Back to School

In case you somehow missed it or don't have the academic year permanently emblazoned on your psyche, children are heading back to school. Facebook is full of posts of my friends' children on their first day, and they are adorable -- proud, exasperated, so much more grown-up than last year. My nephew had this ridiculously hilarious and nerdy statement in response to his parents walking him to school for his first day of second grade: "Depart from me or I shall become a laughingstock!"

In Kenya, Dorothea has been scraping together every bit of money that she can. As the new school year, she needs to buy a new uniform if her granddaughter, Dinah, is going to attend high school. The regulation blouse, skirt, socks, and shoes cost far more than Dorothea has left at the end of one month, or even six months.

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The total price for Dinah to go back to school comes close to $50. It seems impossible.

School attendance is a sacrifice of love and community in a place like Kenya. Dorothea and her granddaughter have been getting by on just one meal a day for the last few weeks to save a few shillings. An empty belly in exchange for an education. Dorothea has gathered small amounts of money from her two remaining adult children, from her neighbors, from her pastor and her prayer group. Money from anyone she can think to ask. Everyone is asking at this time of year. School fees, school uniforms, books. Everyone comes together to contribute what they can.

Dinah's parents both died in the past 18 months, and Dorothea now holds Dinah's future in her hands. Hands with knuckles swollen from arthritis and age and 60 years of cleaning houses count out one crumpled small bill after another in the school uniform store, praying that they will be enough. Enough to launch her granddaughter into a future of promise.

What if $50 means that Dinah won't go to high school?

This story is echoed around the world. This is what back-to-school looks like around the world: Mothers, fathers, grandparents, communities making sacrifices to launch their children into a better future. Everyone circles round to contribute whatever they can, to fan the small flame of hope.

Investing in education - especially education for girls - is one of the most effective ways to fight poverty. When you send girls to school, economies change, women and children are more healthy, and injustices start to be corrected.

Right now, more than 75 million school-aged children are not in primary school (where they should be.) 75 percent of them live in sub-Saharan Africa and South Asia, in places like Kenya. Too many of these children are girls. One in five eligible girls worldwide are not going to primary school.

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It's easy for me to be very nostalgic about my (many) school years. When I see the back-to-school sales for pens and crayons and notebooks, when I see my friends' cutie pie children in their uniforms, I get nostalgic. But the global back-to-school needs go beyond nostalgia.

How can we open the doors so that more girls in poor places can go to school at all? How can we help girls stay in school so that families and communities and global economies can be transformed?

Posted at 10:10

Wordless Wednesday: Fetching Water

fetching water_bike

Posted at 13:37

Dualities

Here is the duality of global health: You live every day with beauty and with brokenness pressed right up against your face. You cannot close your eyes to what it means to live in a world where 18,000 children under 5 die every single day, and this is both a precious privilege and a painful burden.

I thought this one was going to die. He came into my clinic in January terribly sick. His parents had both died, and it seemed likely that he would not live much longer either. But we fought for medicines for him and a place at the emergency shelter, and this week, I got this picture of him commemorating his finish of first grade. You cannot put a price on the light in his eyes.

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But even as I rejoice in being proved wrong in my predictions of death and in seeing a young one escape from those mortality numbers that almost included him, I get the news of a loss. A small boy with complicated health problems for whom we struggled to find an orphanage home after he was abandoned by his mother who just couldn't handle the burden of his medical bills and needs. My housemate had fallen in love with him, and I tried to figure out what we could do for him. But our trying was not enough, and this little life ended this week.

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Hope and hurt. Faith and failure. Beautiful and brutal. Promise and pain. Global health up close.

Posted at 03:12

Michael and his Mother

Michael has been taking HIV medicines since he was 3 years old. He's 10 now -- and he is alive and growing -- but the medicines are not doing what they should. The virus is multiplying in his blood, and he has virtually no immune cells. It's clear that either the medicines are not working or he is not taking them.

At first, his mother claimed that they have no problem taking the medicines, but eventually she started to be able to tell me about how much of a problem it is getting him the medicines every day.

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Michael's mother runs a small bakery. She leaves early in the morning, and she doesn't get home most evenings until after Michael is in bed. This bakery is a one-woman success story. It is how she supports her three children, and her sister's family besides. But her work to keep their family alive is inadvertently threatening Michael's health.

Most of the time, Michael doesn't take the medicines without her there to supervise. And so it turns out that he is missing a lot of doses of his HIV medicines. Without the medicines, the virus multiplies. Without the medicines, his immune system weakens again, and he gets sicker and sicker.

Michael's mother doesn't want to enlist the help of anyone else to give Michael these medicines because if anyone saw those medicines, they would assume that everyone in the family had HIV. And she knows what their community thinks about HIV. HIV means you are dirty. It means you have sinned and you should be avoided. It means you are going to die. She looks around her, and she only sees the potential for stigma and discrimination. If people knew that she had HIV, they would stop coming to her bakery.

"No one wants to eat food that is prepared by one with HIV," she says.

She doesn't want to risk losing the business that she has worked so hard to build. Her family's survival depends on the success of her shop. Michael's mother travels almost two hours to come to our clinic in Eldoret, rather than going to our clinic closer to her home. All because she never wants anyone to know that they come to a HIV clinic.

After our long talk, we planned together some new efforts to make sure that Michael gets all of his medicines. She agreed to try something new. And I had to tell her scary things. I had to repeat how we do not have any other alternatives left if the virus in Michael's body becomes resistant to the medicines he is taking now. And if he doesn't take them twice a day, every day, the virus will indeed become resistant.

They are hard words to say and hard words to hear, but they are true. Once these medicines stop working, then that's it - there won't be anything left to help the boy.  We don't have any other medicine options for kids in poor places like Kenya. (I think that's totally unacceptable, but it's also true. My heart breaks. My heart vows to fight. )

I think she got it though, and so I give them another chance to make it work with the current set of medicines. And I am left with these reminders from my time with Michael and his mama:

How vitally important is our work to determine which families are having problems with their medicines.

How much we need to address the terrible and isolating views of the communities around our families.

How great is our need to make appropriate HIV medicines accessible to children in the poor places where 90% of the world's HIV-infected children live.

Posted at 03:50

Wordless Wednesday: not just alive, but thriving

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(How I measure success)

Posted at 19:55

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