1. ROSA’S WALK
Mozambique, January 2007
REGARDLESS OF WHERE I HAVE TRAVELED, to a major city in an industrialized country or a small remote village in a developing nation, I have found three things to be true.
First, where I see children, there will be some sort of ball. Sometimes the ball is made of rubber or plastic, often just rags held together by twine, but always I see a child tossing it or kicking it and at least one other child returning it in much the same fashion.
Second, my lap is not my personal property. If I plop down on the ground and sit patiently, a child will eventually find his or her way onto my lap.
Third, and most important, parents everywhere want the same things for their children. We want them to be healthy. To be safe. To feel loved. To have an education. To dream big dreams and have a fighting chance to realize those dreams. This is the same everywhere in the world, no matter how much people have to eat, how accessible education may be, or whether the community has running water, electricity, or basic health care. We each define success differently, but as parents, we all want the best for our children.
It was in Mozambique, at a birthing clinic, that I first met Rosa. The site was accessible only by a rutted dirt road, so far from stoplights or street signs or any other markers that I marveled the driver of our jeep had even found it. The clinic was a primitive structure composed of two rooms, a birthing room and a maternity ward. It did have walls, windows, electricity, and running water—four things I had rarely seen as we had driven through the countryside. Still, no air-conditioning or ceiling fan, only the relief that comes from being inside and thus shaded from direct sunlight. It was hot, stifling, hard to breathe.
Entering the birthing room, I found little more than a table with stirrups and another, smaller table holding a few basic medical instruments. In the ward, ten narrow metal beds were arranged side by side, covered with billowy mosquito nets hanging from the ceiling. I found no place to sit, save a lone metal chair stowed in a corner—an indication that visitors were not expected.
There were no doctors. No registered nurses. No professionally trained and educated midwives. In this corner of the world, babies were delivered and mothers attended to either at home surrounded by family members or by health-care workers with the equivalent of a sixth-grade education.
Rosa lay resting on her bed, draped with a colorful sheet. She had given birth an hour earlier; her beautiful baby girl lay beside her. Observing them, I remembered the summer heat I had felt years earlier when pregnant with my youngest son, James. The humid New York City air had seemed to envelop me as I tried to get through my day, step by difficult step. And yet, here was Rosa with eight other women, none of whom seemed bothered by the heat at all.
On Rosa’s face I detected the combination of exhaustion and exhilaration that those of us who have delivered children know so well. A large-boned woman, very dark-skinned, short hair in braids, she had delivered her daughter naturally, lacking access to pain medications or any type of anesthesia.
I wanted so badly to hear what the women in this ward were thinking and feeling, and since Rosa’s was the only bed without its bed net tightly drawn, I came close to her and nodded hello. I wasn’t sure how to begin a conversation. What do you say to a woman unknown to you who has just gone through the intensely personal, not to mention emotional and physical, ordeal of giving birth?
I came up with something innocuous yet friendly. Smiling down at her, I asked, “Is this your first child?”
She answered so matter-of-factly—in such a neutral tone—that at first I was not sure I had fully understood or that the interpreter had gotten it right. “The first one that lived.”
And so my education began.
* * *
I had never experienced a place like Mozambique before, nor had the realities of developing countries ever really entered my awareness. Raised during the 1960s in the northern part of Westchester County, New York, I enjoyed a typical middle-class, suburban upbringing. My dad was a podiatrist, my mom a homemaker and real estate broker. We lived in a relatively large home on a beautiful block, attended local schools, and worried about very little.
The closest I got to “roughing it” was spending part of each summer at a Jewish sleepaway camp in the Pocono Mountains. During my twenties, I dated a boy who was an avid camper and whose ideal weekend included spur-of-the-moment treks in the woods. He would cheerily put up the tent and then grab a bath in a cold lake; I indulged my anxieties by spraying bug repellent everywhere (I have long had an extreme fear of mosquitoes and spiders). His only concession to me: campsites with latrines. Much to the amusement of his friends and their girlfriends, I was more of a princess than I had ever realized. Not exactly a desirable character trait for someone who would end up working in remote areas of developing nations.
A year before meeting Rosa, I doubt I would have even been able to find Mozambique on a map. I had just turned fifty and spent the better part of eighteen years working for the Anti-Defamation League. Wanting more opportunity, I applied for a position as chief operating officer that had opened up at the U.S. Fund for UNICEF (United Nations Children’s Fund). The U.S. Fund’s president and CEO, Chip Lyons, was looking for someone who could run the organization’s day-to-day operations while he focused on global issues. As I listened to him expand upon his vision and recount his vast overseas experience, I began to picture myself working there. My mind was filled with images of myself in remote locations, experiencing the things Chip was describing—opportunities I had only dreamed of. I had a minimal understanding of what poverty really was or what it meant to live in a developing nation, but the pictures were enticing enough, and I was honored to accept Chip’s offer to join his team.
Three weeks into my new job, just as I was getting my bearings at the U.S. Fund, Chip called me into his office, shut the door, and told me we needed to talk. Wondering what I had done wrong, I almost missed what he was saying. He had been offered and had accepted a phenomenal opportunity with the Bill & Melinda Gates Foundation—a dream come true for someone trying to improve the world for children. He would be leaving the U.S. Fund in a few short months. I was stunned, unsure what this meant for my own future. As I caught my breath, I realized he was encouraging me to apply for the top job that he occupied.
I looked at him like he was crazy. “I don’t know. I have never even visited the countries UNICEF serves. I have no firsthand knowledge of the work on the ground. I am not sure I understand the issues, much less the solutions. How could the board even consider me?” What I didn’t say was that I also wondered if I had the temperament for Chip’s job. Chip excelled at diplomacy, adopting a subtle, almost European style in his handling of people. I was more typically American—direct, loud, and proud. At the very least, I would need some coaching.
Chip insisted I could learn what I needed to take on his role, and he offered to mentor me. In the weeks before his departure, we met daily. He gave me stacks of files, books, reports, and other documents to read. And videos—hours and hours of tapes. I’d read and watch, and then we’d talk. The plan was to top off all this work with a trip to the field to see firsthand all I had been learning about. Chip and I and two USF board members would go to Mozambique—a large East African country where Chip had previously lived. He would arrange an itinerary that would expose me directly to the effects of severe poverty on mothers and children, as well as to the role UNICEF plays in meeting those challenges.
I surprised myself by feeling nervous. I had traveled for work in my previous jobs, yet I had never visited Africa or experienced the conditions of a developing country. What shots would I need? What would I eat in Mozambique? Would the travel vaccinations sicken me? What about the bugs? Mostly, though, I worried about how I would do professionally. Would I be emotionally strong enough to maintain my professionalism in the face of all that I would see and experience? How would I react to the sights, the smells, the diseases? Would I be able to witness human suffering with my own eyes, process it, and find the words to talk about it afterward?
* * *
We had landed in Maputo, Mozambique’s capital, a few days before I met Rosa. In a briefing at UNICEF’s offices, I learned some basic facts about the country. Like other developing countries, Mozambique’s population is young, with children under the age of eighteen accounting for half of the country’s 20 million people. Mozambique ranks among the world’s twenty poorest countries, near the bottom in development. The country relies on international aid for half its national budget, making it Africa’s single biggest recipient of international aid. Almost half the country’s children live in extreme poverty, lacking access to adequate sanitation, clean water, schooling, and other basics of life.
I heard these facts but was not sure I fully grasped their meaning. Leila Pakkala, the UNICEF country representative in Mozambique, summarized them in a way that made a strong impression: “Mozambique’s children are like any other group of young people. They have hopes and aspirations. But it is like their whole childhood is being robbed because of poverty.” Leila also gave us a bit of history. As poor as Mozambique currently is, things had been improving. Sixteen years of devastating civil war had ended in 1992, and despite the horrific effects of periodic droughts and extreme floods, Mozambique’s economy had grown at a strong 9 percent annual pace, pulling almost 20 percent of the population up from poverty.1
As Leila’s colleague, the chief of education for our Mozambique team, pointed out, important improvements in the country’s education system had led to significant increases in enrollment and attendance rates, with 81 percent of children ages six to twelve years now going to school. I was especially happy to hear this. The power of education is a basic tenet of my professional life, best summarized in a quote that goes roughly like this: “If we solve all the problems of the world but fail to solve the problems of education, our children will destroy what we bequeath them. But, if we solve only the problems of education, our children will solve the problems of the world.” I think it was Thomas Jefferson who first uttered this idea, but I’m not sure. Whatever the case, I believe in that statement. Education is the only tool in our arsenal that can truly interrupt the cycle of poverty.
As positive as some of these developments had been, a terrible new challenge had emerged: HIV/AIDS. As the health officers on our Mozambique team told me, almost 2 million people—10 percent of Mozambique’s population—had AIDS or were HIV-positive as of 2007, the majority of them women. I was saddened to hear that a quarter of the country’s orphans had lost their parents to AIDS. How would Mozambique ever be able to emerge out of poverty if it couldn’t overcome the human toll and economic burden that HIV/AIDS was exacting? I had lost friends to AIDS, watching once-vibrant lives dwindle.
As the briefing concluded, I tried to imagine being a young child watching my parents succumb to HIV/AIDS—even worse, having them experience it without common pain medications, antibiotics, or government social services. I also tried to picture what life in New York City would be like if one in every ten people contracted the disease. That was almost unfathomable.
The Plight of Mozambique’s Children, 2007
Over half of Mozambique’s population lived in poverty.
Over 10 percent of children died in infancy.
Fully 41 percent of children were stunted by poor nutrition.
380,000 children had both parents die from AIDS.
Almost 40 percent of women ages fifteen to nineteen were married.
Only 28 percent of women could read, as opposed to 67 percent of men.
Almost half of all children had no access to a toilet near their home.
Almost a quarter of children ages seven to eighteen had never been to school.
Source: UNICEF, Mozambique country office; press release, Rachel Bonham Carter, “Report Finds Nearly Half of All Children in Mozambique Living in Extreme Poverty,” December 14, 2006.
We flew to Beira, Mozambique’s second largest city and the epicenter of its HIV/AIDS epidemic, to visit several UNICEF projects on the ground. At the Manga-Mascarenhas Health Center, we saw one of the few permanent medical facilities in the country dedicated to meeting the needs of malnourished children. Children brought to the center were screened, and severely malnourished children were able to take home with them a supply of Plumpy’Nut, a peanut butter–like food packed with calories and essential nutrients. Meanwhile, counselors helped mothers understand how to make a nutrient-filled porridge for their children to eat. The Manga-Mascarenhas facility had just opened, and more were in the works for other cities in Mozambique. UNICEF hoped that the center would cut down the number of children who were dying of malnutrition and also provide a place for children to be tested for HIV.2 I found it really encouraging to see such a concrete example of progress on the ground, even if it was disconcerting to see firsthand evidence of human suffering and poverty.
Next I got a chance to witness what UNICEF and other NGOs were doing to fight cholera and diarrhea, water-borne diseases that hit young children. UNICEF had been helping the government of Mozambique build essential water and sanitation infrastructures—the kind of thing that we take for granted in places like the United States because in our lifetimes we’ve always had it. We saw workers clearing out drainage canals so that floods that hit the area would recede more quickly, thereby posing less of a health threat. Other workers were building waterworks to bring clean water to schools. Our colleagues told us about still other efforts to build more sanitary latrines in household areas, as well as projects aimed at teaching the population about hand washing and other hygienic practices.3
All of this came as a real revelation to me. I had never considered that the water pouring forth from my sink tap was a luxury beyond the grasp of millions of people. Nor had I ever stopped to think what a difference something as simple as hand washing can make in lowering the number of children who take ill, or for that matter, who die. When I was a child, my mother constantly told me, “Wash your hands before you eat anything,” so I had assumed this to be common practice everywhere. How incredible to think that for vast stretches of humanity, it wasn’t.
We spent the next few days observing mobile health units, maternity clinics, and medical facilities serving rural areas. Leaving Beira, we drove north on EN 1, the main road—paved but heavily riddled with potholes—that hugs Mozambique’s coast and runs through its middle. It was a rough ride, bouncing us up and down, leaving our backs aching and rear ends sore. Gazing out the window, I marveled at the massive, ancient baobab trees, whose thick trunks are hollow inside. The terrain was flat and seemed to stretch forever. Periodically, we passed people working in rice paddies and villages consisting of a few mud huts with thatched bamboo roofs. It was approaching 100 degrees Fahrenheit and extremely humid. I was grateful for the air-conditioning of the jeeps, even though you could feel the heat of the sun through the windows. I was also grateful to Dr. Roberto de Bernardi, a pediatrician on our Mozambique team, who as we drove told me stories about his life and conditions in Mozambique, including how few doctors the country had.
We entered isolated villages, and I saw with my own eyes just how meager the country’s medical resources were. The first health clinic we visited was a one-room building with electricity but little else. Staff wrote out medical records by hand on pieces of paper. Many of the most basic medications, things like Tylenol or antibiotics, weren’t available. Sometimes a doctor saw patients here, but usually health-care workers with limited education did that work, with patients waiting in very long lines for the privilege. The place stank of dirty diapers, vomit, and body odor, and we could hear children crying all around us.
Even a clinic like this was a luxury here; a great deal of medical care in Mozambique takes place in the absence of a fixed medical facility. At several points during our trip, we pulled up to a clearing in the bush to find a hundred or more people sitting on the ground or strolling around, quietly waiting for the health-care worker—in this case Roberto, in other cases a trained nurse—to arrive to see their children. These children and their families could receive only the basics, such as vitamin supplements, vaccinations, or deworming. For anything more serious, they would need to travel some distance to a clinic. Often the children were malnourished as a result of severe diarrhea, malaria, or respiratory infections.
Roberto showed me how the children were checked for malnutrition. First, they were weighed on a scale he had hung from a tree. The scale looked somewhat like the scales used to weigh fruit in a grocery store, except instead of a pan on which you’d place whatever it was you sought to weigh, there was a small pair of shorts. One by one, babies were placed in the shorts, dangling (often giggling, occasionally crying) as Roberto noted their weight. Next, the circumference of their arms was measured using a disposable, paper measuring tape. As I stood watching, Roberto did his best to charm the children and make them laugh, while someone took Polaroid pictures of the kids and gave them to their grateful mothers. A single, cherished Polaroid, the first and only picture of their child, compared to the brag book of photos I carried in my purse everywhere I went.
I found myself feeling a mix of emotions. I marveled at the sheer simplicity of what I was watching as well as at the deep respect shown to Roberto by the local residents. Still, I found it disturbing to compare health care here to what I enjoyed at home. I became frustrated when one of my kids fell ill and our family pediatrician couldn’t see us immediately, yet these women would have to wait another month until Roberto or another health-care worker came to their corner of Mozambique. I went through bottles of baby Tylenol when my kids got a fever, gave them special ice pops to restore their electrolytes after a bout of diarrhea, and kept the kitchen drawer full of multicolored bandages, ready for placement on even the tiniest of boo-boos. What would these women think if they could see all of that? And how would I react if I didn’t have these items available to me?
* * *
If life in Mozambique threw me off-balance, it also energized me. I can’t convey the sheer joy that washed over me as we were welcomed into local villages. Each time we pulled up in our jeeps, residents of all ages poured out of their huts and surrounded us, singing and dancing, the women wearing long, colorful dresses, the men and children often wearing T-shirts printed with American slogans. I was particularly amused at how many children wore the names of U.S. professional sports heroes emblazoned on their chests, with no idea who these athletes were. The singing was warm and sincere, and although I couldn’t understand the words, the melodious voices and wide smiles will stay with me always.
The first time I was welcomed into a village, I was so taken with the beauty of the voices and the generosity of spirit our hosts displayed that tears ran down my face. These celebrations were truly an amazing gift being given to us. The villagers might not have had anything to offer us in material terms, but in another, even more important sense they had everything to give, and I felt blessed to receive it. I laughed out loud—right through the tears—when Roberto asked me if I could ever imagine the residents of my neighborhood in suburban Bayside, Queens, offering such a welcome to a group of different-looking people, unexpectedly pulling into town and taking pictures of all they were seeing. Unthinkable!
The great appreciation local residents had for UNICEF also affected me. One night, our group was invited to experience an HIV/AIDS outreach program funded by UNICEF. After bouncing around in our jeeps off-road in the pitch-black dark, we arrived at a large clearing in the bush. Once our eyes adjusted, we discovered hundreds of happy teenagers and young children spread out in front of us. Many had walked miles to sit on the ground here to watch a movie; few, if any, were wearing shoes of any kind. Between the heat and the darkness, I felt disoriented and nervous. All these people nearby—you could hear them moving and whispering, but you could barely see them through the darkness.
Without warning, a projector hooked up to a generator was turned on and a movie was projected onto a white bedsheet hung between two poles. I had to squint, so bright was the light of the projector. A few minutes later, I glanced around and noticed a tent standing off to the side of the crowd, the opening not visible from where we were sitting. As the crowd was watching the movie, laughing and enjoying themselves, teens were quietly slipping off on their own to visit the tent. Curiosity got the best of me, and I walked over to see what was inside.
I found three adults, trained counselors, providing information about HIV/AIDS: where to get tested, the symptoms, how people could protect themselves. The counselors spoke freely with the young people, seeking them out, answering questions, and providing advice. I learned from my UNICEF colleagues that many of the kids in this area were living with the disease or assisting a loved one suffering from AIDS. The darkness of the night, the anonymity of the site, and the lack of required registration enabled these teens to get information they vitally needed without fear of social stigma.
In Mozambique, people with HIV/AIDS were considered outcasts. Many men refused to get tested or allow their wives to be tested, fearing what might happen if their wives were found to have the virus. As a few of the teens told me through an interpreter, many of their friends deemed testing unnecessary. Since there were scant treatment options available to them, why bother risking the stigma or living with the shame if you were found to be positive? Yet, inside the tent, I was pleased to see that some teens were being tested. Unfortunately, as my colleague later pointed out, some would never return to get the results.
I went back to watch the movie, noting how orderly the crowd was. Would hundreds of American kids gathered in any field or park at night sit so quietly? My colleagues and I sat in special lawn chairs set up for us as guests of honor, and the kids came over to say hello. Their genuine warmth touched me; I saw none of the detachment or skepticism common among American teens, none of the need to be “cool” around adults.
When the first reel of the movie had finished, there was an intermission to set up the next one. A group of teens stood up and came to the front, prompting applause from the crowd. I watched them as they began to perform a skit of some kind. As the skit was in Portuguese, I turned to Roberto, who tried to translate and explain what I was watching. I could barely hear what he was saying over the roar of the crowd. Evidently they were enacting a story having to do with HIV/AIDS education outreach. The crowd was completely engaged, yelling answers to questions posed by the actors, cheering them on at certain points, and even hissing at something one of them said. I tried to follow along based upon the actions, noticing that one of the kids in the skit kept saying “UNICEF.”
I asked Roberto about the UNICEF references once the skit had finished. He told me that the dialogue had gone as follows:
“If you think you might be sick, where do you go?”
“If you think your mother might be sick, where do you go?”
“What saved your mother’s life?”
“What made your own life possible?”
I broke into tears, thinking how lucky I was, how privileged, to make even a small contribution to UNICEF’s work of saving the lives of children.
* * *
After leaving the movie that night, I was agape at another constant feature of African life: bugs. We stayed at a guesthouse outside of Beira, and upon exiting a tiny restaurant nearby, we encountered hundreds, if not thousands, of huge, long-winged insects attracted to a lone streetlight, flying directly in the path we needed to follow. While everyone else in our group commented on the bugs and batted them away, I seemed to be the only one who was absolutely terrified. Not wishing to come off as ridiculous, I inhaled deeply, held my breath, and continued on my way, pretending nothing was wrong.
Later that night, I couldn’t sleep. I lay in my bed in my sparsely furnished room, trying to decide if I should cover myself with the blanket so as to keep the legions of smaller bugs still buzzing by my ear off my body or leave the blanket off so I could stay cool. Before I could fix on a strategy, the power went out. The darkness was so complete that it felt suffocating, causing me to panic. I had my laptop with me, and as I still had some battery power left, I calmed myself by putting on a DVD to watch. Halfway through the program, I heard a noise coming from the window.
What was it—an animal? A snake? A huge insect? My heart stopped and I waited. Chip’s room was down the hall, but the others from our group were sleeping in another building. Surprising myself with my boldness, I went over to the window and very slowly lifted the shade to find dozens of eyes staring back at me. I jumped in fright. Once I caught my breath, I realized that these people were local villagers who had been walking back to their huts when they had seen the faint purple glow from my computer peeking out from my room. They had come, wondering what it could be. They pointed at my computer, and I held it up for them to see. We all got a hearty laugh.
* * *
My visit with Rosa came two days into our meanderings in the country. “The first baby that lived,” she had said. When I got over the shock of that softly spoken answer, I pulled the single metal chair in the room closer to her bed and sat down to talk. A member of the UNICEF Mozambique team joined us to interpret, while the rest of our group moved outside to talk with other women at the clinic.
“What’s your baby’s name?” I asked.
She gazed down at her newborn and caressed her cheek. “She has not yet been named.” My Mozambique colleague explained that babies in this part of Africa do not get their names at birth, but rather several days later.
“How did you come to be in this clinic? Do you live nearby?”
She didn’t understand my query, so I tried some other lines of questioning to get at her birth story. I learned that she lived in a one-room mud hut located in a village four hours away by foot. When she went into labor, she had been working in a rice paddy, picking rice and placing it in the basket she carried. “Water up to here,” she said, gesturing at her knees.
“So what did you do when labor began?”
“I put down my basket and began my walk here.”
I couldn’t believe it. “You walked in the hot sun for four hours while you were in labor?” It was over 106 degrees outside, making it difficult for me just to sit there.
She nodded as if there was nothing unusual about that.
“Was someone with you?”
She shook her head. “No.”
“Did you bring anything with you to the clinic—clothes, baby things?”
Again she shook her head. I could see she found my questions odd.
For a second time in five minutes, I found myself at a loss. Looking at Rosa and her new baby, I couldn’t help but register the huge disparity between Rosa’s situation and my own first experience giving birth to our son Lee, at one of Long Island’s finest hospitals. I had prepped for that day for weeks. Lamaze classes. Every baby book I could get my hands on. Then a huge surprise baby shower, making sure I had every single thing I could imagine I’d need for our new arrival. My mother had bought me an overnight bag to take to the hospital. I had packed it over a month before my due date, filling it with a bottle of champagne, a list of phone numbers of friends and family (this was long before cell phones), a book I thought I’d actually have time to read, and a pretty nightgown I naively thought I would get to wear for the experience. The idea that something could go wrong never crossed my mind.
After more than twenty-four hours of labor, my doctors ordered a cesarean section, and with my husband Donald in the operating room holding my hand, they delivered a beautiful healthy boy. I cried. Donald cried. We popped the bottle and celebrated. Family and friends soon arrived, and we welcomed our new son in my flower-filled room.
And here was Rosa, who had walked for four hours, alone, in the heat. She didn’t have a nursery, much less a cradle or bassinette. She didn’t have doctors.
How could this be? It was difficult to get my mind around the disparities between our experiences. Why did I get to deliver my child in a modern, fully equipped hospital while Rosa lay alone in a small room that served as a ward, her only luxuries the screens in the window and the bed net over her head?
I had screamed for and received an epidural as soon as the pain of labor became unbearable. Rosa lacked even the most basic pain medication. I had been upset that my insurance only allowed me a sonogram every three months while pregnant; she probably didn’t even realize sonograms existed. If Rosa had had any kind of birthing complication, both she and her child likely would have died; no one at the clinic was equipped or trained to provide anything more than basic assistance. Nor was there an ambulance outside to take her to a hospital for help, or a hospital anywhere near enough.
I stared at Rosa and tried to imagine what this day had been like for her. I had had no idea that birthing was like this for most women in developing nations. How could I have been so blind?
I felt a desperate urge to call my kids, to hear their voices and feel reassured they were okay. If I had been living in Mozambique, I might well have died giving birth to Lee. And if I had been fortunate enough to survive the complications that had led to my cesarean, Lee almost certainly would not have. I found myself offering up a silent prayer of thanks as I watched Rosa hold her new baby.
* * *
As Rosa recounted still more details about her life, I didn’t detect anger or suffering in her eyes so much as a deep soulfulness, an understanding of the tenuousness of life, an acceptance of its hardships. “My first baby was dead at birth, my second I lost early on.” She gazed down at her sleeping baby, and joy shone on her face. “But yesterday was yesterday. Today is today. And today I have a daughter.”
Once again, tears filled my eyes. “You do, and it’s wonderful.” I was deeply touched by her willingness to speak with me, and by the connection I felt with her, despite all that divided us. We were talking mother to mother. We both knew what it was like to hold a baby in our arms, to thank G-d that it was alive and healthy, and that it was ours.
But if I thought this was all to Rosa’s story—if I thought I could even begin to conceive of what she had been through and would continue to go through—I was wrong. I reached out and touched her baby’s tiny foot through the sheet. “She’s beautiful.”
The baby stirred but just as suddenly settled back down. “She is, but let’s hope she is also strong.”
“What do you mean?”
She adjusted the fabric that swaddled her sleeping child, lovingly stroking her chubby cheeks. “I have the AIDS virus. Since I found out I was pregnant, I came here to get the drugs to stay healthy.” She nodded at her baby. “And to keep this one healthy.”
Everything I had learned about UNICEF’s efforts to combat HIV/AIDS had been so abstract. The AIDS outreach skit the evening before had made an impression, but it was only in talking to Rosa that I fully understood the difference aid organizations were making. This woman sitting across from me had a healthy baby because there was a UNICEF. Despite the hardships she faced, Rosa had been able to go to a clinic and get the anti-retroviral drugs she needed because of the generosity of donors in my country and elsewhere, and because people like my team at the U.S. Fund were working to raise awareness of the need. While I had been motivated before to work for my new organization, hearing this part of Rosa’s story confirmed that by doing what I was doing in New York, I could really make a difference.
“How long will you stay here at the clinic?” I asked.
“Just tonight. I can’t stay away from my husband. We do not stay away from our husbands.”
I nodded in understanding. “And you will walk home?”
She nodded. “Of course.”
“When will your baby see a doctor?”
She looked at me strangely. “The next day.”
Now it was I who didn’t understand.
She mouthed a slurry of words, which the interpreter translated. “I will come back every day. I need to, for the anti-retroviral drugs.”
“And you will carry your baby?”
“I will carry my baby.”
“Why can’t you just take the drugs with you?”
She shook her head. “I don’t know how to read. I can’t understand the instructions. So I do what I can.”
I was beside myself. This woman would need to walk four hours each way under the hot sun for several weeks to obtain the drugs that would prevent her from transmitting the virus to her baby through her breast milk. Yet Rosa didn’t think her walk was a hardship; it was normal to her, something women in her village had to do for the health of their children. This pointed to a deeper, underlying commonality between Rosa and me, and in fact, most women everywhere. When we become mothers, we are so overcome by the joy of parenthood that everything else fades into the background. Obstacles and hardships that might have stymied us before no longer seem so significant. We do what we have to do.
It was time to go—our group was waiting. I posed for a picture with Rosa, kissed her and her baby, and walked outside, where I would continue to speak to health-care workers about HIV/AIDS and where I would continue to learn.
* * *
Three days later, we returned to Maputo for a break and a day of meetings before heading back to the United States. It had been an extremely emotional first encounter with a developing country, and my mind was reeling. Yet one more unforgettable moment lay in store.
During our initial briefing, our staff had mentioned that Mozambique was a predominantly Christian country with a sizable Muslim minority. I had raised my hand and asked if any Jews resided there. The staff member giving the presentation responded, “Yes, we have Jews here.” Somehow the way she said it sounded comical to me, as if Jews were prized possessions, not people. I asked if there were synagogues in Maputo and learned that indeed there was one. I wanted to see it.
I grew up in a Jewish home, celebrating the arrival of the Sabbath every Friday night by lighting candles with my family. I can still picture my mother standing in our dining room, apron tied at her waist, eyes closed, singing the Hebrew words, orange sunset shining through the glass doors that led from our dining room out onto our back patio. Standing almost five feet, nine inches tall, with beautiful blond hair tied perfectly in a French knot, sky blue eyes, and an easy smile, my mom invited us all to acknowledge this holy day of rest. Then my dad chanted, both over the wine in a silver wine cup that had belonged to my grandfather and over freshly baked challah. My brother and I knew he did this more for my mom than out of his own deep religious conviction, yet each week we ignored that fact and said “Amen” when he finished, digging into the dinner my mom put before us.
Memories such as this have left me with an immediate connection to other Jews, regardless of how different we might otherwise be. Perhaps this is why I find myself always seeking out the local congregation when I am far from home. On this day, the UNICEF Mozambique team had arranged for me to visit the Maputo synagogue. I was driven to what at one time must have been a beautiful white colonial building, framed by two large columns and featuring a large Star of David above the entrance. Walking inside, I found the place in disrepair. The wood pews and white walls seemed solid enough, but boxes and other objects were strewn about, and it didn’t seem like much prayer was taking place.
A man greeted me and informed me that they did hold services in the building. Maputo had once had a thriving Jewish community of Europeans who had fled the Nazis. During Mozambique’s civil war, almost all the Jews left, most going to South Africa. The building was requisitioned for use as a munitions storage facility. When the war ended, the authorities returned it to the remaining members of the Jewish community. They had worked on making repairs, yet much remained to be done, as evidenced by the gaping holes I now noticed in the walls.
I asked questions about the Jewish community. Did Jews all live in the same area? Did anyone maintain a kosher home? Were regular weekly Sabbath prayer services held? How large was the community?
The answer to this last question took me by surprise. I had expected to hear that Jews represented only a small percentage of the city’s population, but was shocked to learn that they numbered exactly seven souls.
“What’s it like, having such a small community?” I asked. Jewish tradition holds that a community needs ten adult men (although in reform congregations, women can now fulfill these roles as well) to hold a prayer service, and Maputo didn’t even have that many.
“You think that’s bad,” my new friend said, grinning. “Some of us don’t talk to the rest of us, so instead of one service, we have two!”
I couldn’t help but laugh. Such divisions were so typical, not just of Judaism but of other religions as well. I had often heard a joke told in the Jewish community where I grew up: “If you ask four Jews, you’ll get five opinions.” Here in Maputo, that had certainly been proven true.
Despite the sadness I felt at the dwindling of this once-proud community, I also felt a sense of comfort just being in this building. All along on this trip, I had been pushed headlong into unfamiliarity. The sheer level of poverty and Rosa’s story of hardship had been hard to process. At this synagogue, I felt strangely and unexpectedly at home, as I might have felt in any other city in the world upon finding a synagogue. I hadn’t considered that in a country as distant in every respect from my own there would be Jews. But what do you know, here there were seven.
* * *
Back in New York, I returned to my normal life. Yet things had changed for me. Thanks especially to my visit with Rosa, I had fallen headfirst into a love affair with both Africa and UNICEF. I didn’t just want to stay with the U.S. Fund and become CEO; now I had to become CEO. I knew I needed to continue to stretch myself, to take that extra step and face my fears, whatever they were, so as to earn the right to take the helm of this organization. For the rest of the winter of 2007, I focused on winning the CEO job. I knew I needed to investigate other professional opportunities in case I did not get it, but I couldn’t bring myself to do it. I didn’t want other opportunities. I wanted this one.
By April, the competition for CEO was down to myself and three other people. As a final part of the interview process, the search committee asked us each to do a presentation explaining what UNICEF did. Recognizing that some on the board were concerned about my lack of experience, I took this opportunity to tell them about what I had seen in Mozambique and the people I had met. “Here’s what the reports say about Mozambique,” I told them, “but here’s the reality that I encountered with my own two eyes. I met a woman named Rosa”—and the story flowed out of me.
Several weeks later, I heard that I had gotten the job. I knew then—and I still know—that this never would have happened had I not visited Mozambique. Rosa in particular was my inspiration. If she could give birth with so little and fight so hard to ensure that her child is free from AIDS, then there had to be more I could do to help. I wanted to travel to other new places that would challenge me and shift my perspective. I suddenly saw my age of fifty as an ideal time to start fresh and approach the world again with childlike curiosity.
As of this writing, some five years after my visit, the situation in Mozambique remains dire. The economy has continued to grow at a steady pace, but 54 percent of the country’s people still live in poverty, and fewer than half of all households have access to clean drinking water. Unacceptably high numbers of mothers and children still die of preventable causes, although the country has passed legislation designed to protect all children and created a national council to protect especially vulnerable children. HIV/AIDS remains among the highest causes of child deaths as well as of children’s increased vulnerability to poverty and deprivation (since their parents and other caregivers are getting sick). The country’s first national survey on HIV/AIDS, performed in 2009, found that over 10 percent of men and women are still HIV-positive. The country continues to count almost 2 million orphans, a quarter of whom lost their parents to AIDS.4
The responses and assistance continue. A host of aid organizations work hard to get residents of Mozambique the care they need, relying on new and different innovations as they become available. In places where the population lacks ready access to HIV testing, nutritional counseling, information about prevention, or other basic health services, community leaders with basic health-care training come together to serve as a warning system for emerging problems and ensure that their communities are aware of preventative measures such as immunization. Community theater groups continue to serve as health educators, performing skits like the one I saw, informing and engaging those whose lack of literacy or media access has cut them off from potentially life-saving information.
UNICEF and other groups have also been designating and training individuals as community health workers, giving them kits with basic medicines to treat rampant sicknesses like diarrhea, malaria, and pneumonia. HIV activists—often people who themselves are suffering from AIDS—provide social support, coaching people on how to take ARV medicines and following up to make sure they do take them. These initiatives are a far cry from the high-tech solutions available in countries like the United States, but in the absence of more trained doctors and nurses and more sophisticated interventions, they’re saving lives.5
I never saw Rosa again, never heard what happened to her and her daughter. Yet I remain grateful for the privilege of meeting her. I see life differently, appreciating that many things I had previously taken for granted are not necessities, but luxuries. Equally important, she helped me to understand that regardless of our economic differences, I could no longer see myself as fundamentally different from people living half a world away, under very different circumstances. The material divide may be huge, but we are all human beings with the same goals and desires. We all love our children and want the best for them. This is the same whether we walk four hours to give birth, or drive, as I did, for less than ten minutes. It might sound trite, but it’s absolutely true and often forgotten: what joins us as human beings is at least as important as what divides us.
Copyright © 2013 by Caryl M