A sign warning of the dangers of Ebola outside a government hospital in Freetown. (Pic: AFP)
We twist and turn on the dirt road, the tyres kicking up clods of mud. It has rained intermittently the whole afternoon and the road becomes increasingly difficult to negotiate, requiring the full 4-wheel drive.
The other landcruiser gets stuck briefly, stubbornly revving to keep up behind us. We toss and tumble around on the back seats as the land cruiser dives into another rut. “Welcome to ‘Kah-llun’” the driver announces.
This stretch of the day-long journey to the base at Kailahun started with wishes of “Bon voyage” hailed across the two-way radio in Bo at lunchtime. To get to Bo, we’d left Freetown at sunrise in a minibus, packed to the brim with luggage and mission staff.
There were half a dozen police check points between Freetown and Bo: each stop requiring some unpacking of the car in order to disembark, and then lining up to have our temperature taken, and occasionally having to wash our hands in chlorinated water.
Staff in white coats pointed the thermometer at our foreheads, and read the result out loud, while camouflage-clad troops looked on. “I’m from West Africa, you from South Africa”, one of them laughed, “Yes, we are all Africans!” we agreed, me thinking that a World Cup would have been more likely to bring us together than an epidemic tearing through the country.
But we had it easy. With special passes around our necks, and a Ministry of Health placard on the front window of the bus, proclaiming “ALLOW TO PASS – EBOLA RESPONSE”, we sped to the front of the one kilometre queue, while a line of trucks, cars and motor bikes, with Sierra Leoneans –- mothers, children and men of all ages –- sitting in the heat on the road, waited to be allowed through.
The government has implemented quarantined zones, to be adhered to for 21 days after the last reported case in each zone. It was evident that while usefully restricting movement, these measures were causing havoc in people’s lives, and the transport of supplies across the country. For me, this was the first indication that the posters on houses and trees might be true, that “EBOLA IS REAL”.
We stopped on the outskirts of Bo to take a tour of the treatment centre. Built in only five weeks, the centre can take in 100 patients, and even has a helipad. In the next phase an onsite laboratory will be installed to speed up the time between a blood sample being taken and the result being available.
Few sites have onsite laboratories, and specimens are taken by road for testing, often leading to people who test positive for Ebola mixing with those who test negative for several hours in the waiting area of the centre.
Walking up to the centre, one is filled with awe: the white tent-like structures look like an impressive utopian city. But at the same time, they invoke the fear and intrigue felt by anyone who is drawn to the television news broadcasts of the yellow hazmat suits, masks and goggles. From a distance and for the first time, we catch a glimpse of these suits for real: people unloading a stretcher from the back of a vehicle … “Was that a body?”
Inside, the centre is carefully organised into high and low risk zones. Hand washing points, consisting of elevated plastic vats of chlorinated water, with a bucket underneath, are strategically placed throughout, and the paths through the zones are cordoned off with orange barrier fences and a carefully planned open water drainage system.
We see national staff putting on their Personal Protective Equipment, one layer after the next, as we stand sweating in our single layer of scrubs and gumboots.
Where are the sick and dying? One patient emerges from the high risk zone and takes a seat behind the orange barrier fencing. A few metres away, behind another orange fence, a health promoter shouts across to him, “Hello, Mr X. Since you no longer have symptoms, you are getting better. We now need to wait to see what your viral load result is, and maybe you can go home.”
We crane our necks to get a glimpse of the sick in the high risk tent. While the staff in the hazmat suits move slowly and carefully around the ward, partitions allow the patients their privacy, screening off our inquisitive eyes and those who may well be dying next to them.
We hit the road to Kenema, enroute to Kailahun. In Kenema, the market place teams with people in close proximity, buying and selling goods and food. Where is the Ebola? Where is the fear? I wonder why the fear of infection is not keeping more people away from the town centre.
But I wonder no more as we approach a busy traffic circle: a man lies prostrate in the road, emaciated and his face contorted in pain. With one arm he tries to shade his eyes. Far gone, too far gone. We shake our heads and drive on. We look back. No one will approach him: he will most likely die alone. Yes, Ebola, it’s real.
Kathryn Stinson has a PhD in Public Health and works as an epidemiologist at the University of Cape Town. She has three children, two Great Danes and one very supportive husband. She is volunteering in Sierra Leone for an NGO and writes in her personal capacity.
Mozambicans queue outside a polling station in Maputo to vote in presidential and legislative elections on October 15 2014. (Pic: AFP)
Voters in neat lines started casting their ballots in the capital Maputo shortly after 7 am, with Frelimo facing growing discontent amid an apparent popular swing towards the opposition.
“We want change. We want to choose a new, young leader,” said student Erisma Invasse, who was queueing at the Polana secondary school in an upmarket suburb.
“We want someone with new ideas,” agreed her friend, Raina Muaria. Both are voting for the first time in presidential elections.
The presidential race pits Frelimo’s Filipe Nyusi (55), the former defence minister, against the veteran leader of former rebel group Renamo, Afonso Dhlakama (61).
Also in the running is Daviz Simango (50), founder of the Mozambique Democratic Party (MDM).
“I am convinced of a victory,” Nyusi told reporters after casting his ballot. “We have worked for a long time, very hard to prepare for this election.”
Dhlakama, who voted at the same polling station, has cried foul each time he lost in previous elections but expressed hope that this vote will be free and fair.
“Results will be accepted when they are clean. As you know on the African continent, results are often not clean,” he said.
“We hope for the first time in Mozambique results will be acceptable, proper and with credibility. I believe this.”
The government amended election laws earlier this year as part of peace negotiations with Renamo, which demanded that the opposition be given greater control over the electoral process in bid to improve transparency.
The third presidential aspirant, Simango, voted in the second biggest city Beira, where he is mayor.
Voter surveys cannot be published in Mozambique, but judging from the turnout at some campaign rallies, Frelimo could be in for a shock.
The party’s glitzy final rally in its southern fiefdom of Maputo failed to attract a capacity crowd.
Frelimo presidential candidate Filipe Nyusi supporters cheer during the party’s final campaign rally on October 12 on the outskirts of Maputo. (Pic: AFP)
Twenty-seven parties and two coalitions are competing for the favour of 10.9 million registered voters in the presidential race, plus polls for national and provincial assemblies.
Desire for change Analysts say that while Frelimo is expected to win the election, the opposition is likely to make significant inroads, reducing the ruling party’s overwhelming majority of 75 percent garnered in the last vote.
The desire for change has been driven by a wealth gap that persists despite huge mineral resources, with fast economic growth sidestepping the bulk of a population that is among the world’s poorest.
Renamo, which has lost all elections since the end of the country’s 16-year civil war in 1992, has made a comeback, trying to spruce up its image after emerging from a low-level insurgency waged in the centre of the country just weeks ahead of the election.
“The recent (September 5) peace agreement is an opportunity for Renamo,” said Nelson Alusala, a researcher with the Pretoria-based Institute of Security Studies.
“Mozambicans may be attracted to Renamo for the simple reason of wanting change,” he said.
At the same time the fledgling MDM, led by the mayor of the second largest city of Beira, is gaining popularity.
Formed five years ago, the MDM gained around 40 percent of the vote in Maputo in last December’s municipal elections.
If none of the three garners more than 50 percent of the vote, a run-off will be held within 30 days after official final results.
Official results are expected 15 days after polling.
It was a Facebook message from Liz Moran at the Women’s Institute of Secondary Education and Research (Wiser) that prompted me to research and write this article.
Part of it read: “Many girls engage in transactional sex in order to pay school fees or buy sanitary pads resulting in some of the highest HIV rates in the country (38%). The barriers for female education are so strong that in 30 years, only one woman from the community had attended University.”
This is happening in Muhuru Bay, a town in the Nyanza Province of Kenya. It is situated on the banks of Lake Victoria, close to the Tanzanian border.
The facts haunted me. Young girls engage in sex with fishermen in order to pay for school fees or sanitary towels. And it gets worse: women fishmongers in the fishing communities commonly form relationships with fishermen to secure the rights to purchase the fish they catch and then sell them in the market. The sex exchange typically occurs in a hurried manner, often without preparation or protection. As it compromises their ability to practise safer sex, men and women in these fishing communities are at increased risk of HIV.
Given the nomadic nature of the fishing community here and a lack of education about HIV and Aids, it is thus not surprising that out of at least every ten people, about four of them are HIV positive. Recent figures from the Kenya National HIV and Aids Estimates say that Kenya has the fourth highest HIV prevalence in the world, with about 1.6 million people infected with the virus. Of these, an estimated 191 840 are children.
In the larger Lake Victoria region, it is also common for women and girls to have sex with fishermen to obtain food, or to get fish to sell in order to pay for medicine or school fees. Therefore, it is necessary to break this cycle by offering a solution to at least one of the challenges.
Wiser seems to have found a good one.
“We run an entirely free high school for girls in Muhuru Bay, a fishing village in rural Kenya,” Moran told me. “Girls here rarely complete secondary school. They are forced into marriages, become pregnant, drop out of school to enable their brothers to continue, suffer physical and psychological abuse, and have a general lack of support and positive female role models.”
Students at Wiser. (Pic: Supplied)
In 2006, Dr Sherryl Broverman, co-founder of Wiser, discovered a note that was slipped under her door while she was in Muhuru Bay doing research. “Should I stop having sex with the man who is paying my school fees? I am afraid of getting Aids,” it read. The note was from a 14-year-old girl.
In 2007, Wiser was formed to empower young girls in Muhuru Bay through education. Here girls would be offered a chance to study for free as well as get hands-on skills in agriculture, reproductive health and engineering. The girls would be removed from the environment that predisposed them to health risks, lack of education and instead get a chance to be girls.
The Wiser school in Muhuru Bay provides clothes, sanitary pads, books, healthy food, supportive teachers, mosquito nets, and medicine. About 150 girls have gone through the school, and girls who are pregnant are also welcomed. The school offers counselling and psychosocial support for its students while also helping them realise their talents and leadership skills. According to Wiser and Kenya’s Ministry of Health, this region has the highest HIV, malaria and infant mortality rates in the country.
“Our maiden class graduated this year in March and all the 28 girls passed their final Kenya Certificate of Secondary Education and 17 have qualified for university,” said Moran. “We know that those are girls who will lead their families and communities. They are innovative – some are making solar powered items from recycled materials.”
Members of Wiser’s Engineering Club. The girls have created flashlights with locally available materials which they hope to franchise. (Pic: Supplied)
Evidently, Wiser has long been living up to this year’s International Day of the Girl Child theme, ‘Empowering Adolescent Girls: Ending the Cycle of Violence’. By creating a fee-free secondary school, the organisation is changing the notion of what is possible for girls in Muhuru Bay, and also ending the vicious cycle of transactional sex and gender-based violence in school.
“Before coming to Wiser, the girls were in schools where their teachers touched them inappropriately and others were raped. Due to this, some dropped out. Here, we take a deliberate initiative to protect the girls while in school and we minimise their time out of school as well,” Moran said.
Girls around the world still face discrimination simply because they are girls. As we mark International Day of the Girl Child on October 11, the reality is that there are those who may still have to trade their bodies for a pen, a book or a sanitary pad. Fortunately for the girls in Muhuru Bay, they have one less challenge to overcome. Their education is being catered for and they are gradually being empowered to make their own informed decisions.
Hopefully when the UN Women Executive Director Phumzile Mlambo-Ngcuka marks the day at Unicef, she will challenge each and every one of us to empower our adolescent sisters. We may have resources that we can share to educate them. We may mentor them, we may share our experiences with them, so they could learn from us and us from them.
There is a need for a generation of young girls who are actively involved in their well-being and who are proactively taking steps to end the cycle of violence and inequality. And then, they need to carry it forward to those who come after them.
It is my hope that young girls across Africa will stop exchanging sex for any basic commodities, not merely because of the risk of HIV and Aids or pregnancy, but because they do not have to.
A woman walks past a billboard promoting male circumcision to combat Aids in the capital, Harare. (Pic: Reuters)
Seated on a bench in a clinic in Harare, Taenda Tavira (not his real name) waited patiently for his turn. As he entered the consultation room, the nurse asked: “How can I help you, young man?” Tavira didn’t know where to begin but he managed to point at his pants, mumbling something. Annoyed, the nurse snapped: “You are not the only one to be served, don’t waste my time.”
The young man gathered himself and with difficulty said he thought he had contracted a sexually transmitted disease. As he removed his pants in front of the nurse, she shouted: “I knew when you entered that something is wrong with you! Are you a man or a woman?” Stunned, Tavira pulled up his pants, walked out of the room and never went back.
This wasn’t the first time he was treated this way.
“I, like every other gay person, has to give in to a lot of insults and degrading inhuman utterances every day,” Tavira confides after relating the recent incident. He is open about his sexuality and the discrimination he faces at the hands of health personnel in Zimbabwe.
For Zimbabwe’s LGBTI community, disclosing one’s sexual orientation is a major barrier to getting accurate, appropriate and relevant medical treatment. Gays and Lesbians of Zimbabwe (Galz) is an organisation that works to protect the interests of this minority group in the country. Its programmes manager Samuel Matsikure highlighted that as Zimbabwe’s leadership has openly denounced homosexuality, discrimination and stigma against the LGBTI community goes unpunished and will take a long time to uproot.
President Robert Mugabe has made it clear that homosexuality will never find a place in Zimbabwe. “Homosexuality degrades human dignity. Its unnatural and there is no question of allowing these people to behave worse than pigs and dogs … If you see people parading themselves as lesbians and gays arrest them and hand them over to the police,” he said in a speech at a Harare book fair in 1995. More recently, he maintained that “gays have no human rights” and reportedly called for the arrest of gays and lesbians who don’t conceive children.
This state-endorsed homophobia has made it difficult for Galz to get HIV and Aids prevention messages out to its 2100 members and the LGBTI community at large, who face a backlash from government and society and receive no support from public health institutions. About 15% of Zimbabwe’s adult population is living with HIV and Aids. There is currently no data available on the LGBTI community specifically.
“The hostile environment the gay community is exposed to, especially at health facilities in the country, has impacted negatively on their rights to basic services such as health,” Matsikure said. “Some have been keeping sexually transmitted infections for six to eight months without seeking help.”
“Such discrimination and stigma at the highest level makes our lives difficult and we remain a secretive and isolated community always fearing for our lives,” Tavira added.
Zimbabwe’s Constitution promotes universal access to health, enabling every person, regardless of their sexual orientation, to be treated with respect and have access to healthcare and support. The every day reality, though, is very different.
In a bid to address this, Galz has engaged the Zimbabwean government, the National Aids Council (NAC) and Zimbabwe Doctors for Human Rights to educate them about the LGBTI community.
“We have held sensitisation workshops with stakeholders to root out ignorance and misinformation associated with the LGBTI community. Hostility, and beliefs systems deep rooted against the practise of same sex relationships in the country will need to be reversed,” said Matsikure.
While Zimbabwe’s Constitution stipulates healthcare for all, it also outlaws same sex marriages. The gay community continues to be marginalised, making the fight against HIV and Aids all the more difficult. “The intersectionality of HIV and Aids between the broader heterosexuals and LGBTI community is a reality. If we are to reduce or end new infections, end deaths from Aids, end stigma and discrimination in Zimbabwe no one should be left behind,” said Matsikure.
Sally Nyakanyanga is a freelance journalist and media trainer based in Zimbabwe.
Famine has been staved off for now by the efforts of many agencies and the biggest ever UN humanitarian operation in one country. (AFP)
Water bottle in hand and rucksack on back, his grey trousers rolled up to reveal spindly legs, 12-year-old Gatwech boarded the first flight of his life. His ear protectors dwarfed his head as he gazed wide-eyed through the window of the Russian-built UN helicopter that lifted into the sky, sweeping over lush plains and thick forests.
Gatwech crossed the invisible frontlines separating government and rebel forces in South Sudan’s civil war. Finally, the aircraft came in to land on a ringfenced field in the village of Akobo, deep in opposition territory, and the boy strained to look at the excited crowd waiting under trees. He was about to be reunited with his family for the first time after nine arduous months in a displacement camp.
His best friend beamed, his aunt sang and wept and spat as a blessing, and his uncle gave him a rather formal pat on the head. Gatwech was safe at last. But in the world’s newest and hungriest country, every gain is tentative and every haven fragile. Three days later, there was chaos outside the hospital in Akobo when a cattle thief was bound, chased and whipped by a lynch mob of soldiers, police and vigilantes, including rifle-toting children.
The febrile atmosphere is a sign that the rainy season is coming to an end in South Sudan, raising the prospect of renewed fighting. Aid is working here but diplomacy is not.
Famine has been staved off, at least for now, by the efforts of numerous agencies and the UN’s biggest ever humanitarian operation in one country. Yet bad-tempered peace talks between the warring parties have stalled, agreements have proved hollow and the international community has failed to apply the requisite pressure. The intransigence of two men, President Salva Kiir and rebel leader Riek Machar, is seen by many here as dragging the country towards the abyss.
Thousands have been killed and nearly two million have fled their homes since their war broke out last December. Oxfam and other agencies have warned that an expected upsurge in violence could wipe out recent gains in food security and push the number of severely hungry people up by a million in the first three months of 2015. Describing it as a shift from crisis to catastrophe, they say parts of the country could slide into man-made famine early next year.
A dangerous life
Children, who make up half the population, suffer the most. When the war started, Gatwech – not his real name – ran for his life after government forces attacked the town where his close family was staying. He was carrying a pair of shoes. “I thought my parents were also running,” he recalled, speaking Nuer through an interpreter. “But when I reached the UN camp, they were not there and I thought maybe they were killed. I was very afraid because I heard a lot of gunshots and artillery.”
Nearly 100 000 people are crammed into UN compounds across the country for their own protection, often in inhumane and unsanitary conditions. Gatwech found himself sleeping on a mat on the floor. “I didn’t have anything to do. It was boring. The day was very long,” he said. The boy, who hopes to become a doctor one day, also witnessed attacks on the camp from government troops. “It was a dangerous life. I saw a lot of dead bodies.”
But months later came the news that Gatwech’s parents had been located in Akobo by a family tracing and reunification programme coordinated by Save the Children. It is long, complicated and logistically difficult work: at present 5 660 children have been registered as missing in South Sudan and only 393 reunited with their families. “It’s a needle in a haystack,” one aid worker said.
When Gatwech landed in Akobo last week, his friend Isaac was there to greet him in a crowd of villagers and wandering cows. The 13-year-old said: “I was very happy. I missed him. We weren’t optimistic because we thought in the long run the only way he would come is when there is peace in South Sudan.”
And peace remains a distant prospect, with Kiir and Machar seemingly hellbent on a military solution. Kiir told the UN general assembly last month: “The conflict in South Sudan is purely a political struggle for power, not an ethnic conflict as reported.” Yet violence has broken out along ethnic lines in many parts of the country, pitting forces loyal to Kiir, a Dinka, against those of his former deputy Machar, a Nuer.
Economic self-interest is also fuelling the conflict. A report last month by the Enough Project noted: “The country’s competing privileged elites are sacrificing their own people’s lives to secure the political and economic benefits – including massive state-corroding corruption – derived from control of the state.”
Political and military leaders maintain “lavish homes” in Kenya, Uganda, Ethiopia, South Africa and Australia, the report continued. “Families of the leaders of South Sudan’s warring parties are living in neighbouring countries and their children are attending the finest schools available. Meanwhile, the education system back in South Sudan has collapsed.”
Ammunition sources
The Enough Project said the South Sudanese government had received $38-million in weapons and ammunition from China since the start of the civil war, while there is evidence that opposition forces may have been resupplied with ammunition by Sudan, from which the country gained independence in 2011.
Akobo, a remote cluster of tukuls, or mud huts, in Jonglei state, near the Ethiopian border, was the scene of an infamous massacre in 1983. Last December young Nuer men stormed a UN base looking for Dinka civilians sheltering inside and killed two Indian peacekeepers. Since then the village has been overwhelmed by displaced people, putting pressure on food, schools and hospitals, and driving market prices up. Mobile phone networks have been cut off by the government.
Akobo is now firmly controlled by the rebels, who include large chunks of what used to be the national army, and in the central market there is a sense of something approaching normality. But few expect it to last. Koang Rambang, the county commissioner, predicts famine and even genocide. “Akobo is the first town the government are targeting because they consider it a supply route and escape route for the community,” he said. “We’ll do our best to make sure citizens are aware of the threats they are facing.”
Talking into a satellite phone and flanked by soldiers wielding guns, Rambang is now firmly in Machar’s camp because, he says, it is the pragmatic choice. “People call us the rebels but this is the resistance movement to the onslaught, the killings by Salva Kiir. I have no interest in rebelling to go running in the bush for no reason. But if someone wants to kill me because I am Nuer, then I have no choice. I am ready for peaceful solution but if people choose to go forcefully, I am also ready for that.”
In predominantly Dinka areas of South Sudan there are similar accounts of brutal treatment at the hands of the Nuers and hostility towards Machar. In Akobo, it is the Dinka president who is deeply unpopular. Rambang said, “The communities have no trust in Salva Kiir’s leadership. The solution to this crisis is to have Kiir step aside and let some change happen. The other party might want Machar to step aside. I’m sure Machar will compromise because I have spoken to him several times.”
The war has caused a surge in child brides, according to Rambang, with families pushing girls as young as 13 into marriage so they will receive a cattle dowry. But the biggest crisis in Akobo, he says, is food security. Harvests, markets and trade routes have been disrupted. One in three children are acutely malnourished, with consequences including increased vulnerability to malaria and failure to attend school.
Outpatient centres
The village borders a river where children splash and play and climb trees, exotic blue-and-red birds swoop low and lone canoeists gently push through a surface almost as smooth as glass. It takes 45 minutes on a motorboat to reach the village of Dangjok. Here soldiers stand guard, bullet belts around their shoulders, the Nuer initiation pattern of six parallel horizontal scars on their foreheads. The local chief works at a desk in a gloomy corrugated shed where rocket-propelled grenades litter the floor and bats hang from the wood beams.
Save the Children and a local NGO, Nile Hope, are running an outpatient therapeutic centre where, in a modest building of mud walls and thatched roof, malnourished babies are registered, weighed, measured for height and arm circumference and given the peanut-based paste Plumpy’Nut or, in severe cases, referred to hospital for urgent treatment. Right now the preventative measure appears to be working, with hospital admissions down to single figures.
Nellie James, assistant nutrition coordinator at Nile Hope, said some mothers carry their children for two hours to be here. “None of them give up. These mothers are very strong and very determined. Here in Akobo people value children more. A mother can go two days without eating but the child has to eat.”
Among more than 30 mothers waiting their turn last week was Nyanhial Ruot, who fled the city of Malakal nine months ago. She was on the main street when government tanks opened fire. “Children were crying,” she recalled, wearing a rainbow coloured dress, sandals and yellow headscarf patterned with a red rose. “I’ve seen people dying in front of me. Most of them were mothers and children who were not able to run. We turned left and that’s why we’re alive. Those running in front were killed.”
Ruot, 25, and her family trekked for two months to reach Dangjok, but now her four-year-old daughter and two-year-old son are suffering vomiting and diarrhoea. “I’m worried about my children’s lives,” she said. “Before the crisis we got medicine in the market. Now there is none or the prices have gone up.”
A small paracetamol tablet has risen in price from 10 to 25 South Sudanese pounds (roughly $3 to $8), she complained. Food is also scarce. “We have planted some sorghum and maize but there is not enough for the children. In the dry season we collect fruits, grasses and leaves.”
That Ruot and hundreds of mothers like her are receiving help, and that South Sudan is not yet officially in famine is a notable victory for the aid agencies. Ultimately, however, it is only a sticking plaster. One in seven people are still at food crisis or emergency level and 50 000 children could die by the end of the year. All the good work could be undone if Kiir and Machar fail to make peace, or are not compelled to do so. The Enough Project has called for punitive measures including seizing the homes, bank accounts and shell companies of anyone undermining the peace process.
Tariq Reibl, head of Oxfam’s programme in South Sudan, said: “If famine comes to South Sudan it will come through the barrel of a gun. This is a man-made crisis, not one caused by the vagaries of the weather, and though humanitarian aid is vital it cannot fix a political problem.
“The international community is much better at saving lives than it is at helping solve the political problems that put lives in peril. Nine months of the softly-softly approach to peace negotiations has failed. If the international community really wants to avert a famine then it has to make bold diplomatic efforts to bring both sides to end the fighting.”
