night, we were all commanded to "get up and disembark the bus", and stand uselessly at the side of the road for no apparent reason. After ten minutes in the roadside grass, during which apparently nothing happened, no passports checked, no bribes requested, we were told to board once again.

Some people have said that this is the nature of a Haitian bus entering the Dominican Republic. That such searches and repeated "immigration" boardings are commonplace. I don't really see the logic. As someone described it, a muscle flexing claim of Dominican authority. But, I suppose, if nothing else, it breaks up the monotony 0f a nine hour bus trip into perhaps more tolerable 30 minute segments.

By the 14th boarding by an immigration official, all passengers on the bus started to groan in impatience. Comments could be heard about "the baby girl" and repeated scathing looks from the passengers were directed to the seat in front of us. As the doors swung open to admit yet another immigration official, I glanced at my American companions.

Unable to tolerate one more rant at the mother and infant,we decided that if the baby started crying, then we would ALL start crying, as a means to distract the official from the child.

Maybe, if she holds the baby really low to the floor, we conspired, and we cry loudly enough, he might completely overlook her presence while instead glaring at the three crazy gringas.

If the immigration guy questions our sobbing, I told my companions, we'll just say, 'Hey, man, it's been a really long ride. We're tired and cranky and we just can't help it.'"

We made a few practice whimpers and cries. To my left, my anonymous Haitian companion, against whom I had been wordlessly crushed for eight hours, began to grin.

Obviously, he secretly understood English.

He finally turned and met my gaze. We exchanged a knowing glance.

"Good idea, no?" I said, nodding. "Go ahead. You can cry, too. You know you want to."

He looked away, straight ahead, not acknowledging me as he tried to suppress his smile.

The baby stayed silent. She attracted no attention. We all raised our passports in the air. Except, of course, for her...because in her rush for the bus, or perhaps because of her onboard conception and birth, she had obviously inconsiderately failed to bring hers along.

We settled back into our slots in our human matrix, suspended against each other in our giant organic cell wall. The disco/ immigration man with the bling and gun descended the bus stairs into the darkness. The door hissed shut. The lights dimmed. With my one remaining sensate leg pressed firmly against my smirking Haitian stranger, the bus gears rumbled harshly, propelling us the final leg of the journey from the Haitian frontier to the city of Santo Domingo.