Hedy Lipez returns to Africa decades after her Peace Corps days12:00AM / Wednesday, October 10, 2001
Most people faced with huge and intractable humanitarian problems can only make donations or spearhead local fund-raisers. But New Ashford resident and longtime nurse-practitioner in Pittsfield Hedy Lipez spent nearly six months in the African nation of Zambia combating the HIV/AIDS epidemic there.
Lipez took leave from the Neighborhood Health Center and her private psychotherapy practice to live and work in Chirundu, a town on the border with Zimbabwe. That town is considered crucial because at any given time between 150 and 200 trucks wait two days to a week to cross the border and the bridge over the Zambezi River.
While Zambia has one of the highest rates of HIV infection Ñ as high as 20 percent of its population of 10 million Ñ the rates skyrocket among the sex workers Ñ prostitutes Ñ whose clients are the long-haul truck drivers in this border town. For these women, infection rates are as high as 60 to 70 percent. And an estimated 30 percent of pregnant women there are HIV-positive.
In the entire country, an estimated 70,000 children are infected, contracted from their mothers at birth. And the country is trying to cope with an increasing number of orphans whose parents have died of AIDS. The epidemic has lowered the country's already low life expectancy Ñ in the mid-40s Ñ to 37.
From mid-February to the end of July, Lipez focused her energy and efforts on stemming that tide in the border town of 3,000.
"Some days I went with the coordinators and peer educators to talk to the truckers about STDs [sexually transmitted diseases] and HIV, asking, 'What do you know about STDs and HIV?' and offering to share information on how to protect themselves, asking if they recognize the symptoms. Part of my job was to supervise the interactions and offer technological backup.
"Sometimes we got the reaction of, 'Why blame us?' or that we would promote promiscuity [by condom distribution]," she said. And some feared that HIV was being spread as a purposeful means to take over African-owned land.
"I was surprised how receptive both truck drivers and sex workers were to our message, if we didn't blame or challenge them," she said.
"Or we would go where the sex workers live," she said. To these women they described symptoms and means of transmission.
"Our first daylong workshop was on how to negotiate with truckers over condoms," she said. The transaction asks the prostitutes to balance their health against short-term gain, Lipez said, as condom use reduces their fee for sex often by half. "And this is how the young women supported themselves and their families."
And "we did presumptive, syndromic treatment with both sex workers and truckers," she said.
To battle the AIDS epidemic, Lipez lived in one room of the office and drop-in center, where electricity was intermittent and water Ñ cold Ñ had to be heated for bathing.
"I didn't have a sink, so I held pots under the shower," and washed clothes and dishes in a plastic basin.
There was one telephone line in the town, letters to and from the United States took three weeks to one month to arrive, and Lipez's only access to e-mail was in the distant capital city of Lusaka.
Lipez's stint in Zambia was a return trip to Africa where, in the 1960s, she had been a Peace Corps volunteer teaching English in Ethiopia. Then, she was in her 20s, now, in her 60s, she notes that "I was considered an elder."
Her Zambian stay was through the Crisis Corps, a part of the Peace Corps that arranges for return volunteers to spend shorter times on volunteer efforts than the usual two-year Peace Corps commitment. Crisis Corps was developed in the mid-1990s to muster former Peace Corps volunteers to help in times of natural disasters or humanitarian crises. Through Crisis Corps, Lipez was assigned to World Vision Zambia, an organization funded by the U.S. Agency for International Development and the Japanese government, to join its efforts to combat AIDS/HIV. She worked in concert with two Zambian women clinical officers, similar to United States physician assistants, and 45 peer educators, and helped with the peer educators' training.
"I needed to get away from day-to-day work here," she said. "I felt that we were spending too much time on billing codes and managed care rather than patient care, although I do know we provide good patient care. I felt I was in danger of burning out."
The Zambian stay more than fulfilled her expectations.
"It was marvelous," said Lipez.
"Part of my role was to be a catalyst," she said.
There were about 45 peer educators ranging in age from 18 to 78, whose educational efforts included drama groups that performed skits followed by question-and-answer sessions.
"One of the marvelous things was how invested the peer educators were in their work. Some of them had had relatives die, possibly from HIV infection, or perhaps they themselves had survived serious illness."
They received a meal allowance of $30 a month.
"They were caring for each other, for the community, and for me. People were very appreciative. People would say to me that 'we appreciate that you would leave your family and come here to help us.' "
"People would bring me vegetables," she said. "I loved things like slowly getting to know people, and having them learn to trust me."
"I hated to leave."
"I liked teaching, patient care, being in a different culture."
During her stay, she took one four-day vacation, a canoe trip on the Zambezi where the waters were shared by hippopotamuses and crocodiles.
She was surprised that the prostitutes did not resemble the American variety.
"I expected tough people with an edge," she said. "But these were not drug users."
And, she said, "I guess I expected to see more people looking sick."
Most people there, she said, do not get tested for HIV because the drugs for treatment are prohibitively expensive. Triple drug therapy, which costs $18,000 a year in the United States, costs $400 here, but annual income is $250.
And although the hope is that high-risk behavior will be changed by education, Lipez has learned that one of the women she worked with has died.
The greatest challenge, said Lipez was professional, a sense of combating a scourge of vast proportions.
"It sometimes seemed like we were doing so little," she said. |
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