The Breadwinner Weighs In!

Nancy here for blog post #2.  David has been doing a great job writing about life in Gaborone for our family.  A few people have asked me about my work here.  I’m standing in as the Interim Deputy Country Director for I-TECH Botswana.  Jessica, the person I’ve replaced who has been out on maternity leave, had her baby just before I arrived and will be returning to work on November 12.  The bigger reason I’m here in Botswana, of course, is the HIV pandemic.

HIV is as serious as a problem can be for Botswana as a country and for individuals, families and communities within Botswana.  The most recent data from 2005-06 show that nearly one third (32.4%) of pregnant women aged 15-49 and nearly one fifth of the general population (17.1%) are infected with HIV.  This means that each day as we go about our lives, nearly everyone we interact with is somehow directly affected by the epidemic.  Botswana, along with several other countries in this region (South Africa, Lesotho, Swaziland, Namibia), faces the highest burden of HIV in the world.

Friends and family members often ask about the reasons that Botswana and other countries have been hit so hard.  This is a tricky question, because questions and answers about “why” can often couch judgements or assumptions that “those people must have done something to deserve their fate.”  I don’t believe in such assumptions.  There are simply different realities that different people face in their lives in different settings.  All this adds up to a complex set of answers to the “why” question.  Some of the reasons are:

• With Botswana’s relatively recent diamond-fueled economic growth, the population is highly mobile, with people splitting time between home villages/cattle posts and jobs in urban centers.  This is a condition that can support spread of HIV.

• Botswana has a high rate of “multiple concurrent partnerships.”  People here tend to have the same or fewer sexual partners over their lifetimes than people in most other countries.  Unlike the US, however, where we tend to have lifetime sexual partnerships marked by “serial monogamy” (think about all those couples you read about who are on third or fourth marriages), in Botswana people are more likely to keep more than one stable relationship going at a time.  The phenomenon is sometimes described here as “keeping a little house” (the “big house” is for the wife and the “little house” is for the girlfriend on the side).  HIV tends to spread far more easily in settings with more “multiple concurrent partnerships,” as compared to settings where HIV is more likely to stay “trapped” within a monogamous coupling until that relationship ends and another one begins.  Think about the image of HIV as a vehicle traveling along an interconnected set of roadways compared to a series of dead end roads.

• Botswana has a low rate of male circumcision.  Recent studies have shown that circumcision can reduce a man’s risk of acquiring HIV by about 60%.  The soft tissue of an intact foreskin is exactly the kind of tissue that HIV loves to penetrate.  Because many of the countries with the highest rates of HIV infection also have the lowest rates of male circumcision, these research findings have raised a lot of hopes about the potential impact of widespread circumcision campaigns in slowing the HIV pandemic.  Botswana is just starting on a major initiative for adult and infant circumcision, with a goal of 80% of males being circumcised by 2014.  I-TECH Botswana will be supporting the Ministry of Health on this new initiative through training teams to carry out circumcision procedures and associated counseling, and through evaluation of the initiative.

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In the face of this daunting epidemic, Botswana has mounted one of the most impressive national responses to HIV in the world.  The former President, Festus Mogae, notably and consistently championed the national HIV response (including assuring governmental funding at robust levels), spoke about de-stigmatizing HIV, and supported the move to make HIV testing a routine part of health care services.  His successor, President Khama, has continued in the same manner.  Botswana was the first African country to establish a public program for free access to antiretroviral therapy (ART).  Botswana has also shown some of the best results in the world with its program to prevent maternal to child transmission of HIV, providing nearly universal HIV testing for pregnant women and bringing infection rates in babies born to women with HIV down from nearly one-third to less than 5% across the country.  Yet great challenges remain.  Despite all the efforts, HIV incidence remains high, and most segments of the population have not significantly modified their behavior to prevent HIV (though there are reports of long wait lists for male circumcision procedures).

The diminutive I-TECH building in Downtown Gabs (think: the house in the book "The Little House")

Our organization, I-TECH, has been working hand-in-hand with the Ministry of Health and other partners since 2004 on various aspects of the HIV/AIDS response. Back in October, we organized a “breakfast meeting” to share information about I-TECH and our accomplishments with our professional colleagues from other organizations.  The Minister of Health attended—making it a very high-profile event—and signaled out I-TECH for our contributions.  I find daily pride in knowing that I’m part of these impressive efforts, and daily motivation in knowing that there’s so much still to be done.  Which brings me back to my day-to-day work.

The front desk (with portrait of President Ian Khama flanked Seattle and Gaborone clocks)

In Jessica’s absence as I-TECH Deputy Country Director, I’ve been assuring that all runs smoothly with the operations of the office.  I work closely with 3 wonderful women: Thulaganyo (“Thulie”), our Office Manager; Ditsapelo (“Ditsa”), our Human Resources Manager; and Nkatya, our Finance Manager.   Each brings special personal qualities and all are extremely dedicated and hard-working.  They supervise a few additional staff including a new finance assistant, a driver, and several housekeeping staff.  I also participate in weekly “Directors’ meetings” with Baz, our Country Director, and Batsi, our Director of Programs.  In those meetings we reflect together on strategic and management issues, providing input on decisions to be taken either by Baz or by leaders back at Headquarters.

Our budget as an organization this year is approximately $9 million, about half of which flows through our country office in support of our in-country staff and consultants, infrastructure, communications, field visits, etc.  We are still “young” as an organization, with the in-country office here only having been established 2 years ago.  There are now 33 staff total, with 6 more positions in active recruitment.  About half of the staff are technical specialists “seconded” to work within the Ministry of Health and University of Botswana.  Much of my work has focused on supporting this growth and on building systems, policies and procedures to help us function efficiently, professionally, and in compliance with laws and regulations of the Government of Botswana, University of Washington, and our US federal funders.

Taking the past week as typical, some of the things I have focused on are:

• Interviewing short-listed candidates for Coordinator of our new safe male circumcision initiative.  This was exhausting because four of six candidates were from African countries outside Botswana and we had to interview via phone over often-poor connections.
• Developing vendor agreements for procurement of goods and services—everything from photocopier maintenance to professional photography services for our newsletters—based on competitive bids.  It can be tough to chase down bids in Botswana.
• Working with Ditsa on finalizing an employee guide for staff seconded to University of Botswana.  It has to bridge UB and I-TECH employee policies and takes a lot of detailed consideration of terms and phrasing of sentences.
• Coordinating renovations to a new office space where we will be able to house 8 additional staff people.  This is an outbuilding on the plot beside our main office.
• Developing and/or formalizing policies and procedures related to fiscal functions, hiring of consultants, use of vehicles, and use of IT.
• Analyzing our budgets and providing forecasting to our funders about where we expect our expenditures will lie at the end of our fiscal year on March 31, 2010.  We always need to be sure we are in step with Ministry of Health as we implement our programs.  This means waiting until formal approvals for our strategies and protocols are in place before we can act (and spend).

I have enjoyed working out of the Botswana office and getting to know the team here better.  I have great respect for my colleagues, and this makes the work fun and enriching.  At the same time, it will be nice to get back to my job at Headquarters in December.  Here, most of my work is focused on administration and operations, as you can see from the list above.  While I feel I can handle this type of work quite competently, it’s not really where my passion lies.  While the 3 months here has felt very fleeting in terms of our personal lives—we’re facing packing up just as we settle into a groove—it feels just about right in terms of the length of my work assignment.

My typical daily schedule during the week is to rise by 5, work quietly at home until 6, help get the kids ready to leave for school by 7, and walk to work as David bikes with the boys to school.  I really enjoy my walk to and from work, about 30 minutes each way.  Like my bike ride to the office back in Seattle, it’s my time to get some exercise, directly experience nature and the elements, and reflect on the day ahead or behind.  Botswana has amazing birds, and even here in the city, I am often surprised during my walking commute to see lovely new species that I’ve never noticed before.  Then I arrive in the office by 7:30 or 7:45, work until 6 or so, and walk home as the sun is setting.  Finally, it’s time for dinner with the family, checking homework, maybe a game of cards or reading, then bedtime by 8:30 or so for the boys.  I’m often in bed not much afterwards!