A Gift from A Client

Christmas Eve is always a hectic day at Open Arms with everyone working hard to package and deliver meals as early as possible so that our clients, as well as our volunteers and staff, can enjoy the holiday. By noon, all of the meals are en route to being delivered and we are waiting for drivers to return their delivery bags.

 

By 1:00 in the afternoon I usually tell the Open Arms staff to leave so they can have more time with their families. I stay a bit longer to greet the last of the drivers who are returning their bags and to answer the phone should any clients call with questions.

 

This Christmas Eve, just as I was about to turn out the lights, a client called inquiring about meals that he was anticipating, but that hadn’t arrived. When I explained to him that he wasn’t on the list for a delivery, he was very understanding and wished me a happy holiday.

 

Before hanging up, I asked the client if he had any food to eat. He said he didn’t, but that could buy a few things at neighborhood market to hold him over until we resumed normal deliveries the following week. Since he would be alone for the holiday, he didn’t need too much food anyway.

 

I asked the client to hold as I looked in our coolers to see if there were meals I could deliver to him. We did have extra meals, but I was on a tight schedule. A bakery across town was willing to donate bread to Open Arms if I could get there before they closed in an hour. I thought I could do both – deliver meals to our client and make it to the bakery before it closed – but only if the client could meet me on the street in front of his apartment building so I could double park and hand off the meals to him.

 

Our client was very grateful, telling me that he would be waiting for me in the lobby and that he would run out to my car to get his meals. Ten minutes later, I was on the street in front of our client’s building and before I could pull the meals from the insulated delivery bag, the client was standing next to me. As I handed our client his meals, he handed me a gift – an amber votive candle holder with an electronic candle that flashes a yellow flame.

 

This gift, this unexpected gesture, completely altered my day. Instead of Christmas Eve being a laundry list of activities to be checked off before enjoying the holiday, those activities themselves – from going to the bakery to a last minute stop at the post office – became part of the enjoyment of the day.

 

I came to work at Open Arms in 1997 to help improve the quality of the lives of people living with HIV/AIDS. What I found, however, is that most of my time as executive director is taken up with administrative tasks, strategic planning, budgeting, and fundraising. At this point, I have little interaction with the clients we serve. This brief Christmas Eve encounter with one of our clients reminded me of why I got into this work in the first place. It also showed me, yet again, that I receive much more from my work than I give.

My Christmas Carol

Being of Scandinavian descent, my family immigrated to this country from Norway shortly after the Civil War, I sometimes think I’m genetically predisposed to exhibiting bah humbug-like behavior this time of year. Maybe all of those endless winters my ancestors spent on farms near Norwegian towns like Trondheim and Jevnaker actually froze something in my family’s DNA. Or maybe it was seeing too many productions of Henrik Ibsen’s dark plays, or the screaming paintings by Edvard Munch, that left me thinking that Ebenezer Scrooge probably wasn’t such a bad guy after all – maybe just a little misunderstood. I mean, aren’t we all be visited by ghosts in our memories?

 

The Ghost of Christmas Past who visits me is a sentimental ghost who recalls little brown paper sacks filled with hard candy and peanuts handed out to all the children after the annual Lutheran church Christmas pageant. It’s a ghost who brings back memories of stockings hung from living room curtains (ours was a house without a fireplace), and the exact number of gifts for every child – one of which was always a package of underwear. We all opened that one first – an expected appetizer of a present on our way to the main course of games and toys, wrapped in paper that had been carefully folded and saved from Christmases past.

 

Even those years when money was tight – and that was most years it seemed – there always was an abundance of food. There was Swedish meatballs, turkey and lutefisk. The lefsa my mother had been making for weeks would be gone by the end of Christmas Eve – as would the pumpkin pie; though a few pieces of apple pie would survive the evening meal. Christmas morning would find my dad in the kitchen frying blood sausage that we would smother with butter and dark Karo syrup – never really comprehending what we were eating.

 

By the 1990s, my Ghost of Christmas Future was looking far less sentimental and much more cynical. Being one of the youngest children of several generations of my family, each Christmas was now being recognized as the “first Christmas without (fill in the blank with whoever died the previous year)”. The large family gathering with guests sleeping on sofas and children stretched out on the floor got smaller and smaller each season. By then, we were far enough into the AIDS epidemic that Christmas became a time of wondering if this would be the last Christmas for friends who seemed too ill to survive another year. Christmas was becoming a season of diminishment, and the future seemed as dark as the winter’s solstice. So I did what any Scrooge would do, I threw myself into my work.

 

And my work, as it turned out, brought me my Spirit of Christmas Present.

 

There is no place I would rather be for the holidays – not a favorite Christmas from my childhood, or some future Christmas in a warm and sunny location – than Open Arms. Open Arms captures the sense of abundance and awe that I remember from my childhood and reclaims the hopefulness and activism that was once missing from my future.

 

I love the blast of cold air that comes in the building as volunteers walk through our doors. I love the sound of them stomping the snow from their boots before walking into the kitchen to start cooking or collecting their meal delivery bags. Although our volunteers don’t come bearing wrapped presents to put beneath a tree, they bring something I value much more at this point in my life. They bring a generous spirit and a gift of time.

 

I love the rich smells of hearty soups simmering on our stoves, of free-range turkeys baking in the ovens, and gingerbread cookies spread out on trays just waiting for the colorful frosting that will transform them into gingerbread men and women. I love watching children, and adults, bite the heads off first, before washing the cookie down with a cup of steaming hot chocolate or apple cider.

 

More than anything, I love knowing that hundreds of people who are confronting serious health issues will have nutritious meals to eat – every day of the year – because of the efforts of thousands of caring people in this community. And that is the gift that Open Arms has given me. You have given me the spirit of Christmas that I came very close to losing.

 

However you celebrate the season, I wish you much joy and good health.

Holiday Message

I’m optimistic about the future.

 

People sometimes say I’m naive or a Pollyanna, but it’s not that at all. My optimism is firmly rooted in my life experiences and is largely shaped by the AIDS crisis in this country and abroad.

 

I remember the fear and anxiety that gripped this nation in the 1980s when a mysterious new disease began making headlines. It was a time of uncertainty and helplessness. There was hand-wringing and soul searching. The future seemed very bleak.

 

Friends confided their positive HIV status to me and then implored me not to tell anyone for the legitimate fear of the isolation and discrimination they might experience. Some lost their jobs, their health insurance, and their homes. I sat by friends in hospitals in New York as they lay dying. I attended memorial services for others in the Twin Cities. I swatted flies from the faces of comatose children in Africa who would be dead just hours after my visit.

 

No, my optimism does not stem from a naive view of the world. Rather, it’s grounded in the countless acts of kindness, generosity, and love that are shown in times of crisis. Time and again I’ve seen compassion triumph over bigotry, action triumph over helplessness, and hope triumph over fear. And I’ve seen those countless acts and triumphs at Open Arms.

 

When our founder, Bill Rowe, prepared and delivered dinner to five men with AIDS in 1986, he had no intention of creating a non-profit organization. It was to be a single act of kindness – one person taking action on an issue that was paralyzing so many others. More than two decades later, that single act of kindness has resulted in a million and a half meals coming from our kitchen. That’s a million and a half more acts of kindness in this community.

 

When we began to learn about the escalating rates of HIV/AIDS in sub-Saharan Africa, the majority thinking was that there was nothing that could be done. To some, it seemed that the statistics were just too overwhelming for a small non-profit agency in Minnesota to make a difference. We didn’t accept that. We knew we couldn’t solve the global AIDS pandemic, but we also knew that we could not stand by and do nothing. Eight years later, Open Arms continues to sponsor nutrition programs, emergency food relief, and income-generating projects for thousands of people with HIV/AIDS in the townships outside of Cape Town, South Africa.

 

When women, newly diagnosed with breast cancer, called and asked for our help, there were those who said that Open Arms simply could not do any more. If we assisted women with breast cancer, then what about those with multiple sclerosis, or ALS, or other chronic and progressive diseases? And to those people who questioned a broadening of our mission we said, “You’re right. What about all of those people? Who will help them if we don’t?” With limited resources, but an abundance of clarity and conviction, Open Arms grew into our name and began serving nutritious meals to even more people in the Twin Cities who are sick and need our support.

 

When it became obvious that Open Arms would be preparing and delivering over 250,000 meals by 2008 – a 126 percent increase in service in four years – we knew our current building could no longer sustain us. We also knew that if we moved forward with an $8 million capital campaign to construct a new facility and expand programming, we would be undertaking our greatest project ever. But move forward we did. At the end of September, in the midst of dramatic turmoil in this country and around the world, we held a ceremonial groundbreaking for Open Arms’ new building in the Phillips neighborhood of Minneapolis. With the continuing support of this community, we intend to be operating from our new home by the end of next year.

 

All of us at Open Arms – our volunteers, donors, board, staff, and certainly our clients – know uncertainty, anxiety, and fear. We also know kindness, generosity, and love. We know the positive outcomes that can come from a community uniting to tackle great issues and challenges together. We know it because we witness it every day at Open Arms.

 

Thank you, for all you do for Open Arms, day after day, year after year, to provide nutritious meals to people who are ill. With your dedicated service, compassion will continue to triumph over bigotry. With your volunteerism, action will continue to triumph over helplessness. And, with your optimism, hope will continue to triumph over fear.

World AIDS Day 2008

Another World AIDS Day, December 1, has come and gone. Usually my disappointment about World AIDS Day centers on the lack of media attention the day receives in this country. This year, my disappointment stems from something I actually read in the press.

 

A few scientists and academicians are saying that the time has come to shift financial resources away from HIV/AIDS to concentrate on other global health issues such as malaria and pneumonia. Some have even suggested that it is time to disband UNAIDS, the United Nations agency charged with addressing the global pandemic. They argue that for many people who have access to lifesaving anti-retroviral (ARV) medications, HIV/AIDS has become a manageable disease. They also suggest that aside from the African continent, HIV/AIDS has probably seen its peak worldwide.

 

It is, however, too soon to be reducing the world’s financial commitments to the AIDS pandemic and to be dismantling multi-national organizations that are diligently working to prevent new infections and to treat those who are infected with HIV.

 

Thirty-three million people worldwide – most of them in sub-Saharan Africa – are HIV-positive. Without continuing outreach activities, education and testing, these people could possibly unknowingly spread the virus. Without outreach and education others, who are HIV-negative, may not receive the messages that will help them from becoming infected. And, unlike the developed world, the majority of people with HIV/AIDS on the African continent still do not have access to the ARVs that are making the disease manageable in countries like the United States.

 

More resources must be dedicated to combat other diseases around the world that sicken and kill many more people than does HIV/AIDS. But this must not be an either/or situation. The solution to reduce deaths due to malaria or pneumonia is not to take funds from HIV/AIDS and apply it to other diseases. It is to fully fund more efforts that will reduce disease and save lives around the globe.

 

The critics who chose World AIDS Day to call for a realignment of funds to fight global disease believe that there is a scarcity of resources – that there is not enough to combat malaria and HIV/AIDS and other diseases. I don’t believe that. I believe that we have the resources to do more, but we lack the will.

 

If a day comes when HIV infection rates are falling everywhere in the world; when everyone with HIV/AIDS has access to medications that may keep them alive; when HIV/AIDS has truly become a manageable disease for everyone on the planet; then I will gratefully endorse a realignment of HIV/AIDS funding and a dismantling of AIDS organizations and efforts. But World AIDS Day 2008 is not that day.

Remembering Sibongile

This story was originally published in my book,

Never Give Up: Vignettes from Sub-Saharan Africa in the Age of AIDS.

 

The other day I was rummaging through some files looking for a piece of information on AIDS or South Africa. I don’t even remember now what I was looking for or why I needed it, because something I came across in one of those files sidetracked me.

Tucked between magazines, reports, and notes was a yellowed article from a 2001 township newspaper with the headline, “Hearty party wish for shy Sibongile.” A photo of Sibongile and her aunt accompanied the clipping. It was the photo of Sibongile that grabbed my attention. I pulled the article out of the file and read it for the first time since I filed it years ago. Then I read it a few more times before returning it and closing the file. I could file the article, but I haven’t been able to file the memory it evoked.

I met Sibongile only once – on Valentine’s Day, 2001, a few months before her birthday party that was reported on by the Guguletu press. My partner and I were finishing up a day of meetings with Reverend Spiwo Xapile in the townships when the Reverend told us we had one more stop to make. He said we were going to a local hospital to visit an AIDS orphan who was very ill. “You need to come with me,” he said, “to meet Sibongile and take pictures of her. Americans need to see what AIDS is doing to our children, and you will need photos to tell Sibongile’s story.”

I remember the drive from Guguletu to the hospital as being very quiet. Reverend Xapile was right, of course. If Americans were ever going to understand AIDS in Africa, we would need to connect with the issue on a personal level. I was just extremely uncomfortable with the prospect of taking a sick child’s photo. I was steeling myself for emotions I might be about to experience. The Reverend and my partner also seemed to be caught up in their own thoughts. We drove in silence.

I remember asking one question on that drive: “How old is Sibongile?”

“Four years,” Reverend Xapile answered.

At the hospital, we walked down a long corridor into the children’s ward. There were maybe two dozen beds in the large room – a child in each one. Some children were sleeping; others were awake and playing quietly in their beds or just looking around the room. A few women sat by the sides of beds next to children. Maybe they were moms, grannies, or aunties. Most children had no one at their side.

Sibongile was sleeping. She wore a child’s hospital gown. Her broken right arm, the result of a fall, was in a cast. Her arm might heal, but the HIV-related pneumonia that kept sending her back to the hospital would eventually kill her. My partner and I stood on one side of the bed while Reverend Xapile stood on the other and gently nudged Sibongile awake.

The Reverend spoke to Sibongile in Xhosa. She had that awakened-from-a-sound-sleep kind of confusion. Her responses to Reverend Xapile were so soft that we could not hear them, even though we stood just feet away.

Sibongile didn’t know there were two white Americans next to her until the Reverend told her and she slowly turned her head to see us. She was frightened. We both immediately smiled, said “molo,” and did what most Americans would do in that situation – we gave her gifts.

We had bought a box of candied hearts and a Mickey Mouse doll in honor of Valentine’s Day. Sibongile took the gifts but didn’t respond to them. She lay in her hospital bed, looking at the Reverend and at us, holding Mickey, but saying nothing and doing nothing.

Reverend Xapile broke the silence with, “Take some photos.”

I took my camera out, made some inane comments to Sibongile about taking her picture, and began shooting. My partner did the same with his digital camera. It was awful. Sibongile didn’t respond to the cameras, the Reverend looked pained, and my partner and I were uncomfortable in our roles as amateur photographer/voyeurs. I clicked. My partner snapped. We all felt terrible.

Looking at Sibongile’s image in the screen of the digital camera, my partner got an idea. He showed Sibongile the small screen of the camera that displayed the picture of her he had just taken. The apprehension on Sibongile’s face immediately disappeared, replaced with a look of utter astonishment. As my partner scrolled back through all of the photos he had taken of her, Sibongile’s surprise turned into sheer joy. If a photo had the Reverend in it, she would look at him, then look back at the camera, and then look at the Reverend again. She did the same with photos that showed me in the frame. She would look at the image, then at me, and then back at the camera, simultaneously confused and amazed.

Within minutes, Sibongile had gone from being totally listless and frightened by our visit, to being almost animated. She used her unbroken arm to propel herself into an upright sitting position. My partner would take more photos, these of a smiling Sibongile, and show them to her. Her smile erupted into laughter, and she began rapidly speaking to Reverend Xapile in Xhosa. Now she was playing with her Mickey Mouse doll and eating the candied hearts we had given her. She got out of her hospital bed and sat on a child’s plastic chair next to her bed, with Mickey in one hand and the box of candy in the other.

This seemed like a good time to go. Reverend Xapile explained that we needed to leave and Sibongile nodded, never breaking the smile on her face. My partner took one last photo of a beaming Sibongile as we walked out of the hospital.

A few days after our visit, Sibongile was well enough to leave the hospital. Her aunt picked her up and took her home. Sibongile would be in and out of the hospital a few more times, but she was well enough to be home with her aunt for her fifth birthday party, which according to the newspaper article, was a huge affair attended by neighbors, members of Sibongile’s church, and more than 40 children from her preschool.

I wasn’t at the party, but I have been to enough children’s birthday parties to imagine what it must have been like. And on Valentine’s Day, 2001, for a brief period of time, when Sibongile was discovering something new in a digital camera, I got a glimpse of what she would have been like had she been born healthy and had a chance to have a normal childhood and a normal life.

I know what happened to Sibongile after her last birthday party, but that’s not how I want to remember her. I want to remember her as the little girl who sat with her Mickey Mouse doll and candies, waving good-bye to us at the hospital. I want to imagine her as the local newspaper reported – as a regular kid dancing at her birthday party with “her hips swaying from side to side.”

Did Sibongile Have to Die?

A recent Harvard study has verified what many of us have believed for a very long time – that AIDS denialism on the part of the former President of South Africa, Thabo Mbeki, resulted in the premature death of many of his people. What we didn’t know exactly, but what the Harvard study quantified, is that as many as 365,000 South Africans have died because of Mbeki’s foot-dragging on distributing potentially lifesaving antiretroviral medication to his people with HIV/AIDS. Mbeki’s HIV/AIDS policy also prevented pregnant women from receiving medications to reduce the likelihood of mother to child transmission of the virus.

Now that Thabo Mbeki is out of office, perhaps his biographers or historians will be able to shed some light on why this intelligent man, left with the Herculean task of having to follow Nelson Mandela as president of his nation, failed to implement policies that not only would have saved hundreds of thousands of his people, but also failed to show responsible leadership on one of the few issues – HIV/AIDS – that Nelson Mandela, by his own admission, was negligent on as president. Had Thabo Mbeki looked to early examples of leadership on HIV/AIDS in countries like Thailand, Uganda, and more recently in places like Botswana and Namibia – a healthier South Africa could have been the legacy he left his nation after nearly a decade as its president.

Visionary leadership on HIV/AIDS in South Africa could have positioned Mr. Mbeki to take his policies on the road and share, what could have been South Africa’s success, with other African countries that are being dramatically impacted by the AIDS pandemic. Mr. Mbeki envisions an “African Renaissance” for his continent. It is ironic that he could have hastened that renaissance by becoming the preeminent leader on the issue of HIV/AIDS. Instead, Thabo Mbeki oversaw what the virologist in charge of the Harvard study calls “a case of bad, or even evil, public health.”

I have always known that Sibongile, a four-year-old girl with AIDS who I met years ago in the township of Guguletu, probably didn’t need to die. Had her pregnant mother had access to the inexpensive drugs that prevent mother to child transmission of the virus, the chances of Sibongile being born HIV-positive would have been dramatically reduced. Even if Sibongile had been born with the virus, or if she would have contracted it from breast feeding, she might still be alive today with medications. But, that wasn’t to be. “Bad, or even evil, public health” policies meant that Sibongile didn’t have a chance.

Harvard estimates that as many as 365,000 deaths from HIV/AIDS could have been prevented in South Africa, but I’m not thinking of that number today. I’m thinking of Sibongile – one child who has now been dead longer than she lived. Tomorrow, World AIDS Day, I will remember Sibongile – not the policies that contributed to her premature death.

And That Was That

I was emotionless when I received a call from the sheriff telling me that David was dead. The call confused me, not so much because David was found dead in his apartment, but because he had listed me as the person to contact in an emergency. Emergency contacts, it seemed to me, should be close family members or intimate friends, not the director of a non-profit organization where a client received services.

David, the sheriff informed me, had not only named me as his emergency contact but had also left his personal property to the agency I worked for. Included in his possessions was a frightened cat that needed to be removed from the apartment. As unlikely as it may sound, a co-worker had connections to the “cat rescue community” and within minutes of this startling call, a cat carrier was secured, and I was en route to meet the police at David’s apartment. I arrived just as a body bagged David was being wheeled to the coroner’s van.

Introductions were made with the police, the manager of the apartment building, and me. It would, the police informed me, only take a few minutes to complete a report; then I could enter David’s apartment, get the cat, and discuss the removal of David’s possessions with the apartment manager.

The policeman asked what my relationship was to the deceased. When I told him I worked for an organization that prepared and delivered meals for people with HIV/AIDS and that David was a client, the officer was surprised. Didn’t David have any friends or family? I didn’t know about friends, but because I had pulled his client file before leaving the office, I knew that David did have a mother who lived in a neighboring state. I told the officer that I was as stunned as he was that David had named me as the person to contact in a situation like the one I now found myself in.

With my relationship to the deceased determined, the officer asked for identification to complete his report. While recording information from my driver’s license to his form, he suddenly stopped and said, “You’re kidding, right?” I knew what he was referring to and said, “Ironic isn’t it?”

He finished writing his report, handed my license back to me and said, “Happy birthday. I hope your day improves.”

It didn’t.

The officer and the apartment manager said they would wait in the hall as I retrieved David’s cat. I assumed that one, or both of them would accompany me into the apartment, but they insisted that I go in alone. The policeman opened the door and as soon as I stepped inside, he quickly closed the door behind me. With my very first breath in the apartment, I knew that David had been dead for a long time before his body was discovered. Some smells, when experienced for the first time, are difficult to identify. That is not the case with a decomposing body. It is a smell which is easily identified, and once experienced, it is never forgotten.

I immediately began breathing through my mouth and frantically searching for the cat. When I stepped into the bedroom and saw that all of the linens had been stripped from the bed, I assumed that’s where David had died. And there, by the bed, was the cat. She came right to me and allowed me to pick her up and easily place her in the carrier. I hurried with the cat to the door and stepped back into the hall where I exhaled and said to the waiting cop, “Why didn’t you tell me?”

“Because you wouldn’t have gone in if I did.”

He was wrong about that. I would have still gone in. But he was right not to tell me. It would have been much harder to step into that apartment had I known what the policeman already knew, that David had been dead for five days.

You see, although David had AIDS, that wasn’t what killed him. David had diabetes and based on the detailed journal of insulin injections that he maintained and that was found open on the kitchen counter, the police assumed – and the coroner later confirmed – that David had gone into a diabetic coma and died. The last entry recorded in the journal, along with the state of his body, put the date of death five days earlier.

While taking the elevator to the lobby, the apartment manager informed me that I would be responsible for disposing of David’s belongings. Assuming that there would be mementos or heirlooms that would have sentimental value to the family, I said that David’s mother should be allowed to have whatever she wanted. The manager said that was my decision to make, but since David had explicitly donated his possessions to the agency I directed, I would need to be present to let anyone into the apartment.

The policeman escorted the cat and me to my car. When he told me that the coroner would call David’s mother and give her the news, I asked if I could make the call. I may not have been a friend of David’s, but at least I knew something about him.

When I returned to my office I didn’t hesitate to call David’s mother. This wasn’t the first time that I had to call someone to tell them that a loved one was dead. Although there is no good or easy way to deliver news like this, I had learned that it only gets harder every minute you delay placing the call.

I sensed, when David’s mother answered the phone, that she already knew that her son was dead. The coroner in Minneapolis had dispatched the sheriff in the small Midwestern town where the mother lived to personally deliver the news. The sheriff was still in the house when I called and David’s mother asked me to wait a moment while she said goodbye to the bearer of bad news. Soon she was back on the line and I was extending my condolences to her. The mother said she was in shock, but her daughter was with her.

She quickly began a recitation of things to do including a trip to Minneapolis to collect her son’s belongings. I told her to let me know when she was coming and I would meet her at the apartment. Almost immediately, the mother’s tone changed. Why would I need to meet her at her son’s apartment? I explained that although David had left his possessions to a non-profit agency that she could have whatever she wanted from the apartment. I wanted her have whatever she wanted – personal effects, photos, perhaps even David’s cat.

“David has a computer and TV,” the mother said, “You’re not getting those.”

“No, ma’am,” I said, “you can have everything in the apartment if you want. I just need to be there to let you in.
            I told the mother who now seemed more agitated than bereaved that David’s apartment needed to be cleaned out very soon as it was nearing the end of the month and the building manager had told me the unit would need to be rented. “Well,” the mother said, “my daughter and I have plans to go to the casino this weekend. I hope you don’t think we are going to change our plans to deal with this.”

I wanted to say, “what part of ‘your son is dead’ do you not understand.” I wanted to say that, but I didn’t, because suddenly I realized why David hadn’t listed his mother as his emergency contact. Suddenly, I realized why David would list me, the director of a social service agency, as the first person to contact if something happened to him. I was David’s emergency contact because there wasn’t anyone else.

Over the next few days there would be additional phone calls with the mother – each more difficult than the call before. The mother and the sister arrived at the apartment and took the television and the computer and a few other items of monetary value and managed to make it to the casino on time for their weekend get-away. A wonderful volunteer at our organization – perhaps David’s only friend – packed up the remaining possession of David’s life and cleaned the apartment. And that was that.

And, that was that.

Breaking Ground

Saturday, September 27 was a wonderful and important day for Open Arms. In a joyful and emotional ceremony, we broke ground on our new building in the Phillips neighborhood of Minneapolis.

The day started early for the staff of Open Arms. Taya, our food services director, was in the kitchen at 4:00 in the morning preparing breakfast for our special guests. Over the course of the next few hours every staff member at Open Arms joined in the effort to cook breakfast and prepare the site at 25^th Street and Bloomington Avenue in Minneapolis. It wasn’t long before the staff was joined by every board member of Open Arms who greeted our guests and thanked our volunteers and supporters for all they do for us every day. We were very grateful to also have the help of riders and crew members from the Breast Cancer Bike Ride.

The morning was cool and the skies gray. Although the weather report did not predict rain, we weren’t so sure. Just in case our breakfast and groundbreaking ceremony got rained on, we had prepared small cards to hand our guests with an African blessing that explained that when it rains on guests, it’s actually a sign of good luck. The rain held off and the entire morning was filled with blessings and good fortune.

The footprint for the first floor of our new building was staked out in the property to give guests a visual impression of what the building will look like. Many volunteers were overheard – standing on the grass – trying to find the area in the kitchen where they will be chopping vegetables or packaging meals in a little more than a year when our building is actually finished.

Under a tent, our guests enjoyed a delicious (and of course nutritious) breakfast of buffalo bison, organic eggs, potatoes, fresh fruit and breads. Our good friends at Sisters Sludge (a coffee shop just down Bloomington Avenue) provided the coffee.

Throughout the morning, more and more friends arrived and by 11:00, when we began the morning’s ceremony, nearly 400 people had joined us.

Barbara Hoese, president of Open Arms’ board of directors, welcomed guests and reminded all in attendance how Open Arms began as a response to the HIV/AIDS epidemic in the Twin Cities. She thanked John Frey and Jane Letourneau, who joined Barb on stage, for being co-chairs of our capital campaign and for purchasing and donating the property on which our new building will be constructed.

Executive director, Kevin Winge, told the assembled crowd that although the building was only staked out on the ground, that he could actually see what Open Arms’ new home will look like. He described to the guests what the basement, kitchen, and second floor would look like. He announced that Open Arms has secured $5.6 million towards its $8.1 million goal, and although Open Arms isn’t entirely sure where the final $2.5 million will come from, he assured the gathering that the community will continue to support this vital service.

Minneapolis Mayor R.T. Rybak, a longtime friend and supporter of Open Arms, spoke eloquently about growing up very near Open Arms’ new home. He echoed the thought that Open Arms belongs to the community and that the decision to construct our new building in the Phillips neighborhood will strengthen communities in the Twin Cities.

Gary Schiff, Minneapolis City Council Member, HIV/AIDS activist and advocate for the Phillips neighborhood, joined in the celebration. He spoke of how Open Arms opened its arms to serve even more people living with other diseases and how the entire community can depend on Open Arms to be there for them in the future.

Open Arms’ final speaker, Bill Kimker, had many in attendance in tears. Bill, who has lived with HIV/AIDS for decades, spoke about being the first person to ever leave Hope House, an AIDS hospice in Stillwater, alive. Fighting back tears himself, Bill said that Open Arms “Gave me friendship, support and took good care of me, provided me food and I gained weight. They welcomed me with open arms.” And he credited the chocolate desserts that Open Arms bakes for much of his good health! Although mobility continues to be an issue for Bill, following his comments, Bill rose from his wheelchair, firmly grabbed a shovel, and turned the very first shovel of dirt to break ground on Open Arms’ new home.

It was a beautiful day that honored Open Arms’ past and took a major step into our future.

Open Arms Groundbreaking

As we prepare to break ground on Open Arms’ new building on Saturday, September 27, I find myself reflecting on all of the events of the past 22 years that have brought us to this point.

It was our founder, Bill Rowe, who saw that people with HIV/AIDS needed nutritious meals to feed their body, and the visit from a compassionate volunteer to feed their soul. He never imagined, when he prepared that first dinner for five men with AIDS from the kitchen of his apartment, that Open Arms would still be addressing a critical need in this community over two decades later.

It was Open Arms’ phenomenal growth in the past four years that triggered our capital campaign – The Kitchen Campaign: Building the Future of Open Arms – an $8.1 million endeavor that will allow us to construct a new building and expand our programming to serve even more people in the Twin Cities living with HIV/AIDS and other chronic and progressive diseases.

In the summer of 2004 Open Arms was serving 200 people with HIV/AIDS, and our resources were stretched. We were running out of cooler and freezer space to store food and prepared meals. We lacked the volunteers needed to cook and deliver meals. Our small, dedicated staff was working beyond their limits. And we were facing the possibility of the first deficit in our history. It was a time when Open Arms could have easily decided to do less, but we knew that the need in the community was much greater than the 200 clients we were serving. So, we decided to do more.

We installed additional coolers and freezers. We added Saturday and evening volunteer shifts in the kitchen to increase meal production. We surveyed our clients and discovered that 75% of them preferred a weekly delivery of all their meals rather than the daily delivery they had been receiving for the first two decades of our service. We created new menus to better meet the nutrition requirements of people living with disease and to offer our clients more choice in their meal selection. We developed Nausea Care Packs filled with items like ginger ale and saltine crackers – food our clients told us they could almost always tolerate, even if nausea prevented them from eating meals. And we made a critical decision to enhance our service to people living with HIV/AIDS while also expanding our program to serve people affected by other chronic and progressive diseases such as breast cancer, MS and ALS.

I believe that when you do the right thing, good things happen. And good things happened at Open Arms. By helping more people, more people helped us. More volunteers filled our kitchen and delivery shifts. More community members donated money to allow us to fund our expansion. The shift from daily deliveries to a weekly delivery conserved fuel and avoided a potential crisis for delivery when gasoline prices soared to record levels. And not only did we begin serving meals to people living with diseases like cancer, we actually saw a dramatic increase in the request for service from people living with HIV/AIDS.

Four years ago, Open Arms served 89,136 meals to people living with HIV/AIDS. This year, we will serve 250,000 meals to people living with HIV/AIDS, breast cancer, MS, ALS, as well as our clients’ affected caregivers and dependent children. We are committed to serving as many meals to as many people as we possibly can from our current facility, but we know that sometime in the next 12 months we will reach capacity in our existing building. There simply will be no more space to cook the meals and inadequate space to cool and freeze them. That is why Saturday, September 27 is such an important day in Open Arms’ history.

Breaking ground on our new building at 25^th & Bloomington in Minneapolis will be the next step in Open Arms’ decades-long commitment to ensure that no one who is ill in this community will also have to go hungry.

Comments from Peace Island Conference

On June 5, 1981, the Centers for Disease Control reported on a new disease that was afflicting five gay men. We didn’t know at the time, but that day would mark the start of what today is known as the AIDS pandemic. Twenty-seven years ago, Ronald Reagan was president and in 1981, President Reagan would be silent about this new disease. And in 1982, as more and more gay men, IV drug users, and Haitian immigrants began getting sick, Reagan remained silent. And he was silent in 1983, and in 1984, and in 1985, and in 1986. It would be 1987, one year before Reagan left office, before he would address the issue of AIDS – what today we know as the greatest public health crisis the world has ever seen. By that time, the genie was out of the bottle and HIV/AIDS was on the rise in this country and getting a foothold in places like sub-Saharan Africa.

I’m critical of the lack of political leadership on what has become one of the greatest issues of our time, but there is plenty of blame to go around. At the start of the AIDS crisis in this country some corporations discriminated against people with HIV/AIDS. Too many faith communities were silent on the subject, while others were actually condemning. And sadly, many families disowned their children – oftentimes because they could not accept their son’s homosexuality and HIV status.

I know a bit about those early years of the AIDS epidemic because I lived in New York City in the 1980s. When a test for HIV became available, some of my closest friends tested positive and I saw what happened to them when they lost their jobs, their homes, and their faith, before ultimately losing their lives. And then in 2000, I began going to South Africa to a township where one in five of all adults is believed to be HIV-positive, and I met more people affected by the same disease but people who had no access to life-saving medications, people with no homes, no food, and sometimes with no hope.

Through my work at Open Arms of Minnesota to provide food and nutrition to people living with HIV/AIDS, and through my travels and work in the townships of South Africa, I began to see that HIV/AIDS was much more than just a public health crisis. Indeed, AIDS has been allowed to spread from those first few individuals infected with the disease decades ago to tens of millions of people around the world today because of systems of injustice.

HIV/AIDS has as much to do with homophobia, racism, gender inequality, and economic inequality as it does a public health issue. Compare this country’s silence on HIV/AIDS in the 1980s when it was primarily gay men being infected, to this country’s immediate and widespread response to Legionnaire’s Disease which affected a couple of hundred American Legion delegates – most believed to be heterosexual –  in 1976 in Philadelphia. And, if you don’t think racism plays a role in HIV/AIDS, do you really believe that our lack of response to AIDS in places like sub-Saharan Africa would have been the same had AIDS impacted white Europeans at the same rate? Do you think it’s mere coincidence that now that the majority of people with HIV/AIDS in the world are women and overwhelmingly they are living in poverty, that we simply throw our arms up in the air and say there is nothing we can do?

Just as homophobia, racism, gender and economic inequalities are interconnected with HIV/AIDS, so too must the solutions be more than prevention and care and treatment. We need a comprehensive approach to HIV/AIDS that also addresses: educational opportunities for all, economic independence, access to decent health care, inheritance rights for women, land use, food security, AIDS-sensitive agriculture, the reduction of sexual violence, and same sex marriage.

If you care about any of these issues, you must care about HIV/AIDS because at this point in our history, all of these issues are interconnected – but the solutions don’t necessarily need to be.

I used to say that HIV/AIDS affects people without a voice, but I learned long ago that this isn’t true. It’s not that gay people, people of color, women, and poor people don’t have a voice – it’s just that people with power and privilege choose not to hear those voices. It’s past time that these voices be listened to.

Minnesotans Conduct Site Visit to Ethiopia

(Reprinted from Insight News, July 28-August 3, 2008)

Ato Shallo Dhaba, Director of the Regional Health Bureau of Oromiya, Ethiopia, visited the Twin Cities in January of 2008 on the invitation of the Minnesota Department of Health (MDH) and the National Alliance of State and Territorial AIDS Directors (NASTAD). MDH, with the support of NASTAD, formed a twinning relationship with the Oromiya Health Bureau in 2007. As a result of that partnership, Ato Shallo came to Minnesota to meet with community leaders and representatives of non-governmental organizations involved in addressing HIV/AIDS. One of the local organizations that Ato Shallo visited last winter was Open Arms of Minnesota.

Open Arms relies on volunteers to prepare and deliver nutritious meals to people living with HIV/AIDS, and other diseases, throughout the greater Twin Cities area. Ato Shallo, impressed by what he saw at Open Arms, invited Kevin Winge, executive director of Open Arms, and a small delegation of American nutrition and volunteer professionals, to visit Oromiya and assess whether similar programs could be developed in Ethiopia. Accompanying Mr. Winge was Mary Reed, Deputy Executive Director, Global Programs, for the Association of Nutrition Services Agencies (ANSA), a Washington, D.C.-based organization that provides services to non-profits concerned with food and nutrition for chronically ill people; and Jane Letourneau, a longtime volunteer with Open Arms’ domestic programs in Minnesota and international efforts in South Africa.

In July, NASTAD coordinated a series of meetings and site visits in Oromiya for the delegation to meet with government officials, representatives of international relief organizations, academicians, and iddirs – the community leaders who initially came together as a burial society, but now are involved in a much more integrated way throughout Ethiopian society. The delegation visited Addis Ababa, along with towns on the “high risk corridor” to Djibouti, including Adama and Debre Zeit.

In Debre Zeit, the American representatives, along with Ethiopian and American employees of NASTAD, spent half of a day with 14 iddirs from surrounding communities. The iddirs learned of the services that Open Arms provides in the Twin Cities, and shared their experiences and challenges with HIV/AIDS in Ethiopia.

Although many people living with HIV/AIDS (PLWHA) in Ethiopia have access to life-sustaining anti-retroviral treatment (ART), most lack the food and nutrition essential to get the optimal advantages of the medications. Ato Shallo stressed the potency of these drugs by saying, “If you take the ARTs without food, it’s like poison.” Every iddir in attendance at the meeting concurred that the lack of food is a debilitating factor in properly responding to the needs of PLWHAs in Ethiopia.

In a departing interview with Ato Shallo, the American delegation discussed possible opportunities to address the need for food and nutrition for people with HIV/AIDS. The group was impressed with an urban garden program in Adama that yields fresh vegetables for its 77 beneficiaries to both consume, and to sell as an income generating activity. The Dawn of Hope, a rehabilitation center for PLWHAs, supervised by Ato Mesfin Feyissa, could benefit from more comprehensive food and nutrition support. All agreed that iddirs could prove an effective framework for future endeavors. Any initiatives between these potential partners – the Oromiya Health Bureau, Minnesota Department of Health, NASTAD, ANSA, and Open Arms of Minnesota – could only strengthen the relationship between Minnesota and Ethiopia.

Body Mass Index

I’ve been thinking a lot about body mass index (BMI) lately. Body mass index is the weight to height ratio that is an indicator of whether one’s weight falls within a healthy range. (Google “body mass index” and you will discover any number of conversion devices to calculate your BMI.)

My BMI falls within the “normal” range – but just barely. I’m getting perilously close to a BMI of 25 which would put me in the “overweight” category and increase my risk of co-morbidities. The Centers for Disease Control defines co-morbidities as “conditions that exist at the same time as the primary condition in the same patient” (e.g. hypertension could be a co-morbidity of diabetes). Although BMI is just one indicator of health, mine is high enough to give me pause before eating a cheeseburger and fries.

I was curious about my BMI because of all the discussions I had in Ethiopia about the body mass indexes of people living with HIV/AIDS there. While my BMI may affect how I eat, a person’s BMI in Ethiopia may determine if they eat.

You see, George Bush’s HIV/AIDS initiative, The United States President’s Emergency Plan for AIDS Relief (PEPFAR), outlines three priorities for food support for people with HIV/AIDS: 1) Orphans and vulnerable children; 2) HIV-positive pregnant and lactating women in programs to prevent the transmission of the disease to their children; and 3) Adult patients in anti-retroviral therapy (ART) who have evidence of severe malnutrition as defined by the World Health Organization (WHO) as having a BMI less than 16. PEPFAR actually provides food support for individuals with a slightly higher BMI of 18.5 or under.

While in Ethiopia I met with representatives from a PEPFAR-funded program that distributes food to people living with HIV/AIDS through the World Food Programme. Those who qualify for the food receive wheat, oil, beans, and micronutrient rich flour called, Famix. This got me wondering, if I were Ethiopian and had HIV/AIDS, how little would I have to weigh to qualify for these food supplements through PEPFAR?

The answer: To meet the qualifying BMI of 18.5, I would have to lose nearly 45 pounds and weigh no more than 129 pounds – about what I weighed when I graduated from high school in 1977 – to have a chance of receiving these staples. A BMI of 18.5 is considered mild malnutrition with a moderate risk of co-morbidities.

Now, to meet the WHO’s standard of a BMI of 16, I would need to drop over 60 pounds and weigh approximately 112 pounds. This would classify me as moderately malnourished with a high risk of co-morbidities.

So, let’s say I have HIV, I live in Debre Zeit, Ethiopia (a town on the “high risk corridor”), I’m receiving HIV meds, and I qualify for supplements from the World Food Programme because my weight is below 129 pounds. With medication and access to food, I start to gain weight. Once my weight reaches 130 pounds for two consecutive months, I “graduate” from the program because, according to PEPFAR “Supplementary feeding support should cease once the patient’s BMI stabilize above 18.5 (e.g., two consecutive months greater than 18.5).” (http://www.pepfar.gov/pepfar/guidance/98836.htm)

You read that right, once my BMI is slightly above the “mild malnutrition” classification, I no longer qualify for food supplements. Unless my weight drops when I’m no longer receiving food and my BMI again dips to 18.5 or less – as frequently happens after people with HIV/AIDS “graduate” from the program. Then I can go back on the program and receive food again.

Now in PEPFAR’s defense, qualifications and restrictions do have to be set somewhere, and a BMI of 18.5 is significantly higher than 16. And, in countries like Ethiopia where many people are hungry and malnourished – not just those with HIV/AIDS – diligence must be observed to not create programs that actually offer incentives for being HIV-positive. However, merely encouraging “...the program to leverage other resources and linkages with longer-term food-security activities” will not make it happen. Here’s what I suggest.

PEPFAR retains the current BMI classification of 18.5 for people with HIV/AIDS to receive food support. For those adults who fall in the “normal” BMI range of 18.5 – 24.99, PEPFAR allocates significant funding to pilot local, sustainable, food and nutrition programs including gardens and poultry raising projects. Presumably, if someone’s BMI has improved to the “normal” range, their health would allow them to maintain vegetable gardens and animal husbandry projects. The harvest would provide food for themselves and their families with the excess being sold at market as an income-generating component to the plan.

Should someone’s BMI actually go above 25 and move from a “normal” classification to an “overweight” classification, then “graduating” from the program seems appropriate, since now the increased weight could possibly be contributing to ill health. As someone with a BMI hovering very close to that classification, what a great incentive for staying as healthy as possible.

Queasy

My morning routine changes considerably when I travel and wake up in a hotel in a city like Addis Ababa. The one thing that is constant is that my day always starts with a cup of coffee. Most hotels now have electric pots to boil water for instant coffee, like the one available in my room at the Hilton in Addis, but I have also been known to travel with my own coffee and a French press. A hot cup of coffee, first thing in the morning, is the only creature comfort I really need to get my day started (though a hot shower is always a plus!).

I had some work to do in preparation for today’s round of meetings and site visits in Addis. While waiting for water to boil, I brushed my teeth and – looking at my weekly reminder pill box – I snapped the “Friday” compartment open and took my daily aspirin and multi-vitamin. I then mixed hot water into the instant coffee the hotel provides, and sat down at my computer to begin strategizing my day.

About 20 minutes later, I started feeling a little queasy. The queasiness changed to nausea. A fleeting thought of a terrible case of food poisoning I contracted in Rwanda flashed through my memory, before I correctly self-diagnosed my malady. I was feeling the affects of taking a single aspirin and a vitamin on an empty stomach, exacerbated by drinking coffee. Although I knew the symptoms would pass, especially if I stopped drinking coffee, I dressed and went downstairs to the hotel restaurant where I grabbed two bread rolls from the breakfast buffet, and quickly devoured them. Almost immediately, the nausea disappeared and I ordered a cup of coffee from the server and resumed my activities.

Part of what I had been strategizing upstairs in my room was an upcoming appointment with Ato Shallo, the Director of the Regional Health Bureau of Oromia, the largest – both in geographic size and population – of the nine regions in Ethiopia. I first met Ato Shallo on an extremely cold January morning when he visited our operation in Minneapolis, Open Arms of Minnesota. Ato Shallo had come to Minnesota as part of a twinning program established between the Minnesota Department of Health and the Oromia Regional Health Bureau. The partnership was facilitated through the efforts of the National Alliance of State & Territorial AIDS Directors (NASTAD). I gave Ato Shallo, and representatives from the Health Department and NASTAD, a quick tour of our building and programming before sitting down to discuss the critical role of food and nutrition for people living with HIV/AIDS, and how services can be dramatically expanded and enhanced with the assistance of volunteers. Ato Shallo turned to his partners at the Health Department and NASTAD and said, “Why aren’t we working with Open Arms.” That initial conversation turned into an invitation from Ato Shallo to spend a week in Ethiopia conducting an assessment on possible models for nutrition intervention for people with HIV/AIDS and increased mobilization of volunteerism.

Six months later it was now my turn to visit Ato Shallo in his office in Addis Ababa. I finished collecting my thoughts, and also finished my large breakfast, before leaving the hotel for our appointment with Ato Shallo to discuss our findings.

Ato Shallo began the conversation by talking about the number of Ethiopians with HIV/AIDS who have access to potentially life-saving Anti-Retroviral Treatment (ART). In a country with massive food shortages and malnutrition, few of these people with HIV/AIDS have that same kind of access to food and nutrition that they have to medications. Given the potency of ART, Ato Shallo said, “If you take ARTs without food, it is like poison.”

Ato Shallo’s comment transported me back to my hotel room earlier in the day. I had merely taken an aspirin and a vitamin on an empty stomach, then compounded the severity of my body’s reaction to those pills by drinking a cup of coffee, to gain a slight insight into what it must be like for tens of thousands of Ethiopians who swallow AIDS medications on empty stomachs every day. I also had the advantage of being able to pay hotel-inflated prices for a couple of pieces of bread that would absorb the aspirin and vitamin, resolve my discomfort, and allow me to go about my business.

Ato Shallo identified the challenges. People with HIV/AIDS need anti-retroviral medications to survive. For those drugs to be effective, they must have access to food – and ideally nutritious food. Maybe solutions to these challenges would be forthcoming if all of us with power and privilege experienced what many Ethiopians experience: the debilitating side affects of taking medications without food. Now, our doctors would never recommend that we do that. So, if it isn’t acceptable for us, why is it acceptable for poor Ethiopians?

The High Risk Corridor to Dijbouti

Follow any ground transportation route on the African continent, such as roads driven by long distance truckers who are transporting goods great distances, and you will notice elevated rates of HIV infection along those routes. Truckers are away from their families for extended periods of time, have money, and the opportunity to engage in sex with commercial sex workers who come to these areas knowing there will be a constant demand for their services. In the absence of AIDS education, training, access to condoms, and the ability for commercial sex workers to negotiate safer sex practices – HIV infection skyrockets.

The road from Addis Ababa to the Republic of Dijbouti is an economic lifeline for the landlocked nation of Ethiopia. Following the 1998 war between Ethiopia and Eritrea, the country of Dijbouti became the primary seaport for Ethiopia. Today, the stretch of road between Addis and the Red Sea in Dijbouti is congested with semi-trucks, mini van taxis, buses, and cars. A single lane road, drivers are always on watch for an opportunity to pass slower vehicles, though the high rate of traffic makes for very few passing opportunities that are safe. Traffic accidents are a concern as evidenced by the number of damaged trucks by the side of the road.

Congestion is not limited to the paved road. Along the shoulder, donkeys roam freely, sometimes into traffic which causes immediate slowdowns. Ethiopians walk with their goats or sheep, some carry firewood, some sell watermelons or rugs or insulated containers that keep water cold for those in transit to Dijbouti. Farmland in the Great Rift Valley is tilled with primitive wooden devices pulled by oxen. Although drought is a primary factor for malnutrition and starvation in Ethiopia, the lack of modern farming equipment greatly reduces the yield that can be obtained from small parcels of land.

The city of Adama, 100 kilometers southeast of Addis Ababa, was our final destination on what has become known as the “high risk corridor”. It’s high risk, of course, because many of the factors that can cause a perfect storm for the spread of HIV exist here: poverty, high rates of unemployment, lack of education, and truckers who can pay commercial sex workers.

The high risk corridor has been a priority for HIV/AIDS education and outreach for years. International relief organizations, many of them funded by President Bush’s PEPFAR (President’s Emergency Plan for AIDS Relief) initiative, created programs to reduce HIV transmission, provide Anti-Retroviral Treatment (ART), and improve adherence to medications. Save the Children is here, as is the World Food Program, the Clinton Foundation, and numerous other non-governmental organizations (NGO) both large and small. One doesn’t need to understand Amharic to appreciate that the billboards with a red ribbon are HIV/AIDS messages and reminders. When we check into the Safari Lodge for an overnight stay in Adama I find two condoms in a woven basket by the side of the bed. Although most Ethiopians I have talked with about HIV/AIDS primarily discuss abstinence and being faithful, the existence of coffee flavored condoms and bedside condoms at the Safari Lodge, give me confidence that the complete A-B-C model of HIV/AIDS education and prevention, (Abstain – Be Faithful – Use Condoms), is being practiced here.

But despite the efforts of NGOs, the HIV/AIDS messages, the availability of condoms to prevent infection, and medication to help control the disease, an extraordinary amount of work still needs to happen just along this one high risk corridor. And there are many corridors just like this one on the African continent, and around the world.

Coffee, HIV/AIDS, and Hunger

The popularity of coffee becomes even more obvious in Ethiopia when meeting with representatives from social service organizations who work on issues like hunger, malnutrition, and HIV/AIDS. At every meeting a slip of paper is presented for guests to designate their preference for a macchiato, coffee, tea, or water. Within minutes of indicating your order, a staffer presents a tray with the selected refreshments. Having already consumed enough macchiatos for one day, I politely passed on another espresso shot while meeting with Ato Gonfa, HIV/AIDS Prevention and Control Desk Head, at a sub city level in Addis Ababa. I did not pass, however, on his offer to give me a box of coffee flavored condoms.

The box of three “international quality latex condoms” are marketed under the name of Coffee Sensation and sell for three Birr a box – that’s the equivalent of 30 cents for three condoms. The box is illustrated with condoms and coffee beans and is a big seller in this highly caffeinated country. Although Ethiopia doesn’t have the high rates of HIV infection that are associated with nations like South Africa, the fact that coffee flavored condoms are manufactured in the first place indicates the seriousness of HIV/AIDS here.

Ethiopia has a population of 80 million people, the overwhelming majority of who live in rural areas. Unemployment rates are high – over 50% - and the literacy rate is only about 40%. The overall rate of HIV infection in the nation is 2.1% of adults. Addis Ababa, a sprawling urban center of five million people, has a significantly higher rate of HIV/AIDS. The disease has created a population of approximately 900,000 orphans. Although Anti-Retroviral Treatment (ART) is available for people living with the disease here, there are still thousands of people who could benefit from the medicine who do not currently receive it. Food insecurity is a major factor in the lives of many Ethiopians who suffer from hunger and malnutrition. This is especially true for people with HIV/AIDS who may have access to treatment for their illness, but are taking these powerful drugs on empty stomachs, thereby reducing the effectiveness of the medications and creating other health issues that could easily be avoided with food and proper nutrition.

The global food crisis has resulted in unprecedented increases in food costs in Ethiopia. The food crisis, combined with a drought that has diminished crop production throughout much of Ethiopia, has resulted in increasing rates of malnutrition. UNICEF estimates that there are 75,000 severely malnourished children in Ethiopia and predicts that anywhere from one-quarter to one-half of them will die without intervention. In the future, a coffee flavored condom might prevent HIV infection in these children. That is, if they don’t die of malnutrition or starvation before they reach an age of sexual maturity.

Ethiopia 101

Ethiopia is a landlocked nation in northeastern Africa. Unlike the rest of the continent, Ethiopia avoided colonialization, though the brief Italian occupation (from 1936-41) is still evident by the pastas and pastries served in most restaurants. Apparently, Ethiopians didn’t want to be ruled by Italians, but they recognized good food when they tasted it. The Italians were kicked out, but their cuisine remained.

Ethiopia, of course, is also a coffee drinking nation. Macchiato, which translates to espresso marked with milk, is the coffee of choice here. Drinking multiple macchiatos throughout the day is temporarily warding off jetlag for me.

Pasta may be prevalent, but while in Ethiopia I intend to eat as much local food as possible – which means eating injera at every meal. Injera is the staple bread of Ethiopia. Made of Teff cereal, injera is pulled apart and used to scoop up whatever other food you are eating. Fillet tibs, diced beef sautéed in onions and tomatoes, is a popular dish. Shiro, chickpea gravy with onions and Ethiopian spiced butter, is delicious and easily sopped up with injera.

A popular bar and restaurant, the Old Milk House, is a short walk from the Hilton Hotel where we are staying. An order of shiro, along with beyeainetu – a fasting platter of various Ethiopian foods, was really enough food for three or four people. Bedele and St. George’s, two local beers, were the perfect complement to the meals. At the end of the evening, two main courses and four beers came to 82 Birr – less than $8.50. As tasty as the food is at the Old Milk House, the highlight had to be a visit to the restroom where an attendant not only presents guests with a napkin to dry your hands, but she sells packs of banana flavored chewing gum for three Birr. Who needs dessert when you can buy banana gum in the restrooms!

Waking Up in Addis Ababa

I really am a farm kid from rural Minnesota. I rarely think about that when I’m in the United States, but when I wake up, as I did this morning, in a part of the world that until yesterday was only a name on a map, I don’t think as much about where I am as I do about how far I have come.

Where does a longing for adventure come from? Why does the travel bug bite some of us and not others?

As a young boy I remember sitting in the Lutheran church, built in the middle of a cornfield – a central location for all of the neighboring farmers – listening to missionaries talk about exotic places like Madagascar. And I wanted to go there. I didn’t want to convert anyone, even at that age, but I wanted to see a place that sounded so totally different from my world. If the Weekly Reader had a story about Alaska, that would be the next destination of my dreams. Fess Parker playing Daniel Boone on a television show sparked a desire to see Kentucky. John Denver signing Rocky Mountain High had me packing for Colorado.

Although my family didn’t travel often, aside from an occasional week at Sunset Bay Resort in Minnesota’s lake country, or a road trip to the Black Hills of South Dakota, I always suspected there was a travel gene somewhere in my DNA make-up. I mean, my ancestors had left Norway in the 1870s for the U.S. Granted, they were motivated to establish better lives for themselves, but I believe that these distant family members from Scandinavia also woke up in the New World and thought – not so much about where they were – but how far they had come.

There is a possibility that waking up, as I did this morning in Addis Ababa, Ethiopia, isn’t really as far from where I came from as one might think. Yes, it was a long trans-Atlantic flight to Amsterdam, followed by another long flight to Khartoum in Sudan, before finally arriving in the capital of Ethiopia 24 hours after leaving the airport in Minneapolis. But long before my family left Norway, about 60,000 years ago, my family probably lived here, in Ethiopia; eventually making a journey from Africa, through Turkey, and the countries of Europe, before settling in what is now Norway, and then embarking for the Americas. At least that is what the National Geographic Genographic Project, based on my DNA, believes is the history of my very extended family.

My family believes that we are 100% Norwegian Americans. My mother’s family immigrated from Jevnaker and my father’s family from Trondheim. This belief hasn’t stopped a recurring discussion within my family that we also may be part American Indian. When I heard about the Genographic Project, I hoped that by submitting a swap of saliva to a lab that we might finally discover whether or not there was more diversity in my family than we previously thought.

Just like waking up for the first time in a part of the world that is totally new triggers more thoughts for me about the past than it does the present; the Genographic Project told me less about where our family is today, than where it came from. Currently, the project only tracks my family to the shores of Norway. What may have happened to my DNA in the New World has yet to be charted by National Geographic. But what my DNA did indicate is that thousands of years ago, where I woke up this morning in Ethiopia is where most of our ancestors woke up every day of their lives. And although I haven’t lived on a farm in rural Minnesota for 40 years, it is farming – more specifically hunger, nutrition, and disease – that brings me here to Addis Ababa.

Sometimes the past, the present, and the future are all the same thing. And perhaps Minnesota, Norway, and Ethiopia are not all that different from each other either.

 

To learn more about National Geographic’s Genographic Project visit www.nationalgeographic.com/genographic.