Does PEPFAR Make a Difference? Ask Samuel and Pedro, Yonatan and Dagmawi.

Thanks to all the ONE members who rallied and contacted their elected officials in support of PEPFAR reauthorization. Last week’s action by Congress will bring hope to millions of children living in countries hit hard by the AIDS crisis. If you are curious about how your actions will trickle down to the country and community level, let me share the stories of four young boys orphaned by AIDS in Africa. PEPFAR is helping them cope with their loss and look to the future.

One country that has been particularly hard-hit by the AIDS crisis is Ethiopia, struggling to meet the needs of four million orphans nationwide. This year, a popular children’s television show, “Tsehai Loves Learning,” has helped orphans deal with grief, while changing attitudes among other young children about children made vulnerable by AIDS. PEPFAR funding made it possible for Whiz Kids Workshop, in partnership with Save the Children, USAID and other partners to produce and broadcast four episodes devoted to helping the youngest Ethiopians understand the issues faced by children orphaned and affected by AIDS.

You only have to see the changes in a little boy named Yonatan, now 8 years old, and his half-brother, Dagmawi, 16, to appreciate how PEPFAR funding is benefiting countless children in Ethiopia. Yonatan was only five when his mother died, but he recalls her death as if it happened yesterday. “He always remembers her, tells stories about her and cries,” says Dagmawi.

Through simple puppets, a little animation and a lot of imagination, “Tsehai Loves Learning” has taught both brothers some valuable life lessons. “That was emotional for me,” said Dagmawi, who watched the first episode about coping with grief with his younger brother. “Not to exaggerate, but tears came up. But it gave me the idea that whenever I’m sad about my mom, I can imagine that I’m talking to her and can tell her that I’m doing ok.” (more…)

Sen. Frist in Mozambique: Day 4

I woke up at 3:30am this morning, left my son Harrison in the hotel room, and headed for our 4:30am departure to Nampula, Mozambique. We flew in a Cessna Caravan of AIM AIR with Capt. Dan Spooner. Capt. Spooner had taken me in AIM AIR with Samaritan’s Purse about a year and a half ago to Darfur from Nairobi, Kenya and then into northern Uganda into the area of the Lord’s Resistance Army.

On the plane flying the length of Mozambique, we were able to capture the beautiful morning light with sun rising on a sharp horizon, red-orange turning bright orange and then a brilliant yellow. After about six hours of travel and one stop in Beira to refuel, we landed in Nampula city and were met by Mayor Castro Serafim who spent the day with us. He is articulate and is now running for reelection. He has been mayor of Nampula city for five years. We also had lunch with the Governor of the Nampula province, Felismino Ernesto Tocale. Interestingly enough, he was a former organic chemistry professor before entering politics.

We spent the afternoon with the Millennium Challenge Corporation (MCC). Accompanying me were Cassia Carvalho-Pacheco, Resident Country Director of the MCC in Mozambique, and Paulo Fumane, Executive Director MCA-Mozambique, who will be responsible for implementation of the Compact.

We visited four different sites which ran the spectrum of the clean water, sanitation, and land tenure aspects of the MCC Compact. Since the MCC compact has been signed but not yet implemented, we went to the areas where MCC will have an impact before the program had begun, where the planning stages had started. Implementation does not start until mid-September.

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Dr. Frist Operating in Mozambique

I woke up to a crystal blue sky in Maputo. I began the day performing a major lung operation for tuberculosis (pneumonectomy), and I ended the day discussing with the President of Mozambique the American people’s commitment to fighting extreme poverty in his country.

Maputo Central Hospital: Surgery

At 7:30am, we departed for Maputo Central Hospital, housed in a 100 year old building, but nonetheless a functional, governmental hospital with 1200 beds. All the doctors are governmental employees, and they make about $700USD per month. That being said, they are very prestigious figures in the community. In Mozambique, there are only 500 doctors for 20 million people, and there are very few specialists. In terms of equipment, there is one CT Scan, in Maputo, for 4 million people. By way of comparison, there are probably 32 in Nashville for about 1 million people.

Dr. Atilo Morais, a superb, thoracic surgeon training in cardiac surgery, gave us a tour through the hospital. He introduced us to his patients. Elias Novela, a 59 year old man, had a history of tuberculosis (TB). His symptoms included a shortness of breath, bloody coughing, and fevers. We reviewed his x-rays which presented a huge right lung mass, thought to be an empyema secondary to his TB. This man would die without surgery of his “bronchopleural fistula” that had developed because of the TB. About 2 million people die of TB every year in Mozambique (about 2.5 million die of HIV/AIDS, and 1 million die of Malaria).

I operated with Dr. Morais having been given full surgical privileges granted for the length of our stay. He spoke little English, and I speak no Portuguese – but luckily, cutting and sewing don’t require any talking!

I explored the patient through the bed of the 6th right rib. We removed the empyema cavity, careful not to spill the purulent material within the TB abscess. This is a big operation, but one common in Maputo because of the high incidence of tuberculosis infection. We removed the entire lung, suturing closed the bronchus, the pulmonary artery and vein. The patient as of right now is recovering well. He will remain on anti-TB therapy and should have a good long-term course. This is something very very rare in the US because out TB gets treated early. (more…)

Frist Africa Trip - Day 2

Sen. Bill Frist, MD, is traveling through Mozambique and Rwanda on a 10-day trip to visit and observe the great work of U.S. led initiatives. Throughout the trip he’s blogging on the Healing Hands blog and here on the ONE Blog.

In Maputo, Mozambique, today, I met with senior officials to discuss the progress of the Millennium Challenge Corporation Compact (MCC) that Mozambique signed with the United States last summer.

This five-year, $507 million agreement focuses on the neglected northern part of the country where I will visit later this week. The Compact will bring clean water to tens of thousands of people for the first time—making them less vulnerable to disease and more economically productive. MCC’s grant will also allow Mozambique to build new roads that link poor communities with markets. A land tenure component will help ensure that property rights are respected. Finally, the Compact seeks to eradicate a coconut disease that threatens one of northern Mozambique’s most valuable crops.

Last year, President Bush appointed me to the Board of Directors of the MCC, which was created by Congress in 2003 when I was Majority Leader of the United States Senate to reduce global poverty through economic growth. The MCC represents a fundamentally different way of giving American development aid to the world’s most deserving nations.

In the past, most of our aid money was, frankly, wasted. That’s because we didn’t pay attention to the quality of the government or how well it treated its people. That caused many Americans to grow skeptical about foreign aid. The late Senator Jesse Helms used to refer to foreign aid as a “rat-hole” because of all the waste and corruption!

We learned something from those failures. MCC only awards aid to countries that are accountable, both to their own people, and to the American taxpayers who ultimately provide the grants. There is no point at all in wasting your taxpayer dollars in countries with bad governments. But in well-governed countries, American generosity can produce transformational change in the daily lives of poor people. (more…)

Sen. Bill Frist, MD, in Mozambique

Sen. Bill Frist, MD, is traveling through Mozambique and Rwanda for the next ten days and working with groups like Africare, Save the Children, Samaritan’s Purse, and the ONE Campaign to visit and observe the great work of U.S. led initiatives. Throughout the trip he’ll be blogging on the Healing Hands blog and here on the ONE Blog.

Vanduzi Town, Mozambique
13 July 2008

I had the privilege today to spend time right outside of Chimoio, Mozambique yesterday, in Vanduzi Town. Africare is doing some amazing work in this village, namely a housing project called Project COPE. Africare, partnering with Habitat for Humanity and the government of Mozambique (who provided the land), had built 30 new homes for families in need, many of whom were suffering from HIV. The homes were made with 100% local supplies and modern materials, rather than the traditional homes in the area. They were painted in a handsome, ochre color, and they featured sloped roofs that reached almost to the ground in order to prevent the rains from damaging walls of the house over time.

I met a young widow who was a beneficiary of one of the homes (See picture). Her husband had died of HIV/AIDS, and she was left to support three children. She began to cry because she was so incredibly thankful for the dignity that her home brought to her there. She explained that before this house they had had to live in a terribly camped hut. But, now they were in her dream home. Her little four-year-old started crying as well because his mother was so happy.

Africare also supports a Community Care Committee (CCC) by paying and training fifteen CCC members, chosen by the community, to oversee the humanitarian response. As a part of this response, each of these CCC members takes care of 15 HIV orphans, and they provide them with food, mentoring, education, housing, and a kind of advocacy: they identify their needs and then go to the community seeking on their behalf to provide for those needs. For instance, three times a week they provide a hearty, nutritious meal (see picture: dish of corn, vegetables, peanut butter, etc.) for young Israel an orphan recently diagnosed with HIV, who has been taken in by his grandmother, Taleza (see picture).

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BedNet Delivery on the Zambezi River

I recently returned from Tete Province, Mozambique, where I helped to distribute bed nets and malaria medications to remote communities on the Zambezi River. I joined the adventurous and ambitious Roll Back Malaria Zambezi Expedition, a two-month voyage tracing Dr. David Livingstone’s trip down the river 150 years ago. The Zambezi Expedition aims to track successes and challenges of controlling malaria in six countries in malaria-endemic southern Africa: Angola, Namibia, Botswana, Zambia, Zimbabwe and Mozambique. I joined toward the end of the Expedition, during which crew members and medical teams have traveled more than 1,550 miles to deliver bed nets and medications to remote areas along the river, many of which are accessible only by boat.

We visited one village near the old colonial Boroma Mission, a few miles upstream from the city of Tete. Though we arrived only the evening before to tell the villagers that we would be coming to deliver bed nets, we found the entire village gathered, health cards in hand, early the next morning when we crossed the river from our campsite. They greeted us with impromptu singing and dancing, incorporating the sting of a mosquito’s bite and malaria’s fever and chills in their movements. One of the village women kept the crowd in gales of laughter as she mimed the mosquito’s treacherous path through the night to the sleeping victim. When we hung a bed net from a nearby tree to demonstrate how to use it, she crawled under it and pretended to sleep soundly and safely to illustrate the point.

The Zambezi Expedition’s goal is to show that coordinated action can force back the spread of malaria and help save millions of lives. As this visit showed, Africans along the Zambezi’s banks are eager to join in the fight against malaria—they have the energy, the drive and the dedication—all they need are the tools. The Expedition has drawn to a close, but the lessons of how international support and local implementation can and must go hand in hand are clear.

To learn more about the Roll Back Malaria Zambezi Expedition, go to
www.zambezi-expedition.org

-Emily Bergantino, Malaria No More

Hey G8, Listen to Pedro

Many African countries are facing a grave threat from rising food prices. That’s why we’ve been asking President Bush and other G8 leaders to take immediate action to soften the blow on the poor and reverse the underinvestment in long-term agricultural productivity.

Some of us have been in Mozambique this week; a country like Mozambique is particularly vulnerable to global food shocks. Not only is it very poor (75% of the country lives on less than $2 per day), it also imports roughly 75% of its food and is hit by a drought or flood every six months.

Despite these challenges, many parts of Mozambique have ideal climate conditions for agriculture production and there’s certainly no shortage of land – Mozambique runs 1,500 miles down Africa’s eastern coast and is twice the size of California.

Today we tried to learn why Mozambique is not able produce more food – both for local consumption and export. To find answers to our questions, we visited plant scientist Pedro Fato at the Instituto de Investigacao Agraria de Mozambique (IIAM) just south of Maputo. IIAM is an agricultural research institute jointly funded by the Government of Mozambique and private donors, including the Alliance for a Green Revolution in Africa (AGRA) and the Rockefeller Foundation. Pedro and his team are breeding more nutritious and insect resistant varieties of maize (corn), cassava, sorghum and sweet potatoes – all foods considered staples here in Mozambique. In the accompanying picture you can see Pedro holding orange maize which IIAM has bred to be rich in vitamin A and beta carotene.

Pedro outlined three major challenges to boosting agriculture growth and productivity in Mozambique

1. Water: nearly all agricultural production in Mozambique is rain-fed. With a typical rainy season lasting only three months, basic irrigation techniques and technology could significantly boost yields
2. Inputs (fertilizers and seeds): Fertilizer is expensive and not widely available in Mozambique. There is currently no domestic production; the limited quantities that are available are imported from South Africa. New seed varieties are also lacking. Approximately 70% of farmers are using unimproved local maize, which has lower yields and isn’t as resistant to pests and diseases. Like fertilizer, there is also no local seed production
3. Infrastructure: most of Mozambique’s agricultural activity occurs in the north of the country, where long distances and poor roads make it difficult to move crops beyond village markets. Improved access to markets could dramatically increase incomes for farmers and cooperative groups.

Pedro also told us more money is needed for agriculture research and extension workers so that new seed varieties and inputs can make it into the hands of farmers. He also said commercial farming is needed in Mozambique. Agriculture in here is mainly limited to smallholder farmers, limiting productivity, distribution and export potential. Pedro told us that 95% of maize in Mozambique is produced by small holder farmers.

Mozambique certainly isn’t alone. Many sub Saharan African countries are facing similar challenges. We’re hopeful that the global attention on food prices will translate into a sustained investment in long-term agriculture growth in places like Mozambique.

-Ben Hubbard and Tyler Denton, ONE.org

It Takes Money to Make Money…

It takes money to make money, but poor people in Mozambique don’t have access to credit. Commercial banks don’t want to lend to them because there is no incentive in lending tiny amounts of money in such high-risk, isolated areas. Today, I visited Matola province in Mozambique. I met with Opportunity International, an incredible organization that gives microfinance loans to individuals and groups.

Microfinance loans are small amounts of money (often as little as $50 or $100) that enable very poor people, especially women, to start or expand small businesses. These loans are a vital resource in poor communities, where people have trouble accessing credit from traditional banks and money-lenders often charge exorbitant interest rates.

Their average loan from Opportunity International is small - around $170 dollars - and after just two years of operation the organization is already breaking even in the country, meaning it can expand its operations to reach even more people.

Study after study has shown that in spite of high levels of poverty, high risk and rapidly changing environments, good microfinance programs boast a repayment rate of more than 95%. Evidence also indicates that income generated from microfinance projects can spur wider development benefits because borrowers, especially women, are likely to use their extra income to invest in health care or education for their families.

We were taken to meet two groups of women whose lives had been transformed by the loans. They were able to use their money to buy stock to sell at their market stalls selling biscuits, clothes, charcoal etc. One woman had even used her money to open a restaurant. The great thing about talking to these women was how happy they were. They were so cheerful and delighted to show us around.

One woman, Rabia, has five children who live with her (in fact we met two of them - they were doing their homework at their mums stall). Rabia has one of the best success stories. She took us to see her old house, which was tiny and made of iron sheeting, and the new one she is building with the proceeds of her stall (picture above). The new house is huge (bigger than my house!) and really well organized - one room is bigger than her entire old place. As you can imagine, we were really inspired by these women.

It’s important to keep things in perspective though. One woman we spoke to was happy that she had increased her income, but she still only spent $4 a day on feeding her family of 5. It was fantastic to see what a difference a small loan could make to peoples’ lives, but we could also see that there is a long way to go to lift the community out of poverty.

-Hermione Davies

Clean Water Transforming a Community

In Mozambique, less than half the population has access to clean drinking water. As a result, diarrhea and cholera, two diseases caused by unclean water and poor hygiene, are leading causes of child deaths in the country.

Today, I had the opportunity to see a MCC-supported program in Mozambique that is piping clean water into a community. I saw how lives can be transformed with access to clean water. While most of us in the United States take safe drinking water for granted, there are over one billion people around the world without access to clean water. But thanks to some amazing programs funded by the U.S. and others, some of the world’s poorest people here in Mozambique now have access to clean water, which is not only helping keep them healthy but also increasing their ability to earn money and attend school.

One neighborhood we toured has struggled with cholera outbreaks for many years. In January, with the help of the Global Fund and others, a clean water piping system was brought to the community. The results are remarkable- while last year over 1,000 people were stricken with cholera, by this year that number had fallen to 20.

Another benefit for the community has been more time for work and school, especially for women and girls. Women and children are often charged with the task of collecting water for the family. Before the new piping system was introduced, this meant they often had to spend hours each day collecting water. Now that each family has a stand pipe in their yard or home, attendance rates at schools have improved and women are able to dedicate more time to income-generating activities like gardening.

Clean water is one of the most basic human needs and it was very inspiring to see first-hand how US development assistance is literally saving and transforming lives here in Mozambique.

-Kim Smith

One Last Photo for the Day

More from our trip to Mozambique. (Previous posts here.)

Before we left the suburb, several of the kids asked us to take their photo. (See above.)

I know I’m missing items from today- but I’ll have to fill in more later. The next time we have internet access, I, and/or others on the trip, should be able to post more here.

-Virginia Simmons