"Africa is, indeed, coming into fashion." - Horace Walpole (1774)


lazarus redux

So you can understand what's at stake in the PEPFAR fight in Washington, today I'm rerunning a post from last summer about Congolese individuals who live with HIV/AIDS, and the treatment they receive from international funding sources. While PEPFAR doesn't fund treatment in the eastern Congo as of yet, this will give you an idea of the devastating consequences that a decrease in funding or a failure to re-authorize the program would have.

PLEASE CALL THE 7 SENATORS WHO ARE HOLDING PEPFAR REAUTHORIZATION UP! Tell them that you value the lives of children like Olivier, and that it is inexcusable to deny treatment for this disease to the world's poorest people.


They mention Lazarus a lot around here. You know, Lazarus, him over whose death Jesus wept. Lazarus who, much to the joy of his sisters and friends, came back from the dead (although, as Barbara Brown Taylor points out in a sermon whose title I've forgotten, we never get to find out what Lazarus himself thought of what was surely a rather unpleasant experience.). Lazarus, that name that’s synonymous with resurrection by grace.

My dissertation is, in part (in 1/3, to be precise), about the health care system in the eastern Congo, and, while it’s complicated to figure out the mind-boggling government bureaucracy that is “supported” (read: financed and run) by a conglomeration of churches, community groups, and international ngo’s, one thing is unavoidable: sooner or later, you have to deal with HIV/AIDS.

Nobody really knows what the HIV prevalence rate is in the eastern Congo. The official estimates for this province hover somewhere around 3-4%. That’s 3 or 4 of every 100 individuals. As far as Africa goes, that’s not a bad prevalence rate. As far as accurate statistical reporting, it’s anyone’s guess. Certainly the prevalence of other factors, like rape, war, and poverty, suggests that HIV-seropositive prevalence is much, much higher in the region.

Things have changed in fighting HIV/AIDS since I first started studying Africa. Nine years ago in Kenya, we’d hear whispered murmurs about a cousin or an aunt who’d died of ukimwi, the “slim” disease that causes people to waste away before your eyes. Now, in most places, more and more people are open about HIV and its effects on social organization, on children, on economic productivity. Now, with the spreading availability of anti-retro viral drug cocktails, “HIV-in-Africa” isn’t necessarily a death sentence, though there aren’t nearly enough doses for everyone, meaning that the sickest patients get the treatment.

Even here in Congo, even in just two years, things have changed dramatically. There’s now a national program to fight HIV/AIDS. It's financed by the World Bank, the Global Fund, USAID, and others, and the staff of the Bukavu office are friendly, active, and dead-set on doing whatever they can to keep this illness from destroying their country even more.

I conducted a couple of interviews at their office last week, and one subject, A, invited me back to pick up precise statistics today. By coincidence, we were in the same shared taxi on Saturday. I told him about another ngo I was interested in visiting, and he promised to organize something.

Organize he did. A wants me to see exactly what they do to help those who are here referred to as “PVV” – personnes vivant avec VIH – people living with HIV. He took me to a residential treatment center and a men’s program today, and tomorrow we will go to visit a women’s organization that supports PVV’s in Bukavu in cooperation with an American religious aid agency. (We’re also going to visit A’s daughter, whose name is also Laura. :)

Lazarus. Talk to anyone who works in HIV/AIDS healthcare here, and they’ll tell you the change in a patient who begins taking ARV’s is remarkable. “It’s like Lazarus coming back from the dead,” they say again and again. (It's even in the July issue of Vanity Fair.) Thin, broken bodies become strong again. Mothers who couldn’t get out of bed are again able to care for their children. It’s resurrection.

The center we visited today is an amazing place. A insisted that I take pictures, then that he take pictures of me with some of the PVV’s living there. So that was awkward, but getting to speak with the patients who have come from the countryside to start their ARV treatment was anything but. It is quite a place. Because the rural areas are so insecure, it’s impossible for doctors to do the close monitoring that’s necessary to start ARV treatment. So, these people get to come to Bukavu, where they spent 1 month getting their medicines regulated, and another 2-3 months recovering and getting used to it. If the drugs work, they go home to continue treatment there. If not, they stay.

The amazing thing about ARV therapy is that you can see it working. I saw people who look perfectly healthy – you’d never know that they’d been on the brink of death. I met others who are clearly quite ill, who are living in a strange place far away from home, who might not have places to go back to when they leave. Families often reject HIV-positive persons, seeing them as a danger and a drain on resources.

Later, at the mens’ center, I met the association’s officers, both of whom are HIV positive. All 200-something members of the group are on ARV’s, and all are working to raise awareness about the disease and how to prevent transmission. “It tends to be seen as a woman’s disease,” they told me. “There are many men living with HIV in secret.”

Today I also went to visit the Baptists. They told me that they were the first Protestant church in the region to recognize the need to fight HIV/AIDS – to not shy away from it, but instead to do something. They run a voluntary counseling and testing center in a rural health zone. (They also run an incredibly cool skills program – I wish I had a picture of the guitar workshop, because it was, in a word, awesome.) And the pastors there talk about HIV/AIDS with knowledge and depth.

In February at the Current retreat, I attended a session led by Baylor social work professor Jon Singletary. It was about the church’s response to HIV/AIDS. It’s where I first saw this painting, of Christ with AIDS. It was a tough, convicting conversation, especially knowing that Baptists in the states (even the moderate Baptists) wouldn’t necessarily be the first to react if such a crisis were staring down our church doors. I’m not sure my church does anything to help HIV-positive persons in our own city, much less on the other side of the world. I’m not sure most of us even know what “sero-positive” means, much less how we might find ways to support our Congolese Baptist brothers and sisters who are fighting this disease with everything they have.

There's another Lazarus, you know. He's the guy in one of Jesus' parables who was ignored by the rich man, even though Lazarus was always in plain sight, begging at the rich guy's gate. The rich man spent his money and time doing things for himself, wearing fancy clothes and having big banquets for his supporters. The rich guy gets his reward on earth, and spends eternity in torment. Lazarus gets his own sort of resurrection, if only in the sweet hereafter.

I'm pretty sure I met Lazarus in both his disguises today. I saw him in a dozen surprised, broken, revived, exhausted, grateful, hopeful faces. I saw him begging at the gate, and all I had to offer was a handshake and a smile. I saw him coming back to life, little by little, day by day.

You generally have to be near the brink of death here to get access to ARV’s (there are fewer than 4,000 courses of treatment available in South Kivu at the moment), so the men and women I met today almost certainly know what it is to be at death’s door. They know despair, and they know the tough journey back to life. However painful it might be, it’s clear as day that the men and women and teenagers living with HIV/AIDS are grateful for their resurrection. Amen.


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