(cont., ending)
Friday, November 17th. 12.30pm, in the air above Ethiopia.

“P.M.T.C.T, find out what it means to me…” – my suggestion for an Aretha Franklin-voiced Christmas single to promote Tearfund’s campaign for better “Prevention of Mother To Child Transmission” services...

A silly joke (always my favourite kind), but perhaps unusually this trip – now ending – has been studded with them, apparently flippant but necessary reflex responses to such otherwise-overwhelming despair.

An opinion poll reported on the front of yesterday’s Daily Monitor suggests seven out of ten children remain happy and positive in eight of Africa’smost crushingly deprived nations, Ethiopia of course included. Despite the abject poverty, it’s easy to believe of the irrepressibly eager kids all around.

But it’s a challenging context in which to guiltily glibly speak of “happy”, or at least “happier”, stories. Our re-visit to the Addis Ababa Medan Acts compound yesterday brought us face to face with two more HIV-positive (maybe the sole circumstance in which being “positive” is such a negative) – each tugging along their children, yet only one of the mothers consoled by their child’s health.

In one sense, 35-year-old Shewaye Hailu’s is the “happy” story, as her carefully-timed 200mg dose of Neviraprine during labour effectivelv shielded daughter Lydia from a deadly inheritance – the three-and-a-half-year-old girl now plays with ten-year-old brother Nathaniel, both (sorry, for now) unclouded by infection themselves.

But for all Shewaye’s relief and apparent tranquillity, she remains HIV+ herself, not yet severely-affected enough for ARV treatment but perhaps not far off. Hers, of course, is yet another distressing narrative – long detached from the husband of her first child, a hypocritical church elder who refused to accept any later involvement; probably infected by her cheating, previously-married husband who still refuses to be tested despite his telltale sinking bones and blistered flesh yet continued to force unsafe sex upon her until she finally walked out.

But, having planted between four and nine kisses upon each of us as greeting, she shrugs off any suggestion of being angry at her own fate – or her God – and instead talks up her prospects both working as a cleaner, and selling wheat and vegetable oil thanks to grants in cash and in kind from the helpers here.

It could have been rather different, however: “If my child had beeninfected because of me, I couldn’t have been able to cope with the stress and the agony. I couldn’t have survived this far – I’d have died some time back. The help I received is the source of my own survival as well as my daughter’s.”

How deep, then, must be the pain 25-year-old Mulumebet Bereket endures, even as her two-year-old daughter Tsion runs, plays, hollers, squeals, munches seriously on a handed-out Frusli bar, as the globular blisters sit like tears down the little girl’s cheeks.

Mulumebet, aware of her HIV status, had assiduously taken the 200mg pill as she began labour in her home, but was unable to keep the pill down, then was unable on arriving at hospital to explain to the medics she needed a replacement dose in time.

Tsion was born on the reception room floor – and, sure enough, passed the virus, the latest heartrending setback in a life that began with Mulumebet never knowing her separated parents; brought up, until the age of ten, by an older sister, but hurled out of home when said sister died; bumped from one unhappy, bullying home to another, and another, before even reaching her teens, as she struggled to find lasting work as a maidservant; forced into an affair with one employer, resulting in now-sombre five-year-old Mikias, born at 10am one morning only for his father to have fled by 3pm; persecuted by neighbours whenever lucky enough to find an all-briefly-rented room; often forced to spend days on the street without a scrap of food; brought to the brink of hanging herself with carefully-prepared noose and platform only for a timely neighbour to happen by her home...

Yet her stately, voluble storytelling has us flagging at the horror, more than it seems to affect her - the least we can offer are a fair few dollars for some of the handsome green-crossed, embroidered tablecloths and smocks she proudly spreads across the Medan Acts meeting-room tables.

The tributes to the Medan medics come not just from the patients/worshippers - it seems they have absolute faith placed in them by the appropriate authorities - both regional and federal.
Dr Fikir Melesse, the paediatrician in charge of the family department at the regional ministry of health, reveals all 31 HIV area projects in the capital are now under the control of Medan and a handful of other church-spearheaded NGOs - the politicians and officials seemingly satisfied retiring to the sidelines, especially after a pilot partnership with Intrahealth proved insubstantial to all and dropped after the obligatory year.

Amid the expected bureaucratic waffle, the mistiness of “priorities” and “strategies” and “objectives”, the good doctor does admit ignorance of how much exactly the state had invested into HIV healthcare - but also sighs ruefully, sharply: “You can’t imagine the discrepancy between, say, agriculture and health budgeting - we’re low down, put it like that...”

She also seems frustrated by both their dependence on outside intervention, and its limits - the lack of an effective co-ordinated response to the twin debilitators of HIV and food shortages, albeit expressed accompanied by a slightly startling image: “Malnutrition is the most important issue in an urban setting like Addis. People have nothing to do, nothing to eat, they have no blankets, so they start to make love - and have more children. What we want to see is both tackling HIV and at the same time combating malnutrition. Something too often we’re not even trying to alleviate. There are attempts here and there, even [even?] by Unicef, but at the moment I don’t think that’s anywhere near enough for Addis.”

So - more food, more donations, are needed - but surely, too, better focus and organisation? Often the problem - problems - have looked so vast and forbidding, any response is bound to look a little futile by comparison. But these lesser or greater acts of compassion and practical help, as seemingly exemplified by the likes of Dr Henok and the Medan teams, at least act against some of the all-too-easy cynicism.

It seemed hard to believe, but even the ever-beaming Dr Henok the other day admitted to a brief, recent attack of despair and foreboding, as the full implications of enforced changes to the PMTCT drug regimes began to dawn. Recent studies have shown up alarming limits in the efficacy of the 200mg single doses - only thought now to have, at best, a 50 per cent chance of preventing infection and, as Mulumebet’s plight illustrated, subject to grim mischance. Now, a two-pronged approach will combine Naviroprine with one of several specialist combination treatments - to be prescribed once a day for the final 60 days of pregnancy, and for a further month after birth.

Dr Henok and his old college comrade Dr Melesse are optimistic about the improved chances of success - but the estimated cost of administering to each mother, from the January 2007 changeover, will soar from $10 to $90. Tearfund’s choice of Christmas appeal has just become, perhaps quite unexpectedly, even more worthy and needful...

(The less said, perhaps the better, about our final, anti-climactic encounter of the week, and our second with a supposedly relevant Government official - a hapless number-cruncher and IT assist in the federal ministry of health who, beyond insisting mortality rates were “getting better” albeit without the assistance of specifics, seemed apologetically incapable of sharing any figures at all, or opinions - save for explaining his sideline work of chairing the new “health infomatics association”, only to dry up, baffled, when I straightforwardly, maybe a little sarcastically, asked him how this would actually affect a suffering, struggling individual with HIV. Dr Henok did come to his - and our - rescue by entirely reasonably pointing out the benefits of computerised, comparative data, file-taking, checks and tests-recording, and on and dully-but-worthily-if-belatedly on...)

This is where I left off scribbling, on the flight home last Friday, my eyelids clamming shut and “The Devil Wears Prada” about to start up for the second time… telling myself I could come back to this in between scrawling and typing up, and produce a finer, more thoughtful and climactic conclusion. Sadly, I couldn’t and haven’t and won’t, having no doubt been self-indulgent and turgid enough so far. On returning to work, it’s been tricky to know just how to respond to the inevitable questions of “How was Ethiopia, then?”m guessing the interrogator is neither expecting a breezy “Great, thanks!”, nor wanting a lengthy, agonised description… So far, I’ve resolved to stick with such thus-far-and-no-further, yet still a little emotive, terms as “Fascinating”, “Intriguing” and “Eye-opening”.

Maybe even a humble “Humbling”.

And it was, all those things and many more. Now to batter these overwritten ramblings into something approaching concise common sense by Friday week, World Aids Day…

The End.
For now...