Signing off

I’ve come to the end of my fellowship term, and recently left Botswana. It’s been quite the journey: challenging, eye-opening, demanding, and bewildering at times, but more than anything else, invaluable. I believe very strongly in the benefits of living abroad for an extended length of time; the on-the-ground experience of being based somewhere culturally different has immense potential for learning and enrichment, for yourself as well as for the people you meet. And there is absolutely no theoretical substitute for real-life experience.

I do want to say this: One of the biggest mistakes that people make, in my opinion, is underestimating youth. Quite often, adults will shrug off or disregard the views of young people – a dangerous and ill-advised error. These are our future leaders and professionals, after all. But more than simply for their usefulness in the coming future, I believe that we should listen closely to the thoughts and opinions of younger people around us. In the past several months that I have spent with with adolescents, I have been astounded by their intuitiveness, maturity, and clarity of thought. Talk with them, pay attention, and take their perspectives into account; you may be surprised at how much you learn.

And for people who are interested in global health or development: one of the most difficult aspects of this line of work is the fact that people from all directions – at the administrative level, at the executive level, at the grassroots level, even your colleagues – might tell you that your work is pointless, hopeless, and doomed to fail. Why are you investing your time and energy into something that could very easily go awry? The odds are almost always against you, the goals are often amorphous, and there are many inevitable setbacks and obstacles. Personally, people may have any one of a number of reasons to go into this field, and I certainly cannot speak for everyone. But I will point something out: no one said that development work is easy. The true aims aren’t even really about the results, but about the collective, collaborative journey of the people involved in improving lives, and affecting positive change. I will tell you that despite what some people say, there is so much hope, and so much potential. And, I want to conclude with a thought from Nicholas Kristof and Sheryl WuDunn’s book, Half the Sky: “…never give up. Helping people is difficult and unpredictable, and our interventions don’t always work, but successes are possible, and these victories are incredibly important.” I wish you the best of luck in these endeavors, and hope you facilitate cultural and social exchanges in addition to sharing your knowledge and abilities – there is so much we can learn, and so much to gain.

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Summary of OVC Research

This is a summary of the main part of my research, examining the future predictions and life goals of adolescent OVCs, specifically in the areas of education/career, family structure, and HIV. It also appears as a chapter in a joint UNICEF-University of Botswana publication entitled ‘Thari ya Bana: Reflections on Children in Botswana‘ on page 63-68 (which you can read more about at http://www.unicef.org/infobycountry/botswana_57506.html).

If you have any questions or suggestions, or requests for my inclusive research in its entirety, please feel free to leave a ‘comment’ – I won’t make it public unless explicitly requested.

From “28 Stories of AIDS in Africa,” by Stephanie Nolen

I would highly recommend this book to people who are interested in getting a better glimpse of HIV/AIDS on the African continent.

“By the standard of virologists, HIV is only a moderately infectious bug; it’s not that easy to catch, unlike tuberculosis or Ebola – you can’t get it from being breathed on or shaking hands, and a single exposure does not guarantee infection. The problem with HIV is that its transmission, in blood and sexual fluids and breast milk, preys on our most intimate moments. It targets the subjects we least like to discuss – the drugs we inject, the sex we have, especially the sex with people we aren’t supposed to have sex with – and the interactions least open to honest discussion or to change. HIV grows best in imbalances of power; it has erupted and spread out from the most marginalized groups in human societies, from sex workers and drug users and gay men and migrants. And so we have been correspondingly slow to respond.”

Stigma is one of the most used words in the AIDS pandemic, a two-syllable shorthand for the shame and fear that cling to this disease. Stigma is not, of course, unique to HIV – it is a common feature of incurable, transmissible and deadly illnesses; lepers are banished to colonies, and crimson warnings are smeared on the doors of people infected with a plague. But there is a particular distaste saved for those diseases where the sick are viewed as the authors of their own misfortune, and a particular shame that comes with a disease most often transmitted by sex. Because HIV infection in Africa passes primarily through sexual contact, people who admit to having HIV (even when they contracted it from husbands or… from relationships that are entirely socially acceptable) are perceived both by others and by themselves to be admitted to sin or violation of community mores. Stigma, with the blame it implies, gives people a way to distance themselves from risk: it happens to ‘them,’ not to me.”

“AIDS in Africa is often understood as a disease of poverty – of hungry young women who sell sex for food, slum dwellers who can’t afford condoms, and subsistence farmers who can’t pay for medical treatment. And this is accurate. But that picture is not the full one. AIDS is also a disease of wealth, and therein lie some of the roots of Malawi’s problem. Population surveys across East Africa have found that the rates of HIV infection are more than three times higher for people living in the best-off households than for those in the poorest. A door-to-door survey in Malawi found women in the wealthiest bracket had nearly double the infection rates of those with the lowest incomes. Why? People who have a bit of disposable cash can afford to pay for the services of commercial sex workers, or maintain a girlfriend in the city as well as a wife back in the village, or have sex with an occasional partner and in return pay her school fees or buy her a cell phone.”

“Passion Killings”

There was a murder at the University of Botswana a few days ago – a man killed his girlfriend, then himself. (You can read about it here, in the second paragraph).

These sorts of homicides are often referred to as “passion killings,” or crimes committed about/over a romantic relationship. I believe the term is misleading, and significantly numbs the seriousness of a brutal crime. One might draw parallels to the term “date rape.”

Social workers’ thoughts on sexual abuse

One social worker (female) talked about how to counsel and support OVCs after they have experienced sexual abuse:

“I referred one to a psychologist but [s/he] didn’t want to see the psychologist and only attended one session. Counseling is not easy, one has to be patient: understand their pain and sometimes you do not have to say anything much, you just have to show them support. Confidentiality is more important to them. You cannot go and tell their families what’s going on without their knowledge or consent. I usually confirm more than two times with the child: ‘Are you sure you want to do this, should I tell your family about this?’ Sometimes the child will say, ‘You can go ahead and tell them’ and suddenly they will change their mind and say ‘I don’t want my family to know,’ so it’s a very long process, and you should respect that until the child is fully ready to disclose to other family members or to anyone that there are close to, you can’t go ahead and do that yourself.”

Regarding her ways to help counsel the OVCs, she employs more than typical conventional methods: “I have also used a bit of art therapy, allowing the children to keep journals, to draw, and that is how they express themselves. It is very therapeutic because they are often not able to [communicate] in words but they can express it through drawing and writing. I usually leave them in a counseling room alone so that they can express themselves freely and I leave a note by the door to let everybody know that there is a counseling session in progress. When they are through, I allow them to share what they have written or drawn with me if they want to, and if they want to keep that to themselves I respect that as well, because… on its own it can be therapeutic enough to remove from their system and put it down in writing.”

A guidance counselor (female) says that most of the counseling she gives is about sexual abuse, “especially the girls,” and “it’s usually older men, sometimes they are family members, sometimes they’re not.” The girls she advises are ages 12-18 overall, but most are on the lower end of that range. She says that these experiences are often part of a difficult background, and emphasizes the fact that there is usually a shebeen, or local bar, in the homestead. She also stated that these adolescents have lower maturity for someone their age, yet they are sexually active from a very young age, around 10-13 years. She added, “Usually the girl children are the ones who get [sexually] involved at an earlier age, but at times they are sexually abused at a very early age and as a result, the child also starts having [consensual] sex earlier.”

I asked another social worker (female) why she thought sexual abuse was so common, and she said, “It is partly because of alcohol. Also, the ladies here in Botswana generally get involved for the materials they will get from the men, and won’t report the matter.” She believes there’s also an important power dynamic, with OVCs. “Those people that do abuse these kids actually think they are supporting them, so they have the right to do whatever they want because they will be telling the kid, ‘If you ever say something to anyone, I am not going to give you money for transport and this and that.’” She says she hasn’t come across sexual abuse cases of boys, only girls, in over two years of working with OVCs.

In addressing these issues, social workers and guidance counselors have had several suggestions. One social worker (female) believes that caregivers should communicate more with their children about this topic: “Teenagers are too inquisitive, they like experimenting and very often they drink and date, and these are things they find difficult to talk to their caregivers about. So we always encourage them that ‘those people are your caregivers, you live with them and they are like your parents so they should know what happens with you and how you are living and who you really are.’ This is the main area where they have problems, because they can’t talk to their caregivers.” She says that young people are much less comfortable talking to caregivers than to peers or one’s biological parents. Another social worker (male) also believes that OVCs’ risky behaviors are related to a lack of information as well as a desire to rebel, something that could be curbed: “I think maybe the problem comes from a situation where kids are told not to do things, but they are not told why they shouldn’t do them. I think they don’t understand why they shouldn’t do them, and that’s why we have a problem. For someone to change their behavior, they need to know why they should do what they are supposed to do, I think that is where the problem is. We don’t teach them enough, we don’t convince them enough that you shouldn’t do this because of these reasons and that is why we have that problem.” Another social worker (female) recommends that adolescents put school first, and make peer-oriented activities (dating, drugs, drinking) a lower priority: “I tell them not to focus on relationships and make education their first priority. I always advise them to put first things first and if you put first things first it doesn’t bring down the other things, it adds value to those things. If they were to put school first it does not make them a bad wife, husband or business person but rather adds value to what is yet to come. It is a kind of investment.”

Another, larger-scale suggestion by one of the social workers (male) is to form teen centers and places where adolescents can spend time together: “There is nowhere to hang out besides bars. We don’t have places where kids can really hang out except the library but not everybody likes to read; really, they don’t have anywhere to go.” This is how he believes the current situation could be changed: “Maybe if we have youth-friendly places such as youth centers, that could help a lot because I think kids learn best when they are together. Also, the president has introduced a constituency league, a soccer tournament, which has helped a lot because some kids decide to play soccer and spend most of their time playing with others rather than going to bars and all that.”

Government Strike

There is a strike in Botswana (purportedly the first nationwide strike in the country’s history) that began a couple of weeks ago, during which all government workers went on strike for ten days – ministry members didn’t go to work, teachers didn’t show up at schools, border gates were at very low levels of activity, and medical staff at Princess Marina Hospital (the main public hospital in Gaborone) did not show up. The strike was enacted in order to express desire for a pay raise – one that government workers feel is necessary, given rates of inflation and living costs in the country. This raise has not been granted, and there are murmurs that the government employees may strike again.

It’s fairly difficult to find comprehensive news about the strike online, but you can read more about it here.

Caregivers’ views about peer pressure

Caregivers in focus group discussions stated plainly that peer pressure interferes with schoolwork, learning and growth. Children in general are disturbed by [the effects of] engaging in early relationships, drinking alcohol and abusing drugs. I feel that the government has given children more freedom in terms of children’s rights, and as parents we have difficulty when it comes to disciplining our children.” Thus, the government policies against discipline could potentially lead OVCs (and adolescents in general) to engage in risky behaviors, without negative consequences from the caregivers to discourage them. “Alcohol and drug abuse is a huge issue in the sense that when you abuse them at an early age, chances are that you will have poor concentration in class and in other daily activities.” This was agreed upon by the majority of the group. Another participant said, about the influences of peers, “You will find that in a scenario where five orphans are staying together, they will not think differently from each other. When one does something, all of them will follow. For example, if one starts dating when doing standard 7, all will pass through the same stage and no one will think to change and take a different direction.” The caregivers agreed that if one of them starts dating, they will all date, and that this starts as young as 12 or 13 years old. They don’t approve of this: “Their dating is a problem because it is a sign of disrespect towards the caretaker,” and “It also goes to the schoolwork.”

Excerpts from “Love in the Time of AIDS” by Mark Hunter

Love in the Time of AIDS is an ethnography that examines HIV/AIDS in South Africa. It pays especial attention to gender relations.

“The concept of structural violence often fails to move from a political-economic context into everyday worlds to capture ‘how victims become victimizers and how that hides local understandings of structural power relations.’”

“Today, the quickening pace of alcohol consumption captures not only young men’s new freedoms but also their stresses. Alcohol bestows courage and sometimes leads to violence but, in excess, it can render a man helpless. This dialectic of men’s power and failures – one that becomes embodied through the physiological changes resulting from alcohol consumption – is an important entry point into modern masculinities…”

One woman’s view: “[men] are not good… they are not truthful. They fight you about every small thing that is wrong. They want food, everything, and they drink too much alcohol. Living alone is better. Boyfriends confuse you. It is better that they visit.”

“…viewing male power as simply an expression of patriarchal traditions can downplay the complex changes to masculinities over the course of the twentieth century…. Rather than thinking in terms of ‘rights versus tradition’ (or a ‘crisis in masculinity,’ another common phrase), we need to recognize how masculinities and femininities are interrelated and constantly changing when so many aspects of getting by – from housing to domestic responsibilities – are recast and contested in a context of tremendous inequalities and a world with limited work. And, even further, we need to think through how this world, like masculinity itself, is not natural but powerfully produced.”

“Bringing love into tension with its apparent opposite – material exchanges linked to sex – reveals how love structures relationships, is a site of struggle, and therefore must be taken more seriously. Material and emotion practices are always intertwined; sex and love are always material – worldwide, at all times. What is unique to South Africa today is the shockingly high levels of inequality and unemployment; this results in everyday intimate relations being highly material, very much a part of ‘making a living,’ or social reproduction. By presenting ‘main’ relationships as safe, loving, and long-term, AIDS campaigns frequently ignore the fact that relationships, including those where people have more than one sexual partner, are typically marked by very fluid obligations, some material and some emotional. It is within ever-shifting relationships partly based on love, and especially in those between ‘main’ lovers, that condoms are often least likely to be used.”

Advice for OVCs, from OVCs

OVCs had a lot of inspired advice to give to their peers – people about their age or younger. This included:

Stand up for yourself

Don’t give up – “They should not take life for granted, as life is hard.” –male, 13 years old

Study, work hard in school

Don’t steal, drink, or do drugs

Be respectful to your elders

“Do not become victims of peer pressure” –male, 14 years old

In addition, a few said: don’t date or have sex at this age (yet), and go to church

If he could change something about his peers: Their behavior. They are always complaining when they are told to do things like studying.” –male, 15 years old

“Focus on your school work, and think before you act.” –female, 16 years old

“Tell other people, ‘don’t make fun of me right now, just because I do not have parents.’ You have to be growing and preparing yourself for the world out there because it is not like people are with their parents forever. There is going to come a point when we all have to face the world on our own. You need to be able to stand up on your own.” –male, 14 years old

Go to others for help: When they are abused I tell them to go to their teachers so that they can seek advice and get more help, so that they do not have stress.” –female, 15 years old. Also, My teacher always advises me not to give up in life, like for example when you are mad with your parents you should not bottle it up because it might lead to suicide ideation; rather, tell your guidance counselors, who are fully equipped to help students in these situations.” –male, 16 years old

Stick to your books and when you have a tough time, you shouldn’t give up.” –female, 19 years old

Having a child at an early age doesn’t mean you cannot change your life, you could still do much, as long as you put more effort into what you do; that’s when you can change your life for the better.” –female, 19 years old

“I will say that challenges are the breakfast of a champion, meaning that every time you will face challenges and by so doing you can overcome those challenges and you will leap back and again is not the end of your life; the single minute that you are taking to leap back contributes a lot to your future.” –male, 19 years old

“I would say to them that they should work very hard because nowadays life is not easy, and they have to abstain from doing things that are not good and also abstain from sex. If they don’t abstain from sex, most of them drop off from school, like being teenage mothers.” –male, 17 years old

Something she’s learned: “I have learned that what I want to be when I grow up I should be, and I should not listen to other people who will discourage me. Some people are jealous.” –female, 14 years old

 “I will tell them that life nowadays life is difficult so education is the key to success.” –male, 15 years old

“I think young people in general need to be taught about the consequences of drug and alcohol abuse, and peer pressure, and to denounce going out to risky places such as liquor bars to avoid indulging in deviant behaviors.” –female, 18 years old

“I will tell them that, in life there are challenges but you can only overcome those challenges through listening to good advice, especially that of your parents. I would encourage them not to give up too easily in life no matter the circumstances.”-female, 18 years old

“Refrain from abusing drugs and alcohol and minimize roaming the streets at night. When young people are roaming the streets at night, there is a possibility that they can engage in bad behaviors in a group and end up in jail.” -male, 16 years old

Advice for OVCs, from Social Workers

Overarching themes:

Life is difficult –education should be a priority: “I emphasize education because it’s the key to success.”

Don’t focus on alcohol/drugs/sex, those can be delayed: “When you are an adolescent, you are moving from one stage to another, you are just in-between, you are starting to develop, and there are those hormones… Apart from drinking and getting involved in risky behaviors you have to be educated, you have to go to school, and you will see those things later, alcohol and sexual activities. Your time will come for those things.”

Don’t blame others (or you may do it forever)

Focus on yourself

Your future is up to you: “No one else is going to determine what kind of a life you are going to have.

Also, address the family unit  “I believe that we need to educate the family. If we could have a well-balanced family structure we wouldn’t have OVCs, because OVCs occur because the family structure has disintegrated. We need to work on family values. We need to work on parenting. That is the whole essence of living, having a family which is at equilibrium.  If we are still not having families, we have men like me who are 30 still running around for the 18-year-olds; we are heading nowhere. We are supposed to be the role models and at a certain age, young men should be preparing to get married. We don’t have role models, the family has disintegrated and we are doing nothing about it. So let’s work on the family: family values, life skills, social skills, parenting, that’s when we can be heading somewhere. Because if we are trying to address the OVC’s, we should leave the symptoms and deal with the cause, and the cause is the family. Let’s make everything fine here and we are not going to have OVC’s.”

Another social worker: The reason why society is not functional is because of the background, the foundation. If a child grows up in an abusive environment, they don’t know the difference; to them it is a way of life. So they grow up, and that’s why you find that in this society there is this thing that orphans and vulnerable children are ‘naughty,’ ‘undisciplined’ and all that. It is because we need to understand where they come from, and we need to intervene now when they are still young so that we can show them that there is better life, there is a different way of living.

It’s so sad, like currently I’m handling this case where an adopted mother is abusing [her] adopted children. So they are vulnerable children and I had to move them to a foster home for short-term foster care, but now because time is lapsing I have to have a plan: where do I take them, do I take them back to the mother who is abusive, do I take them to an institution, you know whatever I do is still going to have effects. If I take them back to the mother, it will be bad because we referred her for counseling, to a psychologist. It is a very difficult decision to make because I’m not sure that she got the help that she needed. I will just be hoping that this time around she won’t abuse them. So those are the kind of cases we have, and especially that in Botswana we don’t have many places of safety, yet we have so many cases of child abuse, most of them are day cares, there is only Childline and SOS and it is very difficult. We also have a problem of… I don’t know if I should call them street children because they don’t live in the streets, they sleep at home but during the day they go to streets, so what can we call them? They are there during the day but in the evenings they go home.

We need to fix things when kids are still young, tell them that ‘you can live differently from what you have experienced as a child.’ It manifests in so many different things, look at the relationships that we have to work with, if it’s not abuse, its something else. If you grow up in an environment where you are not shown love, you cannot know what love is and it is ultimately difficult for you to have adult relationships. It’s difficult for you to have a good marriage because you don’t know what it is to care and love someone, you know. So it is maybe because people take for granted the foundation of child development but it is really the foundation, it has to be good, even if it can’t be perfect.”

Other advice:

First things first, they need to acknowledge that there was a situation. We now need to come up with an intervention, how I’m going to help myself or my siblings… The first thing that they need to do is to identify the problem, analyze the problem, come up with a solution, and one thing that they should never ever do in life is to blame others. If you start blaming, you will blame forever. The problem is there, but if you blame other people it will not go away. What they are supposed to do now is come up with strategies of removing these obstacles in front of them, and involve other people who can help you. We are always ready to help. If it is bigger than us, we will pull in other stakeholders and at the end of the day we help the person so that that person can help others.”

Life is very difficult out there, they have to make sure that they become focused on their education, they have to keep themselves from things like alcohol or maybe having partners because these are things which a person can live without, so you can go to school up until the highest level and then you can get married. That’s when you can start most of the things that you have been wishing to do.”

“You have rights, yes, but you also have responsibilities.  You have lost a parent, but it is not the end of the world, so you need to fit in and continue living in a society that you have been raised in.”

“Have role models; aspire to be something in life. For them to do that, they need to stay focused and work hard, they should not think that because it did not work out for their mother or family, maybe she did not make it in school or the family is poor, that they will also be poor forever. It is upon them to change the situation for the better, and they can do it, just as long as they trust themselves. The world would be a better place if they listened to the positive things we tell them and stay away from the negative. Their future is in their hands, if they could just listen. No one said life was easy, it’s full of challenges, challenges you need to overcome to be something, be somebody. It’s just that they are so demoralized, so prone to negative peer pressure, and disruptive competition: they just want to be seen with nice cell phones like their friends from huge families.”

“Education comes first. You just have to be educated first then you can see the other things later. It’s all about education.”

Work hard in school, study when you can: “Take school more seriously because everything in the country is getting tougher and tougher. Use your study period at school to study since it may be the only time you have for studying, because not everybody gets to study when they get home for various reasons. Most of the time when they get home they have to do household chores and afterwards it is already dark, so they should use the study period and utilize the teachers.”

“I think they will succeed when they come to that realization that, ‘I can do anything like any other person who has his or her parents,’ provided caregivers and all stakeholders provide the necessary support these particular children. In that way I don’t think there will be anything that can hinder them to be like any other person – people can come from very poor families but they don’t allow the situation of poverty to prevent them from progressing in life.”

On helping parents of OVCs: “Sometimes when you tell kids something, they do exactly what you are saying. If you say he is naughty, he is going to be naughty because you said so. We are trying to work with the parents so that they can know how to handle them and then try to talk to the kids again so that they know that life is about you as a person choosing your destiny. The parents can say all sorts of things but kids only do what the parents. If we train them or we teach the parents a positive way of talking to children and treating them I think maybe in two years’ time their lives will be different.” She reports that it can be difficult to talk to them because young people often don’t listen, and “To them it seems like we are asking them to do a very difficult thing. But sitting down and talking to them always works magic.”

About mentoring OVCs: “I talk to them about the HIV scourge and they should make sure that they stay away from it. I also talk to them about teenage pregnancy which can affect their school.”

“One thing I want to achieve in these kids is for them to be aware of themselves – who they are and emphasizing that they are special and unique, and making kids love themselves beyond what any other person might love them. By instilling all this in them, they will make the right decisions and they will not easily give in, into anything that comes their way, because they love their bodies and they respect themselves and would not engage in risky behaviors. From my own experience, when you do not have confidence, you can’t even be seen doing anything, you always want to hide and you often make poor decisions.” Also, “Like I said earlier on, I truly believe in loving yourself and being aware of who you are because we grow up in a society where a child is not motivated to become who they want to become or praised for something they did well, but rather criticized for doing something wrong. So one of the things we need to do is praise them for doing the right things and make them aware of the wrong things they do and try to bring them back on track. I tell them that they have a long way to go and they should take their education seriously, and the other things will come later.”