Africa in Vienna

Some good news for women came out of Africa last week, via the international AIDS conference in Vienna. A study in South Africa testing a vaginal microbicide gel has shown that the gel reduced the risk of HIV infection by 39%, and halved their risk of acquiring genital herpes. 39% may not sound like much but previous microbicide trials have shown more like 0% effectiveness, so it’s really very big news! One of the reasons it’s so important is because it’s a method of HIV prevention that women have complete control over. In cultures where women have difficulty negotiating sex (let alone safe sex), this will make a big difference. In fact, it was probably the biggest news at the conference. You can find out more in a webcast, or read the news report.

The World AIDS Day Collection

Just a small collection – of health promotion videos from Africa that have impressed me over the past year of so.  The good news is, they might be working. Acording to UNAIDS, new HIV infections have dropped by 17% in the past eight years, particularly in Africa. The other good news is that with greater access to treatments, more peole in Africa are living longer with the condition.

I’ll let the videos speak for themselves. First, there’s the joyful 46664 – a remix featuring Nelson Mandela that I found on another intercultural blogger’s site.

Then there’s this animation from the Congo.

A cool cartoon collection from South Africa – this is the first in a campaign of seven:

And finally, my old favourite, Bammy Boy’s HIV Hip Hop from Sierra Leone. I’ve posted this before but I reckon you can’t have too much of a good thing. A couple of months ago I showed this video at Punchbowl Boys High, where I’d been invited to give a talk (actually on how I use maths at work). It was a big hit with the Year Sevens and apparently they were singing the chorus all day.

Learning to swim with sickle cell

I seem to be turning into some kind of expert on this. I recently went searching – again – for websites about swimming and sickling, and what should I find but my own post on the first page of Google results! I feel well qualified to be an expert because I have taken Abrantie swimming many times and we’ve only had bad consequences a couple of times – and I’ve learned from them! Mind you, there’s not much to it. Swim in warm water, stay active to keep warm, don’t stay in too long and get out and get dressed before you start to feel cold. Wetsuits may help, if you can make that investment (we haven’t).

However, Abrantie’s school has just started its annual swimming lessons for the whole school, and I thought they may need this spelled out in a little more detail, seeing as how they’ve probably never come across sickle cell before – except perhaps in high school genetics lessons. Also, swimming classes generally follow a particular format that might need to be modifed for a child with sickle cell, whereas with recreational swimming you can do what you like, get out when you like, and you don’t have to stand around (getting cold) waiting for your turn with an instructor. So with DadaK’s permission I wrote an information sheet for the school and the swimming instructor. I’ve uploaded it as a Word document in case anyone wants to modify and use for their own situation.

Today was the first day of swimming lessons and all seemed to go well. Abrantie got wet, got individual attention, had fun, and didn’t get cold or – so far – sick. The catch was that the warmest pool was the baby pool, and it was a bit hard learning to swim in water that was only knee-deep. He’s hoping that tomorrow they’ll try out the bigger pool, which is heated and indoors, though not as hot as the baby pool. Hope that works out okay!

Bouquet to RACP

In late August the Royal Australasian College of Physicians (RACP) released a statement that reaffirmed their position that male circumcision should not be performed on infant boys as a routine procedure. Good on them! Read their statement, a brochure for parents, and the policy which is currently being reviewed.

Circumcision seems to arouse incredible passion and tenacity among its supporters. These are usually – but not always – people from cultures where circumcision is a time-honoured cultural practice. It’s been my observation that in mixed relationships, it’s usually the partner from the non-circumcising culture that gives way, if there’s any disagreement. Well, that may promote marital harmony but seems pretty unfair to the child, who has no choice in the matter. 

I don’t see culture as a defence for what I consider to be an oppressive practice.  Culture is ever-changing and over time, people often repudiate cultural practices that used to be routine – there are, for example, plenty of African women now speaking out against female genital mutilation – and in my own culture many people now reject cultural practices around gender roles that used to be unquestioned.

I also don’t think much of the medical arguments. As the RACP says in its statement, the alleged benefits of male circumcision just don’t stack up against the risks of the operation and the ethical issues around perfoming non-reversible, non-essential surgery without anasthaesia on a minor. And if you are concerned about the big bogey HIV (some studies have shown it may have a protective effect agaist HIV transmission) inform yourself with this briefing paper by the Australian Federation of AIDS Organisations.

I could write a thesis on this topic but that will do for now …. I will sit back and await the brickbats that may shower upon me for revealing that I oppose circumcision.

Sickle cell awareness day

Abrantie's 9th birthday

Ok, ok, I’m a bit late with it, but I wanted to take note of the very first ever World Sickle Cell Awareness Day on 19 June and Hey! I’m I’m only a week late.

The day has come about as a result of a resolution passed at the United Nations last December that recognised sickle cell as a public health problem and called for a day to be set aside each year to raise awareness of the condition internationally. The resolution was proposed by the Delegation of the Republic of Congo Brazzaville and co-sponsored by 24 Member States. You can read more about it in the 19 June UN Press Release.

As I’ve mentioned before both AM’s Dad and his half brother Abrantie have a variant of sickle cell that’s severe enough to affect their lives in a major way.  We don’t know anyone else in Australia who has this condition, although there must be someone, especially since African migration has increased. So as far as I can tell there was absolutely no awareness of World Sickle Cell Awareness Day in Australia.  So this blog post is my two cents worth.

And here’s a quick update on my latest foray into pain management with Abrantie. It was a few weeks ago now that he started to feel pain on the way home from an afternoon in the park playing basketball with me and his brother 50 Cedis and some friends.  (50 Cedis, BTW, is very pleased with his blog name but somewhat disappointed that my whole blog is not about him).

We tried something new. The last time it happened, I’d got him to vocalise the pain – make a lot of noise: “Ow, ow, ow!” This time we tried some righteous anger, with me giving examples of what he could yell at his pain:  ‘How dare you!’ ‘Get out of my life’, ‘I’m not putting up with you any more!’ He did a bit of yelling himself but mostly my no-holds-barred attack on pain got both him and 50 Cedis laughing and laughing all the way home. Which I think is a good thing because it got his attention off the pain and suffering and isolation that comes with sickle cell. I won’t claim it’s a miracle cure, but he got to feel powerful,  not a victim.

However it’s the second time he’s had pain after late afternoon basketball at this cooler time of year, so I guess we’d better not do that anymore, and keep it for the middle of a sunny day.

While I was looking around the web for info on Sickle Cell Awareness Day I came across an interesting blog by a ’28 year old, fabulous and feisty female’ who also defies sickle cell and won’t tolerate being a victim. The title says it all:  Sickle Cell can kiss my A**!!! She is fabulous too. It’s a great blog with lots of interesting info and insights on living with the condition.  She’s also done a short post on her swimming experience – an issue close to my heart as you’ll know if you’ve read my previous posts on this.

And that inspired me to do a search on ‘sickle cell wetsuit’, cos I wanted to know if they are useful. I managed to find one post,  about five year old Atreyu, who has a wetsuit and can swim for up to 30 minutes at a time.  There’s no more info about swimming than that, but still, it’s hopeful. And the article has some good info about kids and sickle cell.

To end my post I’ll quote from Atreyu’s Dad: `We try to live a normal life as much as possible, but the disease is always at the forefront of your mind … But you have to stay positive and enjoy every day with your child.’ Here here!

Swimming and sickling update

G Ketewa at the beach

Last Friday my brother (The World’s Best Uncle – TWBU) and I took AM and his siblings 50 Cedis, G Ketewa and Treasure to the beach. It was a gorgeous day, the waves were just right, the water was sparkling, translucent and a perfect temperature, we had fish and chips for lunch, ice creams on the way home, and everyone had a fantastic time. Except for TWBU, when he had to eat the Bart Simpson ice cream that Treasure licked once and then rejected.

AM took to the waves at the back for five hours, 50 Cedis showed surprising confidence and competence in the smaller waves at the front, and G Ketewa and Treasure grew more and more bold in the shallows.

I mostly left AM to himself – he’s safe in the deep water. The World’s Best Uncle watched the littlies, and I was able to get very wet splashing about in the smaller waves making sure that 50 Cedis didn’t get over-confident and drown himself.

50 Cedis on the boogie board

It was a happy day, and since then Treasure has demanded a return to the beach every time she sees me. She may get lucky, I’m hoping to take her on a few excursions once her brothers are all back at school this week. And it’s very hopeful that she didn’t show any signs of sickle cell pain afterwards (she’ s never been tested for it). She certainly got cold enough to have brought on a crisis, if she had it.

The following day I took Abrantie to a heated indoor pool. This was his compensation for missing out on the beach. We hadn’t taken him because we knew it would be hard to keep him out of the cold water and also because we felt that having responsibility for four non-swimmers at once was a bit too much. Plus I think his frustration at not being allowed to boogie board with 50 Cedis would have far exceeded his disappointment about being left at home.

The pool excursion was a mixed success. Abrantie loved playing in the water and had a great time. But he was very much aware that the friends we went with would really have preferred to go in the big, cold outdoor pool right beside it. Being good friends though, they mostly stayed and played with him in the warm, small pool and one of them even tried to teach him to swim – what a hero.

Typical Aussie beach scene.

To a non-sickler on a scorching day (42 degrees C) the water in both pools felt pretty tepid, but Abrantie’s red blood cells obviously felt differently about it because by the end of the afternoon he was complaining of pain in his leg. Either he’d spent too long in the water or the water wasn’t quite as warm as usual. I felt terrible: guilty that I’d let it happen, sad that  it seemed like taking him to the pool was just too big a risk.

Fortunately, the pain didn’t develop into a major crisis. On the way home in the car I encouraged him to yell and scream and moan as much as he could. I joined in the yelling myself, in Twi and English. Ow, ow ow! Omigod, the pain! Na me adom, awurade, adjee adjee (forgive the spelling, no idea how to write some of these words). He seemed to enjoy this, perhaps because making a fuss about his pain is not really alllowed at home. But I believe in expressing it loudly, providing you don’t frighten other people. It’s not the noise of yelling that’s hurting you, after all.  

Once we got back I cuddled him for a while, then massaged his leg with a hot ointment and gave him some nurofen. His mum, Obaapa is in Ghana at the moment – for Nana’s funeral and also the one year celebration for her own mother’s death – so I reckon he needed a bit of mothering.

Well, one or all of the above strategies worked. I was very relieved the next morning to find out that he had slept ok and the pain had receded. Phew.

Poolside attire for defence against sickle cell. 42 degrees and Abrantie was cold!

I’ve had another look around the web and rediscovered the Sickle cell information centre. This site is a fantastic resource which answers a wide range of questions about sickle cell. Here is some of what they have to say about why swimming in cold water causes sickling crises:

“Cold increases the use of oxygen by the muscles and this reduces the amount in the red cells. Shivering is an example of the extreme of this effect. Cold also causes the blood vessels to contract down and become smaller to preserve body heat. This directly reduces blood flow and any sickling of red cells causes further slowing of flow. The slower blood flow also reduces further oxygen in the blood and low oxygen causes increased sickling.”

 This is good information. However what I’d really like to read is stories from people about their swimming experiences. Is it something people have given up on doing? Or have people found the optimum indoor pool temperature? Can you swim in tropical seas, which are so warm? Perhaps a trip to North Queensland is in order. Sickle cell is bound to become more of a problem in Australia as more Africans migrate here (It’s most common in people of African descent). Perhaps it’s here, where swimmimg is a national obsession, that we’ll come up with some solutions for swimming with sickle cell? Or perhaps I just have to accept that this is one pleasure Abrantie may have to always forego. It’s not easy. For either of us.

Swimming and sickling

4 years old x 4 metres deep

I’ve been thinking about swimming. We’ve just spent a few days up the mid-north coast visiting my parents – which means going to the beach every day for a swim. It used to be twice a day for hours and hours, but adolescence seems to have given AM an allergy to exercise, and now when we stay at the coast it’s once a day for a quick surf and that’s it.

Just as an aside, my boy told me he doesn’t want to be called ActionMan in this blog. In just one short year it has become a misnomer anyway. So until I can think of something more catchy, (that he approves of) he’ll just be AM – which also happen to be two of his initials. Perhaps they could also stand in for AdrenalinMan – his idea of fun these days would be Parkour (if he could persaude some friends to do it with him), parachuting and wing-suiting.  Eeeeek! What’s wrong with good old soccer?

But back to swimmimg. AM truly was an ActionMan from a very early age. I love swimming myself and I’d take him to the pool or beach often when he was little. The picture shows him swimming in a 4 metre deep pool just a few days after his 4th birthday. From the age of about 7  he had surfing lessons every summer.

I’d love to have been able to do the same with DadaK’s children, but as more of them kept arriving on the scene, it became increasingly difficult to manage. Taking a bunch of non-swimmers to the pool without another adult handy is a recipe for disaster.  So none of them can swim. Every summer I hope to rectify this situation at least with the oldest, 50 Cedis, and every summer we don’t quite make it.

I did take him swimming in Ghana, but it was an expensive expedition to go to the pool so we didn’t do it often enough. In Kumasi the only pools we found were attached to hotels. The Kumasi Cultural Centre gave me a list of them, and we went by tro tro and taxi to two that were – kind of – close to where we lived in Asuoyeboah. We went to the Wadoma (off the Sunyani road) and Rexmar (Patasi) hotels.

The joy of burgers

I felt I couldn’t just take AM, but also had to take his cousim Owuraku, 50 Cedis and usually one of his other brothers. AM, pining for non-Ghanaian food, wouldn’t leave the premises without having eaten at the hotel restaurant, so everyone else would have to as well, and I rarely got out of it having spent under $60 – comparable to Australian prices. The picture at right shows 50 Cedis’ rapture at the prospect of the Rexmar’s hotel’s unique mini-burgers and chips. 

We managed to nearly drown Owuraku at the Rexmar pool, which has a very deep spot, but he and 50 Cedis both had a lot of fun at Wadoma, which is shallower, and one of the days we went they got to join in a riotous ball game with some young men who were there. (Who were quite drunk, so I had to keep a vigilant eye on my non-swimmers).

To be frank, 50 Cedis probably would have learned to swim years ago if he wasn’t such a panic merchant. AM hasn’t helped much in this regard; his sense of fun in the water is usually interpreted  as plain sabotage by non-swimmers. In the picture below you can see 50 Cedis enjoying a panic in about 1 metre of water. Perhaps Drama Queen is a better description. But with four siblings and non-swimming parents, the odds of him getting the aquatic attention he deserves have been slim.  Maybe this summer we’ll manage it.

I think swimming is such an important part of Australian culture the government should ditch the controversial citizenship test and just teach all new migrants swimming and water safety. I’m sure it would be more popular. Like barbecues, swimming is a part of our culture that most migrants embrace with enthusiasm – if not for themselves, at least for their children. We even have an Australian designed Burqini – “dynamic swimwear for today’s Muslim female”, just to make it accessible for everyone.

Even DadaK has expressed interest in swimming in the past. Not long after we met I took him to meet my parents, who were then living on the shores of a beautiful tidal lake on the south coast of NSW. I tried – unsuccessfully – to teach him to float on its shallow, sandy waters. In spite of his complete failure to float, it was fun – until the next day, which he spent moaning and writhing in bed, and I spent not wanting to believe that swimming had brought it on. This was my first encounter with a condition I’d only read about in high school biology text books, but neither of us knew it at the time: sickle cell disease.

Sickle cell disease is a genetic blood disorder in which lack of oxygen in the red blood cells – triggered by a range of things, including dehydration and getting chilled – causes them to ‘sickle’ in shape and break down and block blood vessels. The main symptom is incredible, unbearable  pain as the surrounding area is starved of oxygen. The damage ranges from heart attacks and strokes to permanent bone damage to stunting children’s growth.

It took us a few years to get a diagnosis on what DadaK spoke of as his ‘unmentionable’ because his mother had told him never to mention it or it might come on. When feeling daring, he’d call it his rheumatism. These days he’ll refer to it as sickle cell, and still suffers the consequences of a life time with the condition, although fortunately he hasn’t had a severe attack for many years because he’s found a medication that helps stave it off when he feels it starting.

So, I mentioned it was genetic, right? Depending on the combination of genes you get, you can have no symptoms and just be a carrier, or you can have extreme symptoms – worse than DadaK’s. You can only get symptoms – generally – if both parents have a gene for it. And guess what. Out of all the women available, DadaK married Obaapa, who carries a gene for sickle cell.

They have been incredibly lucky really. Out of their four children, so far only Abrantie has been diagnosed with the condition. 50 Cedis and G Ketewa are only carriers (as is AM), and no-one’s been brave enough to test Treasure’s blood, but so far she’s not showing signs of it. Abrantie’s got the same genetic variant as DadaK – bad, but not as bad as it might have been. Bad enough tho, to make swimming a bit of a challenge.

It was taking him to the beach when he was about 18 months old that alerted us all to the fact that he had sickle cell. I got a call from DadaK in the evening afterwards, wanting to know if he’d hurt his leg because he was complaining of pain. No, I said, but could it be sickle cell? It sounded like it. (By this time I was somewhat of an expert on it, having been through quite a few ‘crises’ as the pain episodes are called, and hospitalisations, with DadaK). Obaapa was firmly in denial, DadaK  wanted to be in denial  but couldn’t help admitting that I might be right. A few months later (after another swim) Abrantie had another crisis and sometime the following year or two, he was hospitalised with it and diagnosed. This time swimming had nothing to do with it, to my relief, but you can understand I’ve been pretty wary of taking him to the pool ever since.

Looking into it online I’ve found that people with sickle cell can swim, but it must be in warm water and they have to keep their fluids up – and in my experience, not get chilled. I turn into a monster of anxiety when I take Abrantie swiming: Is the water ok? Are you warm? Are you cold? Do you want a drink? Where’s the towel? Wrap up really well. Are you cold? You’d better get dressed. Oh my god who got your T-shirt wet!? Are you warm enough? Have a drink. 

It’s paid off in one respect, because he’s never had a crisis after going swimming with me, since those two early incidents – and he loves being in the water. But it’s another reason why no-one else in the family’s learned to swim. Sickle cell just complicates the picture. I find it very sad.

I did a quick look around the web for useful sites but decided to just link to two that are for kids, which I intend to show Abrantie. Check them out.

http://www.sicklecellkids.org/sicklecell_temp.html

http://sicklecell.starlightprograms.org/

World AIDS Day 2008

Today is World AIDS Day. Ignore the date on the post, for some reason its reverted to US time. I am definitely writing on December 1.

World AIDS Day is relevant to this blog because globally, sub-Saharan Africa is the world region most heavily affected by HIV/AIDS.  Two thirds of all people living with HIV (67%) are in that region, which also accounted for 75% of all AIDS deaths in 2007. An estimated 1.9 million people in sub-Saharan Africa became infected with HIV in 2007. The majority of these cases are in southern Africa, with over one third of both new infections and AIDS deaths. (More recent figures than 2007 are not available. It takes time to collate them and so my source, the 2008 UNAIDS Report on the Global AIDS Epidemic, is really mostly about the epidemic a year ago. )

I don’t imagine it’s changed much in a year anyway. And those are staggering figures. You can read more detail in the UNAIDS fact sheet for the region.

The good news is that the epidemic in some of those southern African countries seems to be stabilising, and also that South Africa is doing an about turn on earlier policies based on scepticism about HIV as the cause of AIDS. It’s no coincidence that this scepticism has coincided with the largest epidemic in the world - 5.7 million with HIV, according to UNAIDS – so the change is more than welcome.

I read an interesting book earlier this year that attempted to explain what many consider a nonsensical and dangerous position. In her book on HIV/AIDS in Africa, The Invisible Cure, Helen Epstein suggests that South African President Thabo Mbeki clung to the belief that HIV does not cause AIDS because to do otherwise might play into the hands of racists who blamed the African epidemic on stereotypes of African sexual promiscuity and perversion. She argues that he has been a proponent of an African cultural, economic and political renaissance and such a negative explanation of the devastating epidemic did not fit well with trying to project a positive image of Africa and Africans. But he couldn’t come up with any other reason why HIV – in other countries almost exclusively associated with homosexuality, sex work and injecting drug use – has so disproportionately affected heterosexuals in Africa. 

Whatever his reasons, Harvard researchers last week claimed that Mbeki’s policies are responsible for 300,000 deaths in South Africa. I wonder what he thinks about that? And of course it’s not just deaths – HIV has had a profound effect on African economies in South Africa and other hard-hit countries. It would be a heavy thing to have on your conscience.

Epstein does offer an alternative explanation for the African epidemic. Her theory is that in countries like the US, people practice serial monogamy, but in Africa, people are more likely to have more than one relationship going on at the same time. This can be for cultural or economic reasons – such as marrying your brother’s widow, or young women relying on financial support from older men when structural adjustment programs have eroded their employment opportunities. Or it can just be a different way of approaching relationships. Over a lifetime, an individual African may indeed have fewer sexual partners than a serial monogomast in the west, and they may also, Epstein suggests, remain more committed to the ones they have.

Epstein withholds moral judgement on either system, but points out that it’s a lot harder to pass on HIV through serial monogamy than it is when you’re part of a network of “concurrent” relationships, as she calls them. I won’t go into the details – it’s a complex theory worthy of more space than I can give it here.  If it’s an issue you’re interested in, buy the book, I strongly recommend it.

Epstein isn’t just concerned with dissecting African sexuality, you may be relieved to hear. (Though I think she does it with great sensitivity and integrity). The “Cure” of the title is community mobilisation, an open approach to the problem, and honesty about both the causes and the impact of HIV.  She’s fairly critical of mega-bucks projects financed by western money and inspired by western ideas. The solution, she says, pointing to successful campaigns in Uganda early on in the epidemic, lies with Africans who know their own communities best.

 *****

With the epidemic so bad in Africa, it’s no surprise that our own recent figures on the HIV epidemic indicate that in Australia, proportionally more people from sub-Saharan Africa have HIV/AIDS than other communities for the years 2003 – 2007. I stress that we are talking very small actual numbers here. The proportions are calculated according to numbers with HIV per 100,000, and the 2006 Census indicated there were only 248,699 people born in Africa resident in Australia. The National Centre for HIV Epidemiology and Clinical Research (phew, what a mouthful) which has provided the HIV stats, has a graph showing we’re talking maybe 25 per 100,000, as compared to 4 per 100K for Australian born. But there are far, far more Australian born people with HIV than African born (63% of all diagnoses for 2003 – 2007).

If you look at the whole picture, in Africa and here, it means a growing new group of people in Australia who are affected by HIV. As I’ve said, there not actually many African people here with HIV, but add in partners, families and friends in Australia and relatives back home, and it starts to be an issue that those of us who are part of African communities need to address. Indeed, African communities here have been doing so. A couple of years ago Africans held a World AIDS Day soccer tournament in Sydney to raise awareness about it.

So here are some resources that may be useful if you, or people you care about, are closely affected by HIV/AIDS:

The Multicultural HIV & Hep C website has  info about HIV in quite a few African languages. 

PozHet, Straight Arrows and Positive Women are all organisations for heterosexuals with HIV and I think all have had experience dealing with positive people with some kind of African connection. If you’re gay, the National Association of People Living With HIV/AIDS can refer you to local groups. Here’s some info for partners, families and friends of people with HIV/AIDS, and here’s another list of a range of HIV organisations in Australia, including AIDS Councils.

I’ve left it a bit late in the day to post this, but in Australia www.worldaidsday.org.au lists events and actions for World AIDS Day. If you’re not here in Oz, just google the term. Or go out on the streets and buy a red ribbon. This matters to me personally because I have known people who have died of AIDS. So this is for:

Robert Ariss, who died before my son’s birth, Dodj Trafic & Andrew Morgan, who didn’t get to see him grow up, Simon Nkoli who welcomed us to South Africa the first time we passed through, but never since, plus Amelia,  Megan and Richard, Tony, Jacques, Vaughan …

… and for all those still fighting to stay alive & live good lives with HIV.