End of Year Party at Katutura Health Center

I was invited to come to Katutura Health Centre, a health facility larger than a clinic yet smaller than a hospital, for a party for the patients of Dr Z (I do not know how to pronounce her name, in any case it is best if she remains anonymous – not that this blog will incriminate her 😉

Continuing my train of thought from HIV positive mothers who bear children, I will outline what was so special about the party I attended. It was for children, ranging from babies to active, running, hopping nine or ten year olds. And boy they are as active as any child of the age, as I saw them race each other across the courtyard of the antiretroviral (ARV) clinic. We had spoon balancing races and a “three legged” race. My role was to try and translate the instructions of these races – in broken Oshiwambo – while I also helped Dr Z to demonstrate. Since most of the children speak Oshiwambo, but not all as others were Nama-Damara speaking, I had to use my knowledge of the language to communicate with them.  Given the home language of these children, as far as I could all of these children were black. When I say black, by no means do I refer to skin tone. Rather, I refer to that constellation of ethnicities that in popular usage in the United States are referred to as black, since they are not white. In the context of Namibia, I would venture to say all of the children and their mothers came from Namibian ethnic groups, as both Nama Damara and Oshiwambo are indigenous to Namibia.

Aside this brief demographic description of the children, I want to reflect on two moments of this “christmas” party for children that I feel are noteworthy.

When I first arrived there, I quickly had to assume the role of diving about three dozen or so children into rows for face painting. I divided the first two rows at the entry room of this ARV clinic – a special unit with the Katutura Health Center. Once I had made sure there were two rows inside this entry room of the ARV clinic, I realized it was a little crowded and so I ventured outside. There were some women there (I think they were caregivers of some of the children, older sisters, aunts, mothers) and these women assisted me to direct the children outside. Soon I was painting faces, something I did not plan on doing given my feeble drawing talents, on the waiting benches outside. Before I knew it, I was told I had to go back inside:

“ Other children who are not part of us are coming to be painted” One young woman warned me

“What?” I asked

“Those who are just coming to the [outpatient] clinic are also coming here, so we can go in because maybe they [there] will not be enough [facepaint] for our children”

“Well I am not going to turn a child away, so let us just go back in then” I said in agreement as I made my way back into the ARV clinic. I was somewhat disappointed, because I knew that any child would enjoy face paint and so why turn them away if we are having a party they can see? Children who are not part of our party were presumably HIV negative, as they are not ARV patients. I remember saying “We have to find a way of doing this party in a way that does not exclude others”. In my understanding, turning children away from facepainting would be akin to discrimination. On the other hand, we could not provide for all children in Health Center, in Katutura, in the City or in Namibia with just one box of face paint. So we had carefully chose how to use our resources. And we, or the organizers of this party – Dr Z, her family and her coworkers, chose these pediatric ARV patients. In a sense, the HIV seropositivity of these children allowed them access to outlets of recreation and entertainment where their childhood is valued.

I now must refer to medical anthropologist João Biehl who witnessed and documented a similar phenomenon in Brazil, a phenomenon he termed “patient citizenship”. Biehl noticed that the provision of antiretroviral therapy afforded patients (in Namibia we just say patients without the HIV or AIDS) political opportunities while influencing their self conceptions. In the late twentieth century Brazil, HIV patients even received disability grants, which clearly improved their standard of living and making them visible to the state as citizens. In Namibia, we do not have such as policy and we are unlikely to have it given that Brazil phased it out. Nonetheless, there are ways in which the personhood of HIV positive people is cherished, as in the example of the party I attended.  I believe the guiding principle behind this valorization is the disadvantaged position HIV positive people find themselves in society. The children I saw, however, did not appear disadvantaged. From the looks of things, they were ordinary children – seemingly healthy and boisterous – far from the withering image of an AIDS patients (hence the obsolete nature of the term ‘AIDS’ patient).  In this sense, to what extent is it valid to claim these children need this type of fun more than others?

Now I have to write about the second moment I was moved by. In a sense it is related to the first. A mother clutching her infant on one side of her chest was chatting with the teenage daughter of Dr Z.

I came to know this women because I overheard a bit of her conversation with the daughter of Dr Z “..HIV positive…” were the words the woman uttered and I turned to look at her and we made eye contact. I smiled and then she looked at me and announced:

“ I am HIV positive but my son is not…” before she broke into sobs and reached for me. She hugged me with her free arm, the one on the other side of her baby and hugged her back.

“It’s ok” was all I and Dr Z’s daughter could say, I think and that is all we did say.

But I did remember adding:

“Thank God that he is negative” after she had calmed down a little.

 

What actually happened here? Did she have to disclose her HIV positive status us and if so why did she do it?  I want to first emphasize that this women came late, after we had distributed the presents to the children (with the help a young man who works at the health center dressed as Santa Claus. Cultural anthropologists, take note the children were visibly scared of this Santa Claus and many of them were reluctant to approach him!)

Was she initially unsure of whether she could bring her child to this event given his seronegativity? To what extent did she feel she needed to justify the presence of her son and herself at this event by disclosing her HIV positive status? Moreover, was this disclosure a painful and perhaps shameful act for her, but one she nevertheless did in order to secure a gift for her infant?  All of us, including the other women organizing the event assured her we would bring her a present. In fact, she was not the only mother with an infant waiting, not the only mother who had come late. To what extent was her experience unique? Did the others rather remain tacit and play the roles of mothers of HIV positive children, regardless of the HIV status of their children?

 

Again, I want to reinforce the idea of how patient citizenship played out at this Christmas party, whereby the HIV positive children received the attention that any mother would want for her child (I say this because I do not recall seeing even one male relative, no avuncular figures let alone fathers – the only other man there was Santa Claus).

 

Cited Works: Will To Live: AIDS and the Politics of Survival, by Joao Biehl, where “patient citizenship” is discussed at length.

 

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About writinghealth

Wannabe Epidemiologist? Wannabe med anthro person? I guess. Christian, scientist (not Christian scientist), i mean like I studied molecular biology. I am doing a Masters of Public Health, at the University of Cape Town.
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