Fresh water tanker (credit: Preeti Singh)

On a stiflingly hot day at the end of May, the tour company’s blissfully air-conditioned Suzuki SUV slowed down to a stop along a dirt road leading to our destination, a water-side resort on the coast of Kerala, near the southern tip of India.  What could be the trouble?  Broken down car, livestock lingering in the road, plain old traffic?

It was a traffic jam, but one that consisted of a shiny TATA tanker truck parked in the narrow lane, dozens and dozens of plastic buckets and curved steel pots of all sizes, and people who seemed to be racing against time to make sure every one of those containers in the road was filled with fresh water.

I’d spent the previous few days marveling at the amount of water everywhere I looked in Kerala, from the extensive backwaters on which the tourist houseboats motored toward evening thunderstorms that wet the landscape but provided no escape from the humidity.

I had seen a pair of women doing laundry on the stone steps that occasionally cut the canal wall down to the water’s edge, the stones convenient for rubbing the soap deeply into the clothes and the water for rinsing afterward.

I’d seen an elderly man bathing on another set of canal steps once the sun started to set and it no longer seemed so pointless to take a chance on cleanliness.

I myself had found huge bottles of chilled, filtered water ubiquitous in roadside shops and restaurants.

But to see people scrambling for water?

Containers for water (credit: Preeti Singh)

Although I had a million questions—Why wasn’t there infrastructure for tap water? How often did the truck come? How much did this cost them? What did they do if they ran out?—I waited, silently watching until the road cleared, to keep forging ahead to the resort that didn’t lack for a single amenity from a swimming pool to hot showers.

But this nagged at me. Later that night, I Googled safe drinking water in Kerala and learned that although this state gets three times more rainfall than the rest of India, topography allows 40 percent of it to flow into the sea. Growing population pressure means the remaining amount of water is insufficient to meet people’s needs.

But through World Bank funding to the state government over the last many years, communities were to devise and manage their own water supply schemes. More than 3,000 of these projects were reported as of 2008.

I can now hope that the seemingly desperate scene I encountered was actually a home-grown solution to provide safe drinking water in the community. And I hope it wasn’t the symptom of a terrible natural resource and infrastructure crisis driving the poor to suffer unimaginable illness and thirst.

The only certainty I do have is that staying in my air-conditioned cocoon didn’t, and of course couldn’t, yield the answers to my lingering questions.

Kerala Houseboat (credit: Preeti Singh)

Wangari Maathai talks about a hummingbird helping put out a forest fire.  I tried to be a hummingbird on another issue once and had my beak taped shut.

I took a special trip to India earlier this year – special because it involved relatives who almost never see each other to be together for a week.  Three of us headed from dry, dusty, blazing-hot New Delhi to the lushly green, humid, blazing-hot Kerala. This southern state is famous for its calm “backwaters” that are plied by deliberately rustic, thatched-roof, wooden tourist houseboats once designed to transport rice harvests.

On the first of the seven-day trip, one of my relatives began having dreadful intestinal issues, including pain and cramping that almost immobilized him. All he wanted in life then was a constantly-refilled bottle of filtered water and long naps on the padded benches on the houseboat’s covered deck.  “This will go away on its own,” he said, not realizing how troubling it was for me to see him in pain.

It took me one day to convince him—or for him to convince himself—that my cache of the antibiotic Cipro, left over from a recent trip to Gabon where it hadn’t been needed, might be the fastest way to not spend the rest of precious vacation time in a fog of misery.

Years of reading about the rapid evolution of drug-resistant disease organisms—ranging from the parasite that causes malaria to the bacteria that causes staph infections—had me handing him the bottle of white tablets with a warning: take a week’s worth even if you start to feel better.  I figure it’s every person’s individual responsibility not to abuse antibiotics and, if they must use them, to take an entire course of medication as indicated. Otherwise, we’re told, when you stop early you’ve killed most of the bacteria but left behind the sturdiest, which will then be the ones that flourish and become harder to kill the next time around in a vicious cycle that will be eventually leave us without effective drugs.  It is happening every day.

But this prodigy of worldly sophistication handed me back the remaining pills after two days.  “Thank you,” he said, “but I feel well now and the side effects of these pills are now what’s making me feel bad.”  How bad could it be?  Unfortunately, India is advanced enough in communications that we could use a USB-stick-modem to connect our laptop to the internet in the middle of a relaxing houseboat cruise.  So, nausea, vomiting, dizziness or drowsiness.  But think selflessly, I urged. You’re helping keep Cipro viable against stomach bugs well into the future for other people, ones who might be too poor to afford anything better once the cheap, once-reliable standbys stop working, I pleaded.

But it didn’t work. I felt helpless—I cannot imagine what doctors and nurses go through with TB patients who, for example, have to show up at clinics over the course of 6 to 10 months to take really unpleasant combinations of pills in order to beat the disease, when I can’t get a sophisticated person like my relative to adhere to a simple treatment regimen.  I guess now I understand a little better why there isn’t just drug-resistant tuberculosis, or even multi-drug-resistant tuberculosis, but extensively multi-drug resistant TB ravaging various corners of the world today.

I lost on this one, but won’t mean I won’t try again given the opportunity.

Margaret Musambi (credit: Dominic Chavez)

MUMIAS, Kenya — Margaret Musambi is one of those rare people who likes to expand her job responsibilities to have a greater impact on people’s lives. She is an extension agent for Kenya’s Ministry of Agriculture, based here in the western part of the country.

Musambi’s passion in the last few years has been to teach farmers the multiple uses of soybeans, emphasizing their nutritional benefits. She has shown farmers how to make soy milk, soy yogurt, soy cakes, soy sausages, even soy meatballs.

“Soy is wonderful,” she said one day recently, sitting with a group of farmers.

But one of her more creative projects has been to introduce soy to a group of people infected with HIV, the virus that causes AIDS. In Mumias, a town of about 30,000 people, she has begun to work with 50 members belonging to an HIV/AIDS support group.

Helped by a small grant from the US Agency for International Development, the group purchased 50-kilogram bags of soybeans. She told the group members, most of whom are taking anti-retroviral drugs to fight AIDS, that they should incorporate more soy into their diets. She also taught them how to make soy products, which the members now sell in local markets.

“These people are becoming so healthy,” Musambi said. “Their drugs are helping them, and the soybeans are as well. It’s true. You eat soy and it will cheer you up.”

Me hice la prueba de VIH (credit: Coimbra Sirica)

For me, the AIDS2008 conference in Mexico City this August opened in the lobby of a hotel in the Zona Rosa, where a French human rights activist — a young woman with short spiky hair — was trying unsuccessfully to communicate with a trans-gender sex worker from Mexico, a woman with shoulder-length dark hair and very big hands. I helped out for a bit, translating for them until the two had figured out where they might meet later that day to discuss how the French group could help advocate on behalf of the trans-gender group’s rights to HIV treatment and prevention services.

Chance encounters at the biannual international conference can be very funny — and immensely sad — and they often speak to the great difficulties surrounding AIDS. There is no scientific meeting that matches it for embracing the most marginalized of people.  Their representatives are in evidence, often in flamboyant glory. Yet most everyone has in common that they’ve lost people they love at some point in their lives. None of my gay friends from the 1980s is alive. (Except a dear cousin, who describes himself as uptight and Catholic, and says he thanks his parents regularly for repressing him so thoroughly they may have saved his life.)

The conference plays out in other venues as well — sometimes far from the big halls and hotel lobbies. One morning I accompanied a group of reporters to one of Mexico’s largest prisons, the Reclusório del Oriente, which holds 11,000 inmates. Several inmates were taking part in an AIDS prevention workshop, which was run in part by HIV “peer educators” — fellow prisoners.

Reclusório del Oriente (credit: Coimbra Sirica)

Prisoners told us that drug use and unprotected sex between men are common in the prison. One HIV peer educator, Guillermo, 32, said he regularly had sex with men and was HIV positive. He said that it was “normal” in prison for men to have sex with each other, regardless of whether they thought of themselves as gay.

Carlos Ortiz Perez, another of the peer educators, said he was thinking of his two young daughters when he volunteered for the prevention program. “One of them has got pregnant since I’ve been in here,” said Ortiz, 45, who said he too had grown up without a father. “She’s the one who made me want to try to help the young people in this prison.”

Guillermo said his job is to make sure his fellow inmates know how to protect themselves from infection. The warden acknowledged the use of drugs in the prison, but said he doubted there was much sex between prisoners.

“That’s a lie,” retorted Guillermo, who is serving five years on the assault charges. And if they don’t use condoms, he added, “their wives visit and take the virus home with them.”

As we walked down the cement stairs toward the exit, I saw to my left a three-story building. On its plain cement façade were engraved the words, “VISITA INTIMA.” The warden said that inmates on good behavior could stay the night with their wives in one of the rooms.

It made me think about Ortiz and Guillermo and the importance of their efforts to protect inmates and their families from HIV. They said changing their colleagues’ behaviors would never be easy.  “I talk about it only when the men are ready,” said Ortiz, who was convicted of stealing a car. “Differences in here are resolved with blows, so you want to pick the right moment.”

Mariam Yussif (credit: John Donnelly)

ACCRA, Ghana – Over the last decade, support groups for HIV-positive people have flourished around Africa. The best of these groups offer so much: a safe place to talk about the range of issues they face; endless empathy; even connections that can lead to jobs. But rarely have I seen such a need for a group as during a recent visit here, with the Yaddah Dah Allah Muslim Women Association, whose members are HIV positive.

The 35 women share a secret — their HIV status — almost entirely just among themselves. Husbands don’t know. Families haven’t heard. Friends haven’t been told. The reason is simple: Many fear that if they revealed their status, husbands and members of the extended family would kick them out of their homes or worse — even though in almost all cases husbands infected them.

“In the Muslim community, we don’t want to disclose our status to each other,” said Mariam Yussif, the founder of the group. “People would rather kill themselves than bring it out.”

So their escape valve opens only when they meet — the third Thursday of every month. Mariam leads them. She has had a tragic past — her husband and three of her five children have died from AIDS-related causes, she said.

And yet, on a visit recently with a small group of African health journalists attending a Kaiser Family Foundation-sponsored workshop in Accra, Mariam didn’t evoke feelings of sympathy. Instead, we were dazzled by her — she spoke freely and expressed herself with heartfelt precision.

“If we could get the Muslim community to talk about HIV, it would start to do away with the stigma,” she said, standing in front on about a dozen support group members. “Many men have more than two wives, so if he gets infected, it means everyone is infected. And if a Muslim woman is infected in Ghana, she is a prisoner.”

When Mariam finished, Penny Duckham, who is charge of the Kaiser Media Fellowship programs, whispered to me, “She’s a rock star.” Penny was right — Mariam was such an effective speaker that she had the ability to move audiences, and by doing so could greatly help women like herself.

And yet, there wasn’t much else uplifting from our visit. Several Muslim women spoke to us about the troubles in their lives.

“It was so difficult for me to be living with this disease. I need to talk to someone about it, but that wasn’t possible,” said one woman. “So it was such a great joy that I found this group.”

I asked them if they were able to express anger toward their husbands in the group setting. The women all shook their heads. No, they said.

“When we meet, we don’t talk about any anger toward our husbands,” said one. “Instead, we draw strength from each other.”