When hope is not enough

His smile was broad and strong, but his voice was audibly weak. That, coupled with his frail body and slow measured gait, signaled to me that he might not be doing well. It was Wednesday morning, and Nkosinathi and his grandmother had come to Sinikithemba to see the doctor. Before joining the long morning queue, the two of them sat down to chat with me, and I had the chance to get briefly acquainted with this lovely 13 year old boy, who is new to the Gift of Hope program this year. My first impression was that he had the physical stature of a child far younger, but as soon as I began to talk to him he showed the intelligence and maturity of a young teenager.

I asked him to spell and pronounce his rather long and difficult Zulu name for me, and without hesitation he rattled it off in perfect English, although his voice was soft and he had to stop once to catch his breath. As we started to chat, a sad narrative of his life began to unravel, one which I have heard many times in my visits to South Africa. It is the narrative of so many children here who are AIDS orphans, many of whom acquired the virus at birth through mother to child transmission. Such is the story of Nkosinathi (aka Nathi)

In 2005, when Nathi was just a young boy, his mother died from AIDS. He doesn’t know his father, and so like many other South African children in similar circumstances, Nathi has been raised by his maternal grandmother, or gogo in Zulu—the backbone of so many South African families left devastated by the epidemic. Together, with his two sisters (age 5 and 16), an aunt, uncle and his gogo, they share a small house in Umlazi, the second largest township in South Africa, following Soweto. The townships are overburdened by unemployment, extreme poverty and AIDS, and many who live there go without any HIV treatment and simply die. Getting care at Sinikithemba is beyond the means and the mind set of many who live here, as they often struggle to simply put food on their table. For Nathi and his family of 6, they depend on a small income earned by the aunt, and the granny's pension and child care grant. It is difficult, but somehow they get by. "I am trying to manage, but it is hard", says gogo. "It is not enough. I am even thinking of making big cookies to sell to get extra cash.”

With the help of a translator, the granny explains how very grateful she is for the support she has been receiving through the Gift of Hope. “When I heard that I would have this sponsorship I was so happy…I can’t even begin to describe it because it has been so difficult for me. I need 100 rand just for bus fare and to buy Nathi something to eat on the way. And I have no more money to pay for the clinic. So the day I was told I no longer had to pay I was so happy. I really believe that if it wasn’t for the sponsor that maybe Nathi would have been gone by now.”

Nathi is in grade 6 in school and more than anything else he loves to draw! His gogo tells me that wherever he is, she always finds him drawing. He wants to be an artist when he grows up, and gogo hopes he can one day find a school which puts more emphasis on artistic training so that he can develop his skills further and realize his dreams. It is clear from the verbal and visual communication between this child and his grandmother, as they share their story, that they also share a warm and loving relationship. “I love my granny because she takes such good care of me”, Nathi tells me. She smiles with pride as she tells me what a good boy he is, and how he loves to help out at home by cooking meals for the family. He enjoys making his entire family a breakfast of fried eggs, fish fingers and Vienna sausages. I joke with him by saying, “yum…That sounds delicious. Can I come to your house one day and have breakfast with you one day?” The gogo smiles broadly, revealing the gap between her teeth, and says “yes, you will come when he feels better.”

With this prompt, I learn more about Nathi's current health. He has not been well in recent months, and was recently admitted for a two week stay at McCord, where he was treated for problems with his lungs. It seems it was not TB, but rather some sort of lung infection. Thankfully, the cost of his stay was covered by an American organization known as Loving South Africa. They have established a fund at McCord to cover hospitalizations for HIV infected children who are not able to afford the hospital fees. Nathi and his gogo are are so grateful for this assistance. " I could not believe it when I saw the hospital bill and found out that someone else was paying for it. I was so happy."

Although Nathi is feeling somewhat better since being discharged, I can still hear a wheezing sound as he talks and he occasionally strains to catch his breath. We head out into the sunshine to capture some photos and Nathi leans on the arm of his granny as he slowly makes his way up two small steps. He walks with the gait of a frail elderly man, not a healthy 13 year old, and I feel an uneasy concern rising inside of me regarding this child's overall health.

But this concern is temporarily overshadowed by the sheer joy on his face when I give him a small box, covered in red wrapping paper, and a card and photo sent over by his American sponsor, Maria.. Nathi slowly and carefully peels back the paper, his face full with anticipation at what surprise awaits him. He reads the lovely message and studies the photo sent by Maria, then passes it to his gogo, who is so thrilled to see the picture of the woman who has given her and her grandson so much help and so much hope. Nathi opens the box, and the moment he sees the new wrist watch inside, he bursts into a grin which spreads from ear to ear!! “I feel so happy” he exclaims, as his granny throws back her head in laughter and delight! For that one moment nothing else in the world matters to this child or his grandmother. It is truly a moment to cherish, and one I that I will hang onto and remember.

But tragically, and ironically, it was perhaps the last real moment of joy that Nathi ever knew. After we talked on Wednesday Nathi was seen by the doctor at Sinikithemba, who sent him to the outpatient department of the hospital. As I was making my way to one of the clinics later that afternoon, I saw him sitting in a wheel chair, his granny beside him holding his hand. I ran over and inquired how he was feeling and if here being re-admitted to the hospital. The granny sighed with relief and said no, he had been treated and they were going home. I thought that everything was ok...

This morning, after returning from a long weekend, I made my way up to Sinikithemba to meet more children and caregivers. The counselors were all gathered in the office, talking in hushed voices, and each wearing an expression of deep sadness---a part of this familiar landscape they have all come to know too well. "We lost a child over the weekend....it was Nathi." I can hardly believe what I am hearing; that the delightful child I had just met for the first time on Wednesday morning, was now gone. After returning on Thursday and being admitted, Nathi lost his battle and passed away at McCord on Friday morning.

This delightful 13 year old boy will not make any more delicious breakfasts for his 2 sisters he leaves behind, and the gogo who has taken such good care of him. He will not celebrate his 14^th birthday in January, or grow up to be an artist, or measure time by the beautiful new watch he was given by his generous, caring sponsor. Instead, he is now another tragic victim of this terrible epidemic, which is tearing apart families and communities and leaving so much sadness in its wake.

Nathi's story does not have the same happy and hopeful ending that most of the sponsored children enjoy. He and his granny were blessed with the gift of hope, but sometimes that is simply not enough. This serves as an important reminder to all of us that we must stay vigilant in our fight against HIV/AIDS. The best we can do now is to honor his life and treat his loss as a call to action--a call to stay engaged and remain in the fight for the long haul,however long that takes. We must continue to do whatever we can to bring hope to children and their families infected and affected by HIV. They are depending on us and we cannot let them down.

Returning to Durban: All things familiar...

Thank goodness for jumbo jets with enormous fuel capacity; ipads that let you listen to music, read books and play solitaire all with a push of a button; and strong tail winds over the Atlantic! The non-stop 14 1/2 hour flight from NYC to Joburg passed quickly and could almost be considered short, at least relative to my first marathon trip with Jamie, where we spent 10 hours on just the layover at Heathrow! I must admit that I miss Jamie’s company on these solo adventures, but happily the familiarity of Durban, on so many levels, makes me feel like I am arriving at my second home away from home. My first view of the majestic Indian Ocean, set against the Durban sky line, and I am reminded of the beauty of this place and why many travel books call it the playground of South Africa—for its tropical climate, beautiful beaches, and world class surfers who tackle the waves and bring crowds of young onlookers to its sandy shores.

But as you peer out over the rolling hills and coast line, your gaze occasionally takes you inland to one of the many townships scattered through the landscape. Clusters of small tin shacks, many with their roofs held in place by a mere rubber tire, remind me of the first world/ third world dichotomy that struck me on my first trip and has now become a familiar, yet still disturbing site. It is hard to comprehend how the wealthiest and most advanced country in all of Africa can still abide by people living in these horrific conditions, when just around the corner their neighbors live in beautiful Mediterranean style homes, with red tiled roofs, a pool in the backyard, and a gate surrounding the premises for safety and protection of those they fear. I pause long enough to conjure up images of people living in Appalachia or parts of the South Bronx, and remind myself that this disparity in wealth exists in many corners of the world, including in my own country. Nevertheless, it somehow seems more pervasive and more disturbing here in South Africa--or perhaps it is just that I am sheltered from it at home, and here it is a more obvious part of my overall experience.

As the plane touches down in Durban, this sobering thought is soon replaced by the smiling face of Jenny Criticos, who is waiting to greet me at the newly constructed King Shaka International Airport. As I emerge from the customs area Jenny waves to me with one hand, as the other covers her mouth in an effort to disguise her urge to giggle. I am rushing towards her, pulling my wheeled carry on bag and behind me is the airport porter who has saved my life. He is easily identifiable, not only by his bright orange uniform, but also by the cart he is pushing, which can barely accommodate the three enormous bags which rest on it! After a warm embrace, Jenny teasingly quips, “I thought for a moment you were Paris Hilton, the way you came through those doors with all that luggage being towed for you!” With good humor, (tinged with an appropriate level of defensiveness!), I pointed out that the two really BIG bags were stuffed with gifts for the children, and yet I somehow still felt like the ugly American who had landed in South Africa with too many pair of shoes, rather than Santa Clause in disguise!

As we chat non-stop on the drive into Durban, catching up on life on our relative sides of the world, I am grateful to know that I will be living in a flat just downstairs from the home of Jenny and her husband Costa, who have grown to be like my family here. They are wonderful people—so warm and hospitable, and always great fun and great company. It is comforting to know that on those nights that I am feeling a bit lonely in my flat, a cup of robois cappuccino and some great conversation with Jenny and Costa is only a flight of stairs away.

The familiarity of my regular flat means no time needed to adjust to my surroundings. I quickly unpack my bags and head straight to Woolworths, (known to locals as Woolies, and no relation to the US chain of the same name), the flagship store of the little mall only a few blocks from my flat. I am going to their upscale food department to stock my fridge with my South African favorites: danish feta (more like the creaminess of rainbeau ridge goat cheese than the feta at home); peppadews , avo and butternut squash (which adorn most of the delicious salads I have discovered); and of course magnum mint ice cream bars, which recently found their way to the US market and will undoubtedly be responsible for a few extra South African pounds!

As I make my way along the short walk to the Musgrave Center, I pass a familiar mixture of pedestrians, that tell a story of the cultural tapestry that is both Durban and the rainbow nation overall. There is a rural woman sitting on a blanket on the sidewalk, selling enormous, dark green avocados. At the other end of the block is a homeless woman, who has occupied that same corner for the last five years, begging for money from passerbys. Approaching me from up ahead is a group of 3 Muslim women, covered in black from head to toe in their burkas, with just enough space for their eyes to peek back at me with total anonymity. I walk past and hear the excited chatter of some young, attractively dressed Zulu girls, as they make that familiar sound of their native language--the click of the tongue against the roof of the mouth--which despite years of trying, I have yet to master!

I enter the mall and see Indian families (Durban has the largest Indian population outside of India), black families, white families, and every color gradation in between. I find myself smiling, thinking how amazing it is to see this integration of races in a social setting, in what is really a relatively short period of history since the end of apartheid. And at the same time I am still struck by the lingering segregation of people, as they mingle in groups that appear to be organized according to skin color. I suppose that change of this nature happens slowly and that some amount of patience is needed for the level of progress we would all like to see. That is true for so many of the problems confronting South Africa, including of course the challenge of the HIV/AIDS epidemic. Thankfully, enormous progress is being made, but there is still a long, long way to go.

That is the primary reason I have come back...to keep doing my own small piece in this important fight. I am so happy to be here, comforted by all those things that are familiar, and equally excited about all that is new and still undiscovered, and which lies ahead of me. It is sure to be another wonderful and enriching experience, and I look forward to sharing it with you on each step of the journey.

Leaving on a jet plane

To borrow from one of my favorite 60s classic folk songs, "All my bags are packed, I'm ready to go"! Yes, in a few days I will be on my way to South Africa for another incredible journey of hope. It was almost five years ago this week that I made my first trip with Jamie, who was then 17 years old. As I approach my upcoming trip, I find myself reflecting on all that has changed in this rather brief period of time. Jamie, now 22, just graduated from Amherst College. She is moving into NYC on Tuesday and will soon start her first "real" job at a global health consulting firm. It is so exciting to realize that she is embarking on a career in global health, an interest which was undoubtedly shaped in its infancy during that first trip to Durban in 2006. It is amazing to realize what a profoundly impactful summer that proved to be for both of us and how it has set us both on a new and exciting path.

I recall the nervous anticipation we both experienced as we prepared for that first summer of volunteering. We wondered what our days at the hospital would be like and how we would be able to contribute--whether we would have the emotional strength to witness the illness and suffering that we would undoubtedly encounter, and what our reaction would be. Would we fit in and be able to navigate the differences of the Zulu people, language and culture? And most importantly, would we be able to make any kind of meaningful difference to people suffering from poverty and illness and the challenges posed by a highly stigmatized disease?

Today I sit here with the normal nervous energy that precedes any big trip, but with a very different internal calm and confidence, and a profound sense of hope. This is a transformation which has grown with time, familiarity and knowledge, and from the progress I have made with the Gift of Hope program. Much has happened since that first visit in July 2006, when I found myself standing in the OR, dressed in green surgical scrubs, and holding the hand of a total stranger, while she delivered her baby via cesarean section. That beautiful, healthy, little girl, whose smile is as big and bright as her personality, will be celebrating her 5th birthday on July 7th. And like every year since her birth, I will be visiting with her and celebrating her life, her good health, and the very special bond we share. It was this truly life changing experience which formed the foundation of the Gift of Hope, a program which has since funded more than 60 HIV positive women with the needed services to prevent transmission of the virus to their newborns.

It is these special, personal connections --like the ones I also share with many of the110 children being sponsored for care and treatment through the Gift of Hope, which create the richness of my experience. And it is the hope that is being given to women and children for a healthy future and a new generation born free of HIV/AIDS, which motivates me to continue my efforts and return to South Africa every year.

So I leave in a few days with excitement, optimism and my passion for this work, and I invite any of you who wish to follow me on this amazing journey of hope.