All That Is Bitter and Sweet

by Ashley Judd

  “I don’t let the men touch my breasts, because that’s the food for my baby,” she said. She could not stand to go home to breast-feed with the grime of strange men on her as she held her son.

  “What would you do if you weren’t doing this?” I asked. She said she would want a small business, selling secondhand clothes.

  Kate looked at me and I looked at Kate, and suddenly all her warnings from Thailand went out the window. We had to help this teenager right away; no NGO programming, however expertly designed and administered, was an immediate enough intervention for Shola. We knew the nature of PSI’s work was not to rescue women out of prostitution, and gestures like these rarely worked without an established support mechanism. For Shola, we made an exception. She was too compellingly tragic. We dug into our pockets and came up with about $250 U.S. It was enough to pay Schola’s rent for two years. We explained how much it was, admonished her to tell no one she had the money, and gave her the number of the local PSI office with the plea to call us to check in, explaining that they could help her convert the dollars to shillings and keep it safe for her. She rolled it up in a tissue and put it in her bra. Our local staffer told her the name of a modeling agency and how to look it up, something that irritated me and I disagreed with but had to admit that in the short term, while she still had no skills, might help her generate income apart from outright sexual exploitation. We gave her a lot of love and encouragement, then drove her to the bus stop.

  When I think of Shola and that foul blue room jumps to mind, I blot it out with the memory of her pressed into me, my arms wrapped around her, in the backseat of the car, that ephemeral moment when she was safe, surrounded by people who had rallied to her defense. But it was a brief moment indeed; I never heard whether she followed up with our office, and there was no way to track her down in the transitory vortex of Nairobi’s slums.

  In countries like Kenya, where HIV/AIDS, malaria, diarrheal diseases, poverty, and all manner of social problems plague the population, life can be very, very cheap. But the value of a woman in such societies is cheapest of all. That afternoon I had paid 800 shillings for flimsy sunglasses on a Nairobi street; all the women I had met earned 100 shillings for a trick turned on their backs, 200 shillings for one on their hands and knees. Now, that’s cheap.

  Back at the hotel, a perky tourist from Texas recognized me in the business center and asked me if I was on safari. I let her blithe obliviousness and her expensive khakis irk me, and I blurted out bitterly, “No. In fact, I am on a HIV/AIDS prevention trip and have just been to three brothels.” I hoped I had ruined her evening.

  In the morning, we drove several hours on ridiculously bad roads through the countryside to see a malaria program at a rural clinic. On the way, I received full immersion education about malaria, at that time the world’s biggest killer of children under five.

  Because malaria is carried by female mosquitoes that feed on human blood at night, NGOs battle the disease by making it possible for hundreds of millions of people to sleep under nets treated with insect repellent. This works best because entire families often sleep under a single net together, and if it isn’t treated, those whose arms and legs are touching the net will still be bitten unless the repellent is present. The repellent has the added benefit of chasing the mosquitoes out of the room, thereby offering protection to those not under the net almost as well. In this way, multiple huts with long-lasting treated nets in a village can have the wonderful benefit of providing some protection to those who do not yet have nets.

  The challenge has been educating folks about the cause of malaria and the need for every household to have and sleep under a net, the distribution of the nets, making antimalarial artemisinin-based combination therapy drugs available, and teaching those infected to seek treatment. These are the kinds of obstacles NGOs specialize in overcoming and on which good progress has been made.

  It costs $6 to manufacture nets, which are sold for the heavily subsidized price of 150 shillings, or less than $2 in the villages. In 2008, this price was reduced to a mere 50 shillings. We deliver the nets to Kenyan health facilities at which we implement community behavior change communication, while selling the nets at these reduced prices, which can increase a sense of prideful ownership and use of nets. (By 2011, a happy confluence of political will and funding would allow PSI and other NGOs to undertake massive campaigns to distribute nets for free.)

  Most rural Kenyans know about their clinics and women aim to go to them for ante- and postnatal care, even though it is sometimes a two-day walk to the clinic. Knowing the arduous journey will also yield malaria protection, they are more motivated to make the trip. A pregnant woman is highly susceptible to malaria; it makes her extremely sick and can cause a world of ills to her fetus, such as early termination or low birth weight if she is able to deliver. They constitute the highest risk and most vulnerable group and are a core focus of malaria campaigns.

  From what I had observed, it made little sense to confront each condition—AIDS, malaria, unsafe drinking water, malnutrition—as a separate threat to the health and well-being of women and children. This old, siloed approach to health care and development aid was already on its way out. Now PSI Kenya integrates reproductive health, maternal and child health, and HIV prevention communication and services on every level.

  One of the behavior change communication challenges in Kenya is teaching women and caregivers the value of mosquito nets and how to use them correctly. And this was what I was going to help demonstrate at a rural clinic.

  A large crowd of nearly two hundred was gathered for our outreach event. Women sat on the grass, either pregnant or holding babies, and everyone was very curious and attentive in spite of the equatorial sun at midday. There was the usual pomp and circumstance in the form of repetitive welcomes and some fabulous singing to compensate for the stultifying protocol, then I demonstrated how to use and treat a net. I was given a typical plastic basin and showed how to use the gloves and dissolve the repellent tablet in water and saturate the entire net. Wonderfully, even though the event was fun, new technology means such steps are now obsolete, as pretreated nets are standard. And this was only five years ago!

  Afterward, I interacted with my audience and felt confident of our day’s success: None, when they arrived, used nets. Now all would go home with both a net and information about malaria, how it was transmitted, how not to become sick, and treatment seeking behaviors if they were infected. They also said, when asked, that they would reach out to other families with their new empowerment, and last but not least, they said they would stand up to their husbands, who often insisted on sleeping under the family’s sole net alone, even with the knowledge that the mothers and children needed them the most.

  To wrap up the demonstration, some wild, boisterous women sang for me again, becoming quite carried away when I joined them and basically creating a mosh pit where they knocked me from hip to hip like a little bouncy toy until I escaped, laughing, into the calm of the van.

  I had one more appointment before I departed Nairobi. Before I left home, I had asked Gloria Steinem, a mentor and friend, “Who is the one person I simply must meet on this journey?”—something that has become a tradition on my trips. She has thrilled me every time with her introductions. Her referrals have connected me with heroes who have become friends and with organizations I now support that powerfully supplement my engagement with PSI.

  Thus I arranged to meet the two women who ran Equality Now’s Nairobi office, but because of my crazy schedule, the only time to see them was in my hotel room, the night before I was to leave for Madagascar. When I opened my door in my bathrobe and saw two gorgeous Kenyans, Agnes Pareyio and Faiza Jama Mohamed, one in full formal cultural dress, I ushered them in and hurried to pull my act together so I would give them the same honor they had obviously afforded me. I put on my favorite nightgown that passed as a day dress, ordered them coffee, and prepared to be schooled. I was not disappointed.

 
Equality Now is a global NGO dedicated to ending discrimination and violence against women; its emphasis in Africa is on property ownership and female genital mutilation (FGM). In their animated, musical voices, the two women described the campaign against FGM, the brutal tribal custom of cutting a young girl’s genitals. Sometimes euphemistically called “female circumcision,” the practice is so widespread that an estimated six thousand African girls are threatened with it every day. In some tribes it is a ceremonial nick, but usually the clitoris and labia are sliced off by a traditional circumciser, usually without anesthesia or any regard to hygiene. A tremendous amount of blood is spilled when a girl is cut (many girls hemorrhage to death), and circumcisers often use the same filthy tools on more than one girl in succession, spreading disease. The resulting damage to the genitals makes girls more susceptible to STIs and HIV. It happens at various ages, but invariably, it happens. The desired result is a girl with reduced sexual function, who will remain a virgin until marriage and a faithful wife thereafter. It is an exceedingly grotesque example of pathological attempts to control female sexuality. FGM is so difficult to stop because it is an entrenched and pervasive practice, and women are conditioned to believe that they can never marry without being cut. Because every woman in the group has been mutilated, the peer pressure to conform is enormous. In many places, a mythology has evolved around female genitalia to reinforce the practice. In some tribes, it is believed the clitoris will hurt a baby upon delivery, and that it will kill a man. (Well, of course it does, but it’s a delicious death men love and from which they recover! La petite mort, as the French would say.) FGM is so important that should a woman in Tanzania die uncircumcised, she will be cut postmortem, or it is believed she will not go with her ancestors.

  In Kenya, Equality Now representatives travel from village to village, explaining that the clitoris is an organ with an essential function, just like an eye or a hand, using anatomical models of healthy genitals and ones that have been circumcised. They explain that the early onset of vaginal dryness makes sex unbearably painful. The extraordinary pain and difficulties women have with childbirth are related to the lack of elasticity in all the scar tissue where the genitals have been mutilated, including the removed labia. When they do this education face-to-face with both men and women, the practice changes, but Africa is a big place and it’s slow going. They also appeal directly to the older women who perform the mutilations, essentially trying to persuade them to hang up their rusty knives and razors by reeducating them into a small business of some sort or taking the religious route (you’ll go to hell for hurting all these girls so unmercifully!). They are doing fabulous work, and while it is hard, there is progress. Equality Now has partnered with a grassroots group in Maasailand to implement “alternate rites of passage” for schoolgirls. They have engaged in training police officers in ways to enforce anti-FGM laws and have a presence in the courts to hold judges accountable for upholding the rule of law.

  Americans might be shocked to learn that FGM practices have spread to this country along with the African diaspora. A federal law passed in 1996 specifically outlawed female genital mutilation in the United States. Equality Now is at the forefront of the campaign to expand the reach of the law to prevent girls from being shipped across the borders on “vacations” to be mutilated. Sadly, the bipartisan Girls Protection Act did not make it through the House of Representatives in 2010; there are plans to reintroduce the bill in the next session.

  By the time Agnes and Faiza said their goodbyes, I was so fired up that it was hard to sleep. I could feel my horizons expanding as I contemplated the network of organizations like Equality Now that I could support. Each was like an instrument in an orchestra that, when played together, made a glorious symphony of hope.

  Chapter 10

  THE RICE TENTS

  Prostituted women testing HIV-negative in Madagascar

  There is a crack in everything. That is how the light gets in.

  —LEONARD COHEN

  fter a week in the sunstruck urban wastelands of Kenya, the lush rain forest of Madagascar was a balm for my eyes and my soul. Kate had arranged a brief respite for us at a lodge on the edge of the Andasibe-Mantadia National Park, deep in the eastern mountains of this exotic island nation in the Indian Ocean. My plain wooden bed was under a mosquito net, and my windows and doors opened out into a place rich and lush in life and noise, a jungle filled with colorful birds calling in the trees, eight-foot-tall hibiscus plants rustling in the breeze.

  I desperately needed this communion with life, as Nairobi had taken it out of me. I am not an urban person in the best of circumstances, and I’d never been to such a place before, so hard and dirty and tough and desperate. I’d thought everything in the developing world was either like Phnom Penh, basically a large rural town, or Bangkok, modern and muscular with freeways and skyscrapers. I hadn’t known there was such a drastic place with millions of people trapped in slums, barely getting by every day. I had been fully disabused of my romantic notions of Kenya, born of films, books, and tented safari brochures. The Maasai I saw were herding thin cattle on the sides of cratered highways chugging with cars on the verge of collapse. My naïveté made me feel foolish.

  All the domestic animals I’d seen in Africa were very thin, and I said a compassion mantra each time I saw some: Om mane peme hung. It was how I could feel somewhat useful in my total uselessness to them, and how I could keep from crying. Our young guide from the lodge had an amber-colored dog named Ginger that he called over to meet me so I could love on her. She was awfully friendly and sweet, and I vowed to provide her some food. Papa Jack told me no matter how much money I gave our guide, the dog would see none of it, so I retrieved my lunch scraps from the bin to feed Ginger and her friends. I got some especially good sugar from a lovely brown male, and it was confirmed yet again: There is nothing like the love of a fine dog.

  In the morning, we visited an incredible little animal habitat that had chameleons, lizards, snakes, geckos, and the like. It was fascinating that so many unique species had developed in isolation, 240 miles off the southeast coast of Africa. I ended up wondering: How have these creatures so ingeniously and brilliantly evolved to where even their eyeballs make them blend in safely, and we humans have evolved into an eighteen-year-old girl, eight months pregnant, being bought and sold for sex so she can feed herself?

  That afternoon, I clumsily tried to evade Papa Jack for a solo hike and was caught red-handed fetching a map at reception. He was kind enough to go against his own instincts and respect my fanatical need for aloneness, and I gratefully trekked up the rich mountains by myself, where I immediately began to weep. I walked and cried, and nature, as always, was overwhelming enough to absorb my grief and allow me to heal some. After Nairobi, I was starting to feel I could no longer be shocked. I could be touched, I could be moved, I could be distraught, but I couldn’t be shocked—at least not by bad stuff. The worst sights and stories were all different versions of the same tragic tale of poverty, lack of education, gender inequality, disease, exploitation, inhumanity. The variety was in nature and in love, where wonders never cease: the colors of the chameleon, memories of Papaw Judd scrambling my eggs for breakfast, Dario’s humble contrition when he’s wrong and his gentle way of helping me learn when I am, twenty women meeting as strangers at a yoga retreat becoming sisters by the end of the week, a thunderstorm in Big Sur, a flock of thousands of birds gamboling and landing on a loch in the Highlands—I could go on and on. The beauty of the world could break my heart, but its ills could no longer break my spirit. At least not today.

  By now Moyra had joined me on this painful, glorious adventure. I was deeply grateful for her company, and I’m amazed at how we love so many of the same things. As we drove through the countryside, both of us gaped out the window at the cheer the Malagasy put into their tiny clay huts, at the beauty of wild roses, St. John’s lilies, rushing rivers, waterfalls, graceful, inventive orchids, and ridges of green as far as the eye
could see.

  But after this brief, restorative visit, it was on to the teeming capital, Antananarivo, and the challenges of a once isolated people now being slammed headlong into the twenty-first century. I quickly began to see beyond the physical grandeur of Madagascar and into its extraordinary poverty. Even though the land seems abundant, 88 percent of rural Malagasy do not have safe drinking water, and they suffer the consequences of that with the usual tragedies, all of which are preventable, including unacceptably high maternal and child mortality. The land produces fruit, but it earns them little money, as 60 percent of it rots before it can be exported; farmers cannot afford to pay to transport it. The once magnificent forests are being razed for timber and firewood and by slash-and-burn agricultural practices. And while it seems lovely that there is no litter on the ground, it is because there are no goods to throw away. Only half the children are vaccinated, and half the children are malnourished and stunted. The rural infrastructure is extremely minimal, and our mission of delivering lifesaving messages and goods, such as clean water treatment (which costs only 1 franc per liter), insecticide-treated mosquito nets, maternal and child health education and products, and, of course, HIV/AIDS prevention, has been confronted with a whole new galaxy of challenging puzzles. Fortunately, we do have some good funding here from both USAID and the Global Fund, money I was seeing in action in terms of both ideas and programs and the motivated, dynamic local personnel who implement them.

  Although AIDS had been slow in coming to Madagascar, in 2005 it was waiting like a ticking time bomb to explode into the general population. Madagascar’s remoteness, coupled with an isolationist, Socialist government, helped protect its people from the AIDS pandemic that swept the mainland during the 1980s and 1990s. But in recent years, a new leadership had thrown open the doors to private investment, travel, and tourism—and with it, HIV.