Unlike most diseases, there is no vaccine to prevent river blindness, but there is a medication called ivermectin that controls the impact of the disease by killing the baby worms, reducing painful itching, and preventing permanent blindness. Ivermectin is donated by WHO to affected communities free of charge. The medicine is not a cure, and in order for it to be effective it must be taken orally each year, without interruption, for a minimum of twenty years in order to kill the baby worms annually for the duration of the predicted natural life cycle of the parasitic worm. In the early 1980s, distributing ivermectin became a formidable challenge. Neither WHO nor any African government was able to develop the resources or infrastructure to sustainably deliver medication annually to each impacted community for the required period of time.
But then something amazing happened: the communities themselves recognized the great suffering caused by this illness and took action, stepping in to lead the necessary change. Guided by ubuntu—which teaches that one suffering person is everyone’s responsibility, and that our ability to flourish as individuals is inextricably linked to the ability of our community to thrive—the communities self-organized, appointing individuals in each village as local community distributors of the medicine, donated by WHO. Each year these community distributors took turns delivering treatment, volunteering their time and effort completely free of charge. Communities had complete ownership of these programs; the solutions arose from within, rather than from an external “benevolent” source. As a result, high treatment rates were recorded, the spread of this devastating and pervasive disease was significantly stalled, and those who had contracted the disease got their lives back.
Humbled and grateful, I give Betty a tight hug and delight in her strong and youthful embrace.
* * *
“Ready?” Ernest asks, signaling that it’s time to get going. I watch Betty bound away, healthy and happy, and I am filled with hope that I will encounter many other children like her, in this village and others; children who were living in terrible pain but who are now attending school, laughing and running, their suffering a distant memory.
“Ready!” I follow Ernest to our first meeting with the community leaders, still brimming with joy at the sight of Betty, and ready to hear about all the impressive progress the community has made in addressing river blindness. I know challenges remain, but I am positive we can work together to address them.
* * *
I recognize most of the leaders who are gathered in a small yard, the men sitting on wooden benches and the women on the ground. The warmth in their voices when they greet me feels like being hugged by the African sun. I sit with the women, prepared to listen and learn and strategize. They thank me for the increased medication and are happy to report that everyone in the community has equal access to treatment.
I ask how they have been able to reach everyone. Although overall we have seen high treatment rates across all river blindness–impacted communities, there are still pockets with low treatment coverage despite the availability of medication. One woman eagerly jumps in. “Aaaa, us, now we are also in charge. Now that we have enough medications, us women are also involved as community distributors.” Another woman, looking up at the men with a cheeky expression on her face, says, “Yes, and us we do a better job. We are more patient and refuse to give up until everyone takes their medicines, even if sometimes we have to go back to the same house every single day.” She erupts in laughter, and the women and some of the men join her. I take mental notes, filing away these stories, even more convinced that substantive, lasting change happens only when communities work together to lead from the inside out.
As Ernest and I venture into the community over the following five days, the changes are obvious. There are still blind village elders being led with a stick by young girls and boys as a result of river blindness, but we speak to more children who are now in school, all thanks to the additional treatment and the community’s efforts to deliver it equitably. Inside smoky huts we speak to mothers with blotchy skin, the dark pigment having been literally scratched away by their own hands, but at least now they are no longer isolated and are able to concentrate on our conversations.
When we go to the maize fields, my heart swells with joy to see crops sprouting on what was once barren land. We find one woman, Apio, and her children busily plowing their maize field. The sun is shining, the sky wide open, endless and bright.
“Aaaa, my sister, us, we are winning!” Apio exclaims, smiling. Her voice is cheerful. Her baby is strapped to her back with a bright orange-and-red sarong that matches her dress and head scarf. Her other children—three daughters and a son—are plowing a few meters away. In the early 1970s, most communities, including Apio’s, abandoned their homes and the fertile land near the rivers for fear of contracting river blindness. The results were devastating: hunger, poverty, and a high drop-out rate in schools. Now these same families are returning to their homes and farms and thriving once more.
“Look at all this, my sister,” Apio says, pointing to her maize field. “Look at God’s blessings.”
“Praise God, my dear sister,” I say, remembering the same joy on Gogo’s face every time the rain—which Gogo called God’s tears—blessed our fields.
“Aaaa, us, we did it ourselves, my sister. Me and other women are now community distributors, working together with the men,” Apio says proudly. “My sister, us, we realized something important, you know. We realized that we have to take care of each other, because what is done for us, without us, is not for us,” she adds. There is conviction and passion in her eyes. She reminds me again of Gogo, always fighting for what’s right, refusing to give up.
“Why do you think you have been so successful, Apio?” I ask.
“Aaaa, this one is simple, my sister.” Apio laughs and throws her head back. “Us, we always take care of each other, my sister. All this work, distributing treatment, we all do it for free. Yes, we do it for each other. Because, us, we are a community, we are one family.”
Standing proudly over her maize field, full of hope and purpose, her family at work beside her, Apio has articulated what lies at the heart of who we are as Africans. I reflect on Gogo’s many teachings and think of how fiercely proud she would be to see the manifestation of ubuntu in Apio’s community. Change was happening in Budongo because the community understood that being part of a collective means treating each other with compassion and respect—the central belief of ubuntu. When we support others in their suffering, even when it’s hard—especially when it’s hard—everyone benefits. Apio and her community understood that prosperity was only possible if they all worked together to be each other’s keeper, and that’s what they did, to terrific success. Their story proves this singular truth: that no matter the hardships and suffering Africans experience, we always find a way to uplift one another as a community, because of our ubuntu. Our individual and collective resilience is astonishing. I feel great pride, once again, that I am a girl from Africa, here and now, doing this work, meeting these incredible people and hearing their stories.
As I leave Uganda and visit more communities across Africa, thoughts of my second trip to Budongo lift my spirits and reinforce the importance of the work I do, as well as the power of ubuntu in accomplishing this work. Gogo’s valuable lessons show me again and again that we are all connected, and that “I am because we are.” With my boss, Dr. Uche Amazigo, a fearless Nigerian parasitologist, we also realize that we must encourage gender balance in the distribution of river-blindness treatment. We need more women like Apio creating greater impact in their communities; we need more stories like Betty’s.
* * *
I continue my journey across Africa, encouraging more women distributors to be involved in the fight against river blindness. But as I meet and talk with more people, I come to understand that it’s not about encouraging only women to be a part of the solution; I also need to convince the men, because in keeping with cultural and social norms i
n many of these traditional, rural communities, men still make the majority of the important decisions. The question is: how to sway them to the importance of this approach?
“No, no, no! Me, I will not allow my wife to go outside the home!” a man shouts, jumping to his feet and pumping his fists in the air.
I make every effort to remain calm as I look out over the faces of the men I have invited to this meeting, with the support of the community chief, in the Mahenge Mountains district of Tanzania, a five-hour drive from the lively hustle and bustle of the capital city, Dar es Salaam. Here, in Tanzania, home to Mount Kilimanjaro, the highest mountain in Africa, the East African mountains are green and lush, not at all like the icy Swiss Alps I see through my office window in Geneva. Here, the mountains surround you. In Switzerland, it is as if the mountains were cut out from some sharp material and pinned to the sky. Here the air is heavy with humidity, while in Geneva it is often wintry and thin.
“No women distributors!” The men are adamant, some of them angry.
I politely address the man who is still standing. “Let me ask you a question, my brother. If your wife is taking treatment and she experiences some of the side effects, would you be more comfortable with her discussing how she feels with a male or a female community distributor?” Without saying it out loud, I am referring to a commonly known side effect of the treatment: itching around the genitals.
I can tell this lands powerfully, and there is a brief moment of silence. “Okay, okay,” he finally says. “Definitely a woman community distributor.”
By engaging with both women and men, instead of excluding the men’s voices or opinions, we actually welcome more women distributors, and more people receive the life-changing medication. When everyone’s effort is equally accepted, then everyone is equally invested in solutions and success. This is how hope and healing emerge in communities affected by river blindness.
* * *
After my trip, Dr. Amazigo wants us to do more. Her mind is always working, thinking and strategizing about new solutions that will better the lives of more people. Sometimes I wonder if Dr. Amazigo ever sleeps or grows tired. “We must maximize the benefits of this community-driven development approach,” she says. Guided by this methodology of solutions by Africans for Africans, we eventually launch a curriculum of “Community-Directed Interventions (CDI),” at fourteen African universities.
Of course, there is always more to do. River blindness is not the only disease that takes or destroys lives in Africa. Every year, millions of children die due to a vitamin A deficiency, and every year millions of adults and children die of malaria in countries across the African continent. Dr. Amazigo decides that we need to empower our community networks to more effectively and efficiently address other diseases, like malaria, and also child mortality.
Three months later, my colleagues and I launch these pioneering pilot projects in Cameroon, Nigeria, Uganda, and Tanzania. Together with the river-blindness medicine, entire communities—women and men—coordinate the distribution of vitamin A supplements and insecticide-treated nets, as well as repellant and medication for malaria prevention and care.
* * *
When I travel to the French-speaking country of Burkina Faso in West Africa, also known as “the land of honest people,” I share the stories of people like Apio and others who are harnessing the wisdom of ubuntu to practically and effectively address their challenges as a community, acknowledging the agency they have over their own lives instead of applying the traditional “savior” approach that assumes “those with less should have no say at all in how they are helped by those with more.” This is not a formula for success; instead, real sustainable change comes from the inside, driven by the people for whom the change matters most and sustained by the community that best understands their own needs and culture. This always creates the most concrete and lasting impact.
While in Burkina Faso I contract malaria; not for the first time, but this strain is particularly severe, so much so it takes the life of a fellow UN colleague. My fever is so high it triggers hallucinations, and I am utterly flattened, devoid of energy. When I am eventually rushed to the hospital, there is a great deal of panic about my dire condition. My fever won’t break and I am growing weaker by the day. The doctors sedate me heavily, and for two weeks I lose consciousness as my body fights its way back to health.
When I come to, I am still weak, but well enough to be discharged from the hospital and return to Geneva. There I find several voice messages waiting for me; Amai has been calling me for a week, and each message is more desperate than the last.
I play the first message over and over again, willing it to change, for the news to be a terrible nightmare, and each time I push play, I pray to hear different words, for a miracle.
“Gogo has passed. We need you back home.” Amai’s voice is raw with emotion and also a fair bit of panic and concern; she’s likely wondering where I am and why I have not answered the phone or responded to her messages.
At first, I’m simply numb, on my knees in front of the machine, listening again and again to the words: Gogo has passed. I think to myself, It’s not possible. I just saw her when I was home for Christmas only months before; she never said anything about being sick. She looked frail, which made sense given her age, but death? Gogo was ninety-three, but two of her older sisters lived past one hundred. She has always been so formidable, so strong and capable—it’s hard for me to believe that death would stand a chance. I pace around my apartment, gasping for breath, still feeling the effects of my protracted illness. We were supposed to have Gogo around for at least another seven years.
I sob myself to sleep that night, and when I wake up, I think, Perhaps it was all a terrible dream, but I know I must face the brutal truth. And with that, my world falls apart. It’s like I’ve fallen into a great crack in the ground, falling down and down, even though I am still in my clean, white apartment.
By the time I make it home to Goromonzi, Gogo has been buried in the family cemetery next to her field of maize. I stand next to her grave, place my hand on my heart, and hear her voice as if she is sitting right next to me, or speaking into my ear. Whenever you need me, I will always be right here with you inside your heart, my dear child. Never forget that, never forget. The pain is unbearable. It seems impossible that I will never hold her or speak to her or laugh or cook with her again. Without the anchor of her presence and guidance, I feel unmoored and untethered from the world as I have always known it, and lonelier than I’ve ever felt in my life. I collapse onto her dusty grave, curl myself into a ball, and wail like a wounded animal, crying over her, blessing the soil and her soul with my tears.
Gogo: my rock, the woman who knew best my whole heart and loved me with hers. The first to teach me what it means to be a proud girl from Africa, Mwana Wevhu, child of the African soil. The first to teach me how to see and relate to the world and others in it, to live according to ubuntu, finding my humanity by finding it in others. The first to teach me that to be human is to belong—here in Africa and everywhere in the world.
I stay for a long time at Gogo’s graveside, until the shadows lengthen and the light fades. As the magic of dusk falls across the familiar landscape, I place my hand on my heart and promise to carry and share her teachings, all the days of my life.
Where there is love, there is no darkness.
—Burundian proverb
10
I wrap my hands around a steaming bowl of dumpling soup, trying to get warm. It’s nightfall, and I’m sitting on a wobbly wooden chair in a dimly lit, cramped, and absolutely freezing room. The walls are painted bright green, bringing a touch of cheer to the otherwise depressing space, which is barely big enough to fit a couch, a coffee table, two wooden toddler-size chairs, and a tiny television on a black metal stand. Hanging on the walls are photographs of a happy-looking woman and man and their two children, a girl and a boy, inside cherrywood picture frames embellished in gold. The room has no heat,
and the bitter cold is made much more intense by the drafts moving through the cracks in the broken window. The house reminds me of Amai’s shanty neighborhood in Epworth, the way everything felt close to falling apart, and the shabby rooms that were always either too hot or too cold.
I am in the rundown Ortachala neighborhood of Tbilisi, Georgia’s capital city, where some of the most impoverished residents live in densely populated and dilapidated apartment buildings and small houses with colorful metal tin roofs. This is in complete contrast to the sleek and beautiful city center just a twenty-minute drive away, with its art nouveau buildings, quaint cafés, and chic clothing boutiques that remind me of the allure and urban beauty of Geneva’s old city. Through the broken window I see a grimy apartment building; colorful clothing flaps from clotheslines strung across balconies, which are lit by bright fluorescent lights. People are constantly moving in and out through the different apartment doors, their voices and laughter filling the otherwise cold, gray evening with lively energy.
Keeping my hands around the hot bowl of soup, I try not to shiver, and say, “Tell me about your experience,” looking first at Ana, a petite, auburn-haired woman in her late twenties, with a round face and tiny brown, bright eyes, the size and color of a hazelnut. Her friend Elene is roughly the same age, with a slim face framed by loose curls of long black hair that match her dark eyes. The two women sit together on a sagging maroon couch directly opposite my chair, inside Ana’s home.
I Am a Girl from Africa Page 13