21 days on the road

Sanibonani from Arusha, Tanzania!

Our internet access on this bus tour hasn't been good enough to really commit to blog posting. (I say this knowing that one of our fellow travelers has blogged consistently, even posting photos. Perhaps it's more about us than the internet connection.) But I've been taking good notes, so eventually you'll have more information.

We started at Victoria Falls, which was stunning, and traveled through Zambia. It was interesting to see the differences among the countries we visited. Lake Malawi was absolutely gorgeous, and the Great Rift Valley is unparalleled.

Tanzania has been fascinating. The Serengeti was great at times — we saw 45 lions, including about a dozen cubs — and not so great at other times. We've camped almost every night, which has presented challenges of its own.

Overall, I'm very glad to have done this trip. The whole bus tour part is interesting and merits more discussion later. But we're alive, well and headed for Kilimanjaro!

Salani kahle!

Signing off from Swaziland

Sanibonani.

So, this is it. We leave on the first khumbi for Johannesburg in the morning, and we'll say goodbye to Swaziland for now.

I can't explain how I feel. These weeks have been full of goodbyes and tears (mostly mine). They've been full of gifts and dancing and singing and eating meat. They've been full of packing and planning and printing and playing. I have a brand-new niece to meet when I get home, so these weeks have been full of excitement for that as well.

It's all just too much.

Two years ago, Jack and I embarked on what we knew would be an amazing adventure. He had no idea what his immediate future would hold (get his eloquent final thoughts here). I was more aware of what I was getting into, but Peace Corps Swaziland was still more abstract concept than concrete reality.

Now I'm walking away. I leave a kind and welcoming family behind, as well as a core group of amazing friends in my community. I leave a club of great girls who I know will become strong women. I leave a support group with at least the beginnings of a community garden. And I leave a piece of myself.

I take a piece of Swaziland with me.

I hope that when I'm stressed out about life or sad about a loss, I remember my host dad's favorite words: "Life is just like that."

I hope that when I'm feeling sorry for myself, I remember the astonishing women I've met who bear up under the challenges of difficult marriages, abuse, HIV and oppression. I smiled, screamed and danced alongside them. Together they were stronger than any one alone.

I hope that when I'm struggling to reintegrate into the fast pace of American life, I remember to walk slowly when it's hot and nap under a tree in the afternoon.

And I hope that when I'm frustrated with Americans and the way we talk about and treat this continent and its people, I have compassion and patience.

I'm so very, very glad I served here. I'm so happy and lucky (SO lucky) that Jack was willing to move half a world away to share this experience. I am thrilled to enter our future together.

Thank you to everyone for your support and kind words. I'll see you in America on Sept. 28.

Salani kahle (stay well).

Quick hit

Sanibonani, team. My ACA blog has started up over here: http://blythereadstheaca.blogspot.com/. I think we're looking at a potentially different audience.

I'll try to give you a real update here this week on my final days. It's been hectic. I did sign Sakhile up for the TOEFL exam, so I'm thinking we can move ahead there. Thanks so much to those of you who have already donated!

I'm saying my goodbyes this week, as well as introducing the next volunteer to my village. Whirl. Wind.

Salani kahle!

Reading the ACA, part 2

Another ACA post, brought to you while we borrow internet so my host sister can work on TOEFL prep. If this doesn't interest you, please ignore!

July 14, 2014

Day Two. I actually kind of enjoyed my efforts of Day One, so I’m feeling positive going into an amendment to the Public Health Service Act. Let’s get to it!

This is part of that section that prohibits insurers from refusing to provide coverage for pre-existing conditions. From my recollection, this was a huge deal. This part also talks about how insurance eligibility can’t be affected by:

-       health status

-       medical condition (physical and mental)

-       claims experience

-       receipt of health care

-       medical history

-       genetic information

-       evidence of insurability (including conditions arising out of acts of domestic violence)

-        disability

-       anything else the secretary says

These factors also apply to continued eligibility. So if I’m eligible one year and am diagnosed with a chronic condition, my insurer can’t boot me the next year.

I think the domestic violence notation is particularly interesting. I suppose this means that if someone experiences intimate partner violence and can’t access her or his home to get insurance information, she or he can’t be determined ineligible. Does that seem right?

Page 91 includes talk about wellness programs. They’re not allowed to be “a subterfuge for discriminating based on a health status factor” or “highly suspect” in their methods. I’m digging the sinister language. SUBTERFUGE.

Some kind of 10-state demonstration of wellness programs should have started by July 1 of this year. Or a demonstration of states applying the provisions to existing health-promotion programs? I’m not entirely clear on what’s being demonstrated on p. 93.

Bronze, silver, gold and platinum plans: These designations refer to how much the health care benefits are worth (compared with the actual cost of services). For bronze it’s 60 percent, for silver it’s 70, gold is 80 and platinum is 90. From what I can tell, catastrophic plans are allowed if you meet certain criteria (younger than 30 and poor, it appears).

Abortions: not paid for by federal funds, ever. It looks like insurance companies aren’t required to pay for them, but I need to verify with section 1303 and the “special rules.” I know the U.S. pays for them for military members in case of rape. I’m not sure what the rest of the rules are. But as always, in general, no abortion funding.

It looks like states can make their own abortion rules for community health insurance plans, as long as no federal funding goes to them.

Something funny is happening on page 124. This is an amendment about optional services, and it says the secretary, when estimating basic costs, can’t take into account “any cost reduction estimated to result from such services, including prenatal care, delivery or postnatal care.” What I’m getting is that the secretary isn’t allowed to look at the future benefits of having insurance coverage for these “extra” services. Right? My brain flagged this because it seems to suggest that even when there’s good scientific evidence about future benefits of investing in care now, the government can’t calculate them in looking at costs of service.

BUT this is referring to actuarial costs (remember how “actuary” is always the No. 1 job on those “best jobs” lists?), so maybe this is more about accounting rules than public health.

As everyone probably knows, these exchanges are called American Health Benefit Exchanges. Another program exists to help small businesses, the Small Business Health Options Program (SHOP, naturally).

Note: insurers aren’t allowed to market their plans in such a way that would discourage people with significant health needs from enrolling. Insurers are also supposed to include providers in their network who serve low-income, medically underserved people. Sounds like a good thing.

Also, the much-talked-about government portal for insurers is supposed to allow us to compare plans based on ratings by those enrolled.

Plans should have annual enrollment periods (with exceptions), as employer-provided insurance typically does. If you’re an American Indian, there are special monthly enrollment periods for you.

Exchanges have to be government agencies or nonprofits established by states. I’m trying to determine whether there are other examples of the latter bit. Is it common? What other nonprofits are established by states?

Dental insurers are allowed to offer their plans through the exchanges, as long as they provide pediatric dental benefits.

Several sections have discussed “child-only plans” for those younger than 21. I think insurers are required to provide these plans, but I’m not sure why. So parents have to get full insurance for their kids even if they themselves qualify for catastrophic? Must investigate.

State power: States can require their insurers to provide additional benefits, but they have to work to defray the cost to the consumer.

The health exchanges are supposed to be self-sustaining as of Jan. 1, 2015.

On p. 144, the measure states that health exchanges “shall not utilize any funds intended for the administrative and operational expenses of the Exchange for staff retreats, promotional giveaways, excessive executive compensation, or promotion of Federal or State legislative and regulatory modifications.”

That’s kind of specific, right? I totally feel like government agencies would justify using their proceeds on “staff retreats.” And I wonder what determines “excessive executive compensation”? I suppose you’d have to be called out on this to get caught. Also, the exchanges are supposed to report “monies lost to waste, fraud and abuse” on their Internet websites.

Health plans must justify premium increases before they’re implemented, and they have to “prominently post” the increases on their websites.

If you’re in jail or in the U.S. illegally, you’re excluded from all of this.

OK, that’s all for today! I wanted to hit 80 pages since I could feel my momentum waning. There was some interesting stuff today, though I wouldn’t call any of it surprising.

We’re ending on p. 161, at “Sec. 1313. Financial Integrity.” Are you as excited as I am? (Here’s a preview: exchanges are supposed to do accurate accounting. THE FUN NEVER STOPS.)

Reading the Affordable Care Act

OK, so here's a project I've started. It's not related to Peace Corps. Several weeks ago, I decided I wanted to read the Affordable Care Act. I'm writing as I go, reflecting on what I read and trying to understand it. I'll probably embarrass myself with my lack of understanding, but what the hell?

If anyone reads this, I might give it a blog of its own. 

Here goes nothing. This was Day One:

July 13, 2014

I’m going to read the Patient Protection and Affordable Care Act.

I’m not a doctor, a politician or a policy wonk. I have a master’s of science in public health, but I’m mostly a normal person (and journalist). I’m probably going to misunderstand a lot of it, but I’m going to do my best.

I remember hearing pundits talk about how so many politicians haven’t read the act. It is long. The version I downloaded, with amendments, is 2,409 pages. I imagine the proper way to read it is to read the actual act and then return to the top and read the amendments. I’m not going to do that. I’m just going to read it all the way through. That might muddle my understanding of the document, but I think I’ll manage to get the gist.

Or maybe it makes more sense to read the amendments first, rather than reading a version that was later updated. I haven’t even scrolled through to see whether amended sections are struck through.

Also, I’m in a hut in Swaziland in southern Africa, a month away from finishing a two-year stint as a volunteer. I have a lot of down time. I will use this time to read the Affordable Care Act and to write about it here. I am not speaking on behalf of anyone but myself. Also, I don’t have great Internet access in my hut, so chances are that I won’t always be able to look up things that confuse me. I’d appreciate it if you’d cut me a break if I muse over something I could have just Googled.

If I misinterpret wording or if you disagree with me, please feel free to call me out. This is just an exercise in which a normal American Person tries to read and understand an important document produced by the American Government.

Let’s get started!

---

I’m 11 pages in, and I’m still on the table of contents, with its titles and subtitles.

Stuff I’m interested in learning more about:

-       Public health initiatives such as data collection about health disparities

-       Community transformation grants

-       Medicaid coverage for freestanding birth center services

-       School-based health centers

-       Reasonable break time for nursing mothers

-       Scholarships for health professionals

-       Spending for Federally Qualified Health Centers (FQHCs)

-       Limitation of excessive remuneration paid by certain health insurance providers

-       Additional hospital insurance tax on high-income taxpayers

-       Excise tax on elective cosmetic medical procedures

-       Indian health care improvement

Stuff that gives me pause:

-       Termination of provider participation under Medicaid if terminated under Medicare or other state plan (If a state dumps Planned Parenthood, for example, the federal plan must also do so for Medicaid recipients?)

-       Inclusion of cost of employer-sponsored health coverage on W-2 (My health care costs are considered income, which could mean I’m taxed at a higher rate?)

-       Additional requirements for charitable hospitals (This is under revenue offset provisions. What does it mean?)

Part of the ACA requires summaries of benefits and coverage to be presented in a uniform format that’s four pages or less and printed in at least 12-point font. I assume they talked to insurers about whether this was feasible. I think it’s awesome. I sure as hell can’t remember ever reading more than four pages of a document about my insurance benefits. But I’ve been lucky (read: healthy or lazy) enough to not need to read the fine print.

UCR fees = usual, customary and reasonable fees

The ACA requires every hospital to publicly release the cost of standard charges for items and services. TRANSPARENCY FTW.

Every state has to have an ombudsman. Love me some ombudsmen. This is who I’ll contact if I’m looking to get some health care when we return to America.

There’s a lot of talk of Internet websites. To the Internet website! I require informations!

Insurers have to submit justifications for “unreasonable premium increases” to the state and feds BEFORE they increase the premium. They also have to post it online (see Internet websites for details). I’m sure the ACA elaborates on “unreasonable” somewhere – in Section 2794. This section is called Ensuring That Consumers Get Value for Their Dollars, which I am all about. It also suggests that insurers who (this is America, so they get to be “who”) have a pattern of increasing premiums “unreasonably” could get booted from the exchange.

Subtitle B is “Immediate Actions to Preserve and Expand Coverage.” I’m going to read it, but since it’s irrelevant – I believe this is all the stopgap measures that were put in place between passage of the act and 2014 – I probably won’t have much to say about it.

Basically, if you were in a high-risk pool, you should have transitioned to coverage from a health exchange by Jan. 1 of this year. Did that happen? I hope so.

By Aug. 1 of this year, the Treasury Secretary should have notified any insurers that have been assessed a penalty (p. 77). I’m sure this is public information. Just, y’know, FYI. I suppose I’m not sure whether the government would update its Internet website to reflect this in real time.

Session one: pp 1 to 80, started with “December 24, 2009” and stopped at amendments to Subtitle C – Quality Health Insurance Coverage for All Americans

Helping Sakhile

Sanibonani!

My host sister, Sakhile, has been selected for a program called Africa's Tomorrow. It helps African girls get through the hurdles involved with applying to and attending college in America. Right now she's preparing for the TOEFL, which she must pass in order to be accepted. It tests how well she comprehends English. If you want to help pay for it, go here and scroll down to Sakhile from Swaziland. Any help you can provide would be greatly appreciated.

She wants to study dentistry. I don't know the statistics, but I know dentists are few and far between in rural Swaziland.

If you can help her out, it would be huge.

Siyabonga kakhulu! (We thank you so much!)

Goodbye, good luck, give me a job

Sanibonani, all.

Sooo, here we are. I have less than a month left here, and it's becoming a whirlwind already. My host sister made it through step one (of a MANY-step program) to go to college in America. That'll mean the TOEFL for her and lots of preparation help from me. There's supposed to be another volunteer replacing me in my village, so I'm hoping that volunteer can help shepherd her the rest of the way. I'll be fundraising to help defray the cost of the exam soon. As of now, I'm paying for it.


I'm preparing to leave and getting ready to say goodbyes. We had one of our last girls empowerment club meetings last week. I had been waiting to talk about reproductive health until I felt that the girls were comfortable with me. This was the time.

We covered the whole female reproductive system, and they asked a few questions. But then I brought out my trump card: the question box. The girls bolted for the scrap paper and started writing the questions they were too embarrassed to ask aloud:

- Will my period hurt?
- How old will I be when I get it?
- What if I have my period, and my mother wants to see my vagina?
- What happens if I have sex while I'm still young?
- Can I get pregnant if I have sex while I'm menstruating?
- What do babies eat inside the womb?
- How does the baby get out of such a small opening?

We had more than 20 questions from our group of 24 girls. As we answered them, girls would run up and put more questions in the box. It was absolutely amazing. These girls are young, 11 to 14, so I didn't expect them to have much information about this yet. But I was thrilled that the other club leaders and I could help explain this confusing process that is adolescence. It was so gratifying.

The next week, my friend and I taught a great HIV and STI session at the high school, where the kids peppered us with questions:

- How long does HIV survive outside the body?
- If a woman is HIV-positive and has an HIV-negative baby, what is she supposed to feed it if there's HIV in her breast milk?
- How can an HIV-positive woman and an HIV-positive man make an HIV-negative baby?
- If one person has HIV, and the other partner doesn't, will they always get infected if they have unprotected sex?

Afterward, the teachers who were present said they'd also learned a lot. And my friend, who had been hesitant before, eagerly took my HIV materials and lesson plan so she could reuse them.

It's been a gratifying couple of weeks.

I've also gotten deep into the job hunt, which is nerve-racking and a little terrifying. But Jack and I know we'll make it through it. Who wants to hire us? Anyone?

Salani kahle, all!

Branding day

It's always a bit of an adventure when my host dad approaches me on a Sunday afternoon. It typically means we're about to talk Monday-morning cattle ops. This past Sunday, that was the case.

"We have to burn them tomorrow," he said.
"Oh, like brand them?"
"Yebo."

Babe showed me where the brands go. On the back left thigh is our dip tank number, 401. On the left shoulder is the oval with four evenly spaced lines poking out -- the Swazi shield. They use both so that if a cow is stolen and taken into South Africa (or Mozambique, I suppose), they know it's a Swazi cow. Then they know it came from our dip tank, and I think there are records that Babe would be able to use to claim a cow as his own.

Babe and my host brother rounded up the cows and counted out the number that needed branding. They brand each year, but this was the first year the farmers were handling it on their own. Government vets helped the previous two times. The count yielded 55 cows with hides that required the iron touch.

I asked Babe what time we'd need to leave in the morning.

"Four, unless there is no moon. If there is no moon, the cows can't see, and they won't go. Then we would wait."
I looked up at the overcast sky and decided to set my alarm for 4:15.

I heard Babe's pickup start after I hit snooze the second time. I dragged myself up and into my clothes. We loaded the firewood for branding, and Babe sent me out to wait for the cows to leave the kraal. He had his truck, and I, foolishly, decided not to bother with a headlamp.

It had been humid when I awoke, but the morning was growing colder as we stumbled through the bush. Babe kept behind us, headlights on the animals, as I tried to avoid stepping off into an unexpected creek bed.

"Be careful! You will break your legs!" he yelled out the window.

I strained my eyes to make sure no cows were wandering off, but it was as dark as I've seen it here. No town lights permeate this route, from the rural homestead to the even more rural cow-dipping channel.

I stumbled repeatedly, scraping my bare shins against the thorn bushes.

We arrived without my noticing. Babe told me to be careful of the rocks to my right, and I realized the cattle were pressed against the wooden fence near the dip area. Two fires were going nearby -- a big one for the branding and a small one to warm the children who had come to have their goats counted by the government vets.

We stood, waiting silently, while Babe went to go pick up a man to help us. It was clear that I wasn't up to whatever challenges branding might bring.

An hour passed. At about 6:30, the sky lurched into gray light. The chill remained.

We couldn't see anything happening inside the kraal where the men were branding. I could hear an urgent moo every now and again, but no chaos broke out. At about 8 a.m., it was our turn to shuffle in. The cows, sensing what was going on, took the opportunity to make a mad dash. Hundreds of cows were clumped behind us, and my brother Senzo had to bang his way through the crowds, picking out Babe's bunch.

The excitement started after we hustled the cows into the kraal. Branding required four to six men per cow (and one woman). The first man tried to loop a rope over either the thorns or the back legs. Once he caught one side and wrestled the cow down, he and others tied the head to the back legs, tied up the other legs and placed another rope around the cow's midsection. Someone had to hold each of these -- head, two sets of legs, belly. Once they had the cow in place, left side up, they yelled: "inombolo!" (number!) and then "lihawu!" (shield!). The men with the 6-foot branding irons would haul them over from the fire -- on the other side of the kraal fence, for safety -- and press the flesh. The cows would jerk and wail while clouds of smoke rose from their bodies. The smell, at first nauseating, reminded me of a hair salon.

After each brand was finished, a woman with a plastic dish would paint antiseptic goo on top. The cows would get up and go about their business, often unhappily.

At one point, a white cow with red spots and wicked-looking horns charged up after his branding, furious, kicking at people and butting at other cows. I was daydreaming in the kraal entryway at this point.

"HIT HIM! HIT HIM HARD!" Babe yelled at me from across the kraal.
"What?! Which one?" I flung my cow-whacking stick at every nearby animal.
Senzo bolted over and started in on the cow, driving him and the others away across the enclosure.
"Hit him hard next time," Babe said. "Don't try to be friends with him."

I hadn't witnessed the precursor to this moment, but Senzo later told me the cow wanted to kill me.
"If you had black skin like me, he would have killed you. But you are white. He thought you were an animal. He was confused."

The process took nearly three hours. I wasn't doing any of the hard work, of course, just making sure no cows entered or left the pen. Once Babe had burned his 55th cow, we were ready to drive them home. He stuck around to help the men who helped him. I, satisfied with my first (only?) cattle-branding experience, went off in search of warmer clothes and a liter of coffee.

AGOA and Swaziland

Swaziland is about to enter an interesting, and probably challenging, period. The United States has revoked its eligibility for African Growth and Opportunity Act benefits. What this means is that as of Jan. 1, Swaziland won't have duty-free access to the American market for its manufactured goods.

The U.S. government says Swaziland hasn't done enough to protect workers' rights, specifically freedom to assemble and organize.

There's been a lot of discussion in the Swazi papers about it. Some factory operators expect to lay off workers or to close entirely. It's been difficult to get a sense of the real financial impact. Jack and I haven't seen specific reporting on how much costs will increase or how expensive it would be for manufacturers to actually pay the duties involved in shipping goods to America. We're also not sure what percentage of goods manufactured here end up in American markets.

Regardless, people seem nervous about what this change will mean in Swaziland, where unemployment is already above 40 percent.

Meeting my pen pals!

This is an entry I wrote for Peace Corps' official blog. I'm not sure if it'll appear on the PC site, but here it is for your perusal.

---

I had woken up early that May morning: There was work to be done. My mom joined me in the kitchen as I mixed the dough and slipped small blobs into hissing oil. We were making Swazi treats, fat cakes, for a special crowd.

Since September I had been writing letters and sending photos to a first-grade class at North Glendale Elementary School, and it was time for all of us to pair names with faces. I was back in America for my sister’s wedding. North Glendale, the suburban St. Louis school where I’d spent my tender years, was in the neighborhood.

I was excited to meet Iyana, who had asked me if the scorpions of Swaziland came into my hut and ate my food. I couldn’t wait to hear more from Brock, who had informed me that, in contrast with my rural African homestead, they had running water in America. I wanted to meet the children whose letters had started off simple last fall, containing more pictures than words, and had grown to three-page missives by spring.

Alongside my fiancé, Jack, I entered the school in my traditional Swazi wear with a basket of fried dough. The office staff members directed me to Mrs. Coombs’ class with nary a raised eyebrow.

The conversation started immediately after I walked in the door, and the questions never stopped. What if my traditional clothing (tied at the shoulder) fell off? Why did the king have more than one wife? What if the king wanted to marry me? What kind of animals did I see? How long did it take to get to America from Swaziland? Could you go by car, or did you have to fly?

One student, Carlye, raised her hand.

“Do they have hospitals there?” she asked.

“Yes. There are some hospitals in the cities, and in the rural areas there are clinics. Some of them are bigger than others, with doctors. Some are small and only have nurses.”

“Oh.” She thought a moment. “Because having babies is dangerous, and you need good hospitals.”

Rendered nearly speechless, I could only agree. I studied maternal and child health at public health school. This was a child after my own heart.

We spent a fast-paced hour together. Jack and I shared more photos from Swaziland, passed around Swazi money and celebrated one of the children’s birthdays. They ate the fat cakes and each took a small Swazi coin to keep. And we took some photos of our own – two normal ones and a goofy one (you’ve got to have a goofy one). As we lined up for the photos, the children crowded around to hold my hands. I tried to grab as many little paws as I could. For a moment, I was back in my African village, laughing with children who were excited to make a new friend from a foreign place.

At the end of our visit, Mrs. Coombs told me the children had been looking forward to the day.

“Some parents were even telling me how excited the children were to come to school today,” she said.

As we left, I couldn’t stop smiling.

GLOW!

To my dear readers,

Sanibonani!

I apologize for my lengthy absence, though I take comfort in knowing you all just went about your lives as usual.

Since we last spoke, we had our Girls Leading Our World camp. GLOW brought together nearly 80 girls from across Swaziland, as well as about 20 Swazi counselors and a group of Peace Corps volunteers. The girls learned about sexual and reproductive health issues, and they talked about relationships and other topics related to adolescence and womanhood. They also learned how to apply for university and how to interview for a job.

And, of course, they played games. We had an art day and a service day. During the service day, they played team-building games and had races with condom water balloons. Photos of all are below.

My counterpart/friend joined me, and we brought three girls from our community. Camp ran from April 28 to May 3. At the beginning the girls were shy, avoiding looking at me or speaking to me directly. By the end, we were hugging and high-fiving. On the last day at breakfast, they had prepared a tiny statement thanking me for allowing them to come.

As part of the camp, the girls had to apply. They were required to get a recommendation letter as well as parental/guardian permission, and each had to write an essay and undergo an interview. I know those skills will serve them well as they apply to university and for scholarships.

When I left camp, I was on a huge high. I watched my friend teach an abstinence session that she and another counselor prepared on the fly. I watched quiet girls come out of their shells, and we all watched as a shy girl with a disability stood up in front of everyone and sang solo at the talent show. It made our tiny little hearts vibrate.

On the whole, it was probably the most worthwhile activity I've participated in during my service. Since my service ends in a couple of months, I doubt it'll be outdone.

If you contributed to GLOW, thank you! And if you contributed to me by being supportive, thank you!

Photo post

 So, first, I want to thank everyone who responded to my previous post. I have had some insightful exchanges and discussions about the issues that have been on my mind. These conversations have helped me put development work in perspective, and I very much appreciate it. I'm not necessarily closer to knowing what I want to do come this fall, but we're getting there. As they say in Swaziland, kancane kancane. Bit by bit.

These are photos from a hike Walker and I did yesterday in northern Hhohho region, near Jack's place. We came across a fire tower, and Babe Sibandze, the fire watchman, let us climb up inside and take a look. The hand-cranked alarm is in the photo below. You probably can't tell, but there's a Star of David in the center of the circle. That made us curious about where the alarm came from. Any thoughts?

Babe Sibandze, pictured below, has been keeping watch for fires for 40 years.

Below that are photos from my recent trip to Cape Town with Jor and her dad. We had an amazing time. We stayed at a place called Olaf's in Sea Point, just outside of downtown Cape Town. We were able to take public transport most places we wanted to go (70 cents for a ride > $15 for a daylong tourist bus pass).

We did a daylong winery tour, and we had sundowner cocktails with the rich and trendy set in Camps Bay. And I drew a heart on the beach. You gotta draw a beach heart when the opportunity presents itself!

I was able to run on the beach in the morning, and the sunrise shot from that is below as well. We also visited the gorgeous botanical gardens and Green Market Square, where tourists buy lovely things.

Cape Town is amazing. If you have the opportunity, please go. It is glorious.

The aid industrial complex and crises of conscience

When I was leaving for PC, most people were supportive. You kind of get treated like a hero, as if you're sacrificing a huge amount to go live as people in the developing world live. It is certainly a sacrifice. You miss big events -- weddings, the arrival of babies, birthdays, graduations -- and you have to take a bath in a basin. But it isn't heroic, and I go back and forth about whether we as a nation should be doing this at all.

My feelings on my time here have varied wildly of late. I go from deep cynicism about aid and development work to a feeling of personal joy when I spend time singing with and teaching girls in my community. The best way to describe it is ambivalence, a strong love and a strong hate for the aid structures that are in place.

A problem with aid work is that it is difficult to avoid being patronizing. In a sense, anyone who comes in from another country to teach or train people is suggesting that the people in the developing country need help from outside their borders. It suggests that they aren't adequately addressing their own problems, whether that's attributed to a lack of money or a lack of knowledge/training/skills. Then, when you come in as the outsider, it's assumed that you do have the money and the skills. Your presence alone suggests that you think -- or your sponsoring agency thinks -- you know best.

Many volunteers and development workers don't believe this. Many want to come in with humility and learn from and share information with local communities; they don't want to be paternalistic. I've been told that it's far better to think about Peace Corps service as sharing information rather than as "helping." I think about how I would feel if someone from another country came to America and started telling me that I ought to use a condom or eat more vegetables. I'd want to know just who the hell she thought she was, coming in and thinking she knew more than me about my life, culture and country. I'd want to know why she thought I needed her help. There are educated people everywhere. Legions of skilled, intelligent Swazis are already trying to provide public health information to their neighbors.

So, what am I doing?

Truth be told, I'm not sure. It feels a bit repugnant to be here, whatever my intentions were when I arrived. Have I affected the lives of some people in my community? Perhaps. I only hope I haven't done more damage than good. I hope I haven't reinforced that developed-developing country hierarchical dynamic. I hope I've been more than a sign of white privilege and wealth, an ignorant, arrogant outsider who flits in for two years and uses terms like "girls empowerment" and "permaculture" and then watches American movies on her MacBook all night.

On top of my personal moral quandaries are those related to the big picture of development. The vast majority of the work is being done in developing countries. The vast majority of the money comes from developed countries. This creates a power imbalance. Can a Swazi health official truly stand up to an American aid official if he or she disagrees with how U.S. money is being spent? When Western organizations seek community input, are they truly listening? Do they trust the feedback they get? Or is it more of an act of courtesy? Sure, tell us what you want, but we already know what we intend to do. It's also difficult because funding and grant writing often precede those community conversations. How much flexibility is there, really, when you've already made promises to funders back home?

By and large, I think organizations that seek community input do hope to use that input to inform their work. But regardless, most of the money is coming from outside the country and is being spent by outsiders. Reports go back to Washington; there are numerical targets and legislators to answer to. Is that the best way for us to work toward improved global health and development outcomes?

There's a big push now toward capacity building and sustainability. Organizations want to train people on the ground to do the development work they're doing and to perform the research that foreign academics are performing. That's laudable, I believe. The people who live in these countries, whose lives will be affected by the research, programs and policies in place, ought to be a major part of setting the research agenda and determining how development moves forward. But that presents difficulties of its own, which I won't explore here.

At the end of the day, I have more questions than answers. People often say that in public health, the goal is to work yourself out of a job. Are we that altruistic? I hope so. That's a question related more to human nature than development, however. This field is ballooning. The future of public health workers, to an extent, will depend on people NOT having what they need to be healthy. Seems like a tenuous system.

These are the thoughts floating around my head as I prepare to look for a job back home. Do I attempt to plug myself into this system? Do I believe in it enough? Are we doing it right, or do we need to blow it up and start afresh? I haven't even touched on colonialism and how its legacy ties in with what the West is doing in the developing world now. And then there's aid as foreign policy, which represents another strand of the web.

Many others before me have considered these issues at length and more coherently. I'm nothing if not unoriginal, friends. Perhaps what I need to do is read more about how others have found their way through this maze of concerns and out the other side. Insights, article and book suggestions welcome.

Weekend update

Sanibonani, bangani bami! (Hello, my friends!)

I'm killing time till Jor arrives in the place with probably the best Wifi in Swaziland. I could probably watch a YouTube video if I wanted! It's THAT good! I don't mind not having access to Internet, really. I've been living without a computer of my own since January, and it has not been apocalyptic. I feel like I'm going to be overwhelmed by the go go go of life back home when I get there. TOO MANY INSTAGRAMS. Do people still use that, even? The Internet will be unrecognizable to me.

I attended the cultural evening at Jack's school last night, and it was delightful, if a bit chaotic. I think my favorite part was listening to 20-something primary-schoolers singing "God Bless America." I was moved, not gonna lie. It made me even more excited to visit home in a month and a half.

As part of this cultural evening, I baked six apple pies. Yes, I made the crusts by hand. And then I had so much extra crust that I baked two chocolate-chip pies. I have officially surpassed my lifetime pie-making total in the past year. People seemed to mostly like them, though Swazis tend to find American desserts too sweet. What can I say? We love our sugar and butter.

The event also included Swazi cultural dances, which I always love, and a section of Afrikaner culture. The children wore the traditional clothes of the Afrikaner settlers. I was thinking "Little House on the Prairie." The kiddos did a great job.

I can't remember whether I've talked about our Future Plans. Jack and I were considering staying here another year. He had a lead on a job, and I was considering extending my Peace Corps service. I would have moved to town from my homestead, so I would have had more of the modern conveniences. We were pretty sold on it for a week or so. Then things fell apart a bit with his job offer. I wasn't thrilled with the direction my plans were heading. At the end of the day, the benefits of going home outweighed the benefits of staying.

So I'll finish up my service in August, and Jack and I are planning a packed post-PC trip. The one certainty is hiking Mount Kilimanjaro in Tanzania. Aside from that, we're looking at Victoria Falls, Lake Malawi, the Serengeti, Zanzibar and Morocco (some combination of these). We'll see how we go. I'm sure we can't go wrong, and if we miss something, it'll just mean we have to come back. Kute inkinga, as they say (no problem).

THEN it will be on to the wedding in November and trying to persuade someone to hire us, probably in Washington, D.C. If y'all know anybody who wants a journalist/social media pro in Jack or a journalist/public health type in me, drop us a line. I'll be ready to do ALL THE WORK.

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In work news, my counterpart and I have chosen the three girls who will go to our Girls Leading Our World (GLOW) camp next month. I'm excited to participate. It's a whole week, and I expect it to be exhausting and exhilarating. The girls will learn about health topics, community service, leadership and other fun stuff. There will be arts and crafts and games as well. I wasn't able to go last year because of health problems, so it'll all be new.

Have I told y'all that I've been writing letters with a first-grade class from my elementary school? Their letters are pretty amazing. I tend to reply by email and explain things like toilets, our lack of running water and which animals I've seen. I also told the kids recently that I've read more than 100 books since I've been here. It's kind of great what facts stick in their minds.

These are some of the questions I've gotten:

"What are the titles of the 100 books?"
"Was one of the books Go Dog Go?"
"What was your favorite of the 100 books?"
"Have you seen a dust devil?"
"Do you go to college?"
"What is your mom's name?"
"How do you play?"
"Do you like fashion and makeovers? I like fashion and makeovers."

And my favorite comment: "We have running water here."

Kids are pretty great.

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We have a new puppy on the homestead! She is covered in fleas and ticks because I haven't had a chance to wash her yet. Babe calls her Tsatsakhona (take and eat), the same as our other dog. I'm going to call her Wolverine in hopes that she'll be a survivor. I will try to avoid getting attached.

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Did I tell you guys that I'm getting my wedding dress made here by a Swazi designer? I am. It's pretty exciting stuff, AND he thinks he can arrange a fitting while Jor is here. That will be my first traditional girl move.

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OK, I think that's all the news that's fit to print for the moment. I hope to be able to post photos from Cape Town after our trip. If you were feeling sorry for me because I never have Internet or running water or whatever, don't. I get to go to CAPE TOWN, which is an incredibly sweet place.

Stay tuned.

Salani kahle!

Bread, transport, etc.

Sanibonani!

Here are some weather words for you:
Emafu = clouds
Liyana = rain
Lilanga = sun (this word also means day)
Futfumele = warm
Kuyabandza = It's cold
Kuyashisa = It's hot

And some from my current activities:
Ngibheka sinkhwa = I'm baking bread
Ngifuna kulala = I want to sleep
Ngiyagijima = I am running
Ngine umhlangano = I have a meeting

A PC friend taught me how to make challah and biscuits this past Monday. It was a gray, cool, rainy day, perfect for that activity. She lives less than an hour's drive from me, but transport in Swaziland meant that I had to travel an hour to Manzini, meet her in the bus rank at 8 a.m. and get on a bus to her spot. We sat on the bus/van for about 45 minutes until it was full. The bus carried us through the hilly bush, easing through places where water was running over low bridges.

We arrived at her place after an hour or so and went to work, making the dough and letting it rise. We chatted about challenges we were facing with our work and drank delicious coffee. About four hours later, I had a lovely loaf of challah to share with Jack and a handful of biscuits for me to munch on.

I could have spent the night at her place, but PC restricts how many nights we're supposed to spend out of our village per month. I knew I'd be out for other reasons, so I decided to try to get home. I waited for about half an hour on the road that would have taken me the short way toward my place. Nothing. No cars, no bikes, no motorcycles (not that I'd have taken one, strictly forbidden). After about half an hour, I spotted the same bus we'd come in on, this time heading back to Manzini.

"Is it better for me to take this to Manzini and go back to my place?" I asked a woman who was also waiting.
"Yes, it is much better."

I hopped on the rickety bus and headed back down that sketchy, hilly dirt road. There was less fog this time, and the ride was beautiful. It was also nerve-racking. It was nearly 4 p.m. when I got on the bus, and I knew I'd have an hour's ride to Manzini. I also knew that I'd have to get right on transport back to my site and hope like hell that I'd make it by dark. Being out after dark is a real no-no in the SWZ. No one does it in the rural areas (the cities are different), and the night is ruled by scary dogs and unsavory types. So I was getting stressed. Darkness falls between 6 and 6:30 these days.

The bus labored into Manzini by about 5 p.m., getting caught in a huge line entering the bus rank. Rush hour, y'know? So I hopped out and made a beeline for the spot where my khumbis hang out. I was the second-to-last person on. These modes of transport, basically minibuses, leave when they're full. That means you could wait on one for five minutes or for more than an hour. It's a crapshoot. And sometimes you find that there isn't one heading to your location, so you have to wait in line for who knows how long. It's a logical system for the SWZ, but it can certainly be a pain in the ass.

In summary, I scored big time by being almost the last person on. We rolled out just after 5, and I knew it'd be smooth sailing as long as we didn't break down or hit something. I made it to my bus stop by 6 and was home in time to keep my host family from worrying. Success!

Also that day, I dealt with my first electrical issue in a while. The night before, my lights had gone out. This was strange because my other electrical sockets were still functioning. I got ready for bed in the dark and puzzled over it a while. It took make and babe's help plus a call to the electrician to nail down the problem: blown fuse. Duh. That was the first thing babe told me to check. Host dad doing a great job at typical dad functions.

Electricity in SiSwati: igesi

That's all for now! I'm at Jack's school filling in for their volunteer computer teacher today. We're selecting our girls for the girls empowerment camp soon, and I have a support group meeting Friday. I haven't seen those ladies for months, so I'm pretty stoked.

AND Jordan visits starting March 22, if I didn't mention that. It'll mean SWZ adventures and EIGHT DAYS in amazing Cape Town. Hurrah!

On February

Sanibonani, team.

It has been criminally long since I updated, which is partly because my computer is dead. This post is sponsored by Jack, whose laptop I've snagged for the morning. Also, I'm at one of the only places in this country with a bottomless cup of coffee. Mugg & Bean, you're my hero (as is Jack, obviously).

I want to tell y'all what I've learned about the child who asked me for a job. As is often the case, the situation is more complex than I realized.

My friend who tracked him down told me this: The child's parents did both die, and he was taken in by his paternal grandmother. They moved him to a new homestead in my community. He didn't want to stay there. He keeps running away and returning to his previous homestead, which is uninhabited. So he does live alone, as he told me. She also said he is 12, not 14. She told me that his family has sent him to school repeatedly, but he runs away. He says he would rather get a job than attend school. My host father actually ran into him as well. The child also asked him for a job. My host dad instead asked where he stayed and took him back to his grandmother's house. (My host dad is a pretty awesome guy.) I don't know whether the child has since run away again.

So it's interesting, right? The situation isn't as dismal as I thought it was; the boy does have family members who are concerned for his whereabouts. He still isn't in a safe or stable situation. I don't know why he continues to run away. It's entirely possible that there are issues at home that make his life difficult or unpleasant. I certainly can't speak to that. But he has resources and a backup in case of emergency, and that's better than nothing.

If I have more contact with him, I'll write a bit more about it. I haven't yet remembered to ask my host dad for details of his encounter with the boy.

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Onward!

February has been extremely busy. Yes, you read that right: I've actually been busy. One of the staff members at the clinic was on leave for the whole month, so they asked me to fill in at the registration desk in the HIV section. It meant getting there at 8 a.m. Monday through Thursday and staying till about 3 p.m. I KNOW, RIGHT?! Who works those hours? It's INSANE.

But seriously, it is extremely rare for me to be doing anything, especially sitting, for that long. It was kind of exhausting. I did find, however, that it made me super productive. That's a thing, right? The busier you are, the more productive you are with other parts of your life. When I have a ton of spare time, I find it difficult to get myself to do anything. When I'm busy and have to pack in activities, the momentum keeps me going. So in January and February, in the midst of busyness, I wrote the first draft of my second "Haunted Library" children's novel (buy the first one here! http://www.lulu.com/shop/blythe-terrell/the-haunted-library/ebook/product-17421356.html). I wrote it out longhand because that's how I prefer to do it. I want to have all the original thoughts and scratch-outs and notes, so I don't like typing creative writing. I think it turned out OK, but I'll type it and edit as I go, I'm sure.

I also wrote a few poems, which is not a thing I usually do, and I experimented with some truly awful short stories. I'm going to take another stab at those in the coming months.

Also this month, my friend and I started a girls empowerment club at one of the primary schools, and I helped start weekly spelling bees at the other primary school. It's meant running around a lot and has been really satisfying.

March will bring more club meetings, preparations for the annual girls empowerment camp in April, and probably some time with the support group I've been working with. Jor visits (!!!) at the end of the month, and we're heading to Cape Town as Jack goes back to the US of A for Wedding Extravaganza 2014. I'll be back for Morgen's wedding in May, and I'm scheduled to complete service in August. I feel like these months will really fly.

Salani kahle! Nginibona ngeMay (I'll see y'all in May)!

A thing that happened

I was on a walk one Sunday afternoon in my community when I passed a child walking the opposite direction. He was lean and wearing worn clothes, not unusual for the weekends here. He carried a bulging plastic bag. I figured him for 8 or 9.

"Ngicela umsebenta," he said. "I'm asking for a job."
"Ncesi, ngilivolontiya. Ngite umsebenta," I said. "I'm sorry, I'm a volunteer. I don't have a job."

We walked our separate ways. I overtook him again on my way back, after I'd hit my turnaround point. I didn't have a whole lot more I could say in SiSwati.

I asked if he could speak English.

"I am asking for a job," he said.

I explained again that I didn't have one to offer him. I wished I had.

I asked if he went to school. He said he did not.

I asked if he had brothers and sisters. None, he told me. I asked if he lived with his mother.

"She has died," he said in English.

I asked if he lived with his father.

"He has died," he said.

We went through the grandparents, and I asked who he lived with at home.

I am alone, he told me in SiSwati.

I asked how old he was, "unangakhi iminyaka?"

"Fourteen years," he said.

This silenced me. We walked quietly together. After this long in Swaziland, I figured I'd be immune to feeling sad in these situations. I've met many children who have lost their parents. It's rare, however, to find a child who doesn't live with another adult relative. I felt myself starting to tear up, which is approximately the least useful reaction.

After a few minutes, I thought of a question.

"Uthandaza kuphi?" I asked. "Where do you worship?"

He told me the name of his church, and it was a church that I knew. I asked what his name was, and he told me.

Normally, I wouldn't give money to anyone in my community. If I'd been carrying money, I almost certainly would have given some to this child or bought him bread. But I didn't. I wasn't even sure where he lived, exactly. But I had a name and a church.

Since that conversation, I've spoken with a friend who lives near his church. She's talked to the head of the youth committee there and confirmed that the child attends. I intend to find out more about his living situation. But it gives me great relief to know there's a community helping him. Although I don't go to church, I know that sometimes it's the only support system an orphan has here in the SWZ. I'm thankful for it.

Holidays in the Southern Hemisphere

Sanibonani and umnyaka lomusha! (Hello and happy new year, sort of. Umnyaka lomusha just means "new year," but it seems to be the common thing to say to wish someone the best.)

I wrote a chunk of a post and then tried to add a photo, but Google is now doing something really dumb where it requires you to sign in to get photos from some imaginary online space, so ... I might be looking for new blog options in the future. Regardless, the holidays were lovely.

Highlights:

We enjoyed some Christmas hiking and potluck at Ngonini in northern Swaziland. We stayed with our friend Kathy, who was a PCV in the 1980s and has lived in Swaziland since. It was a lovely time.

We headed to Tofo, Mozambique, on Dec. 28. It's a 12-hour drive from Swaziland, and we were lucky enough to have friends to organize the transport. Otherwise, you have to take a khumbi about three hours to Maputo and then stay the night before getting additional transport to Tofo. No, thank you. Our driver was stopped by cops a few times, and he was always able to talk them down on the fine/bribe.

TOFO is glorious. It has amazing white sand beaches on the Indian Ocean, and a spot called Fatima's hosts a days-long New Year's party. We spent the first three nights camping at a hotel called Mozambeat. This was grand, except Jack sustained a bite that we think led to African tick bite fever. He saw a doctor immediately upon our return to Swaziland, so it never developed into full-blown illness (thank goodness). He's basically a Peace Corps volunteer now, though, as ATBF is a bit of a rite of passage. I haven't gotten it, probably because I'm too tough for ticks to bite.

The food in Tofo was ah-mazing. I ate barracuda with coconut curry, a fish with a face, and a traditional dish called matapa (pureed spinach with coconut milk and peanuts). There are also natural and spicy cashews available from dudes on the roadside. Surprisingly, we found amazing Italian food there as well. Everything we ate was fabulous, and they make amazing bread there. We also drank all kinds of tasty Mozambican beers. Sorry, Swaziland and South Africa: Your beers are terrible.

We went snorkeling with whale sharks one day. As it turns out, I do not enjoy snorkeling on choppy open ocean. I hopped out of the boat once, and that was enough for me. Luckily, it was whale shark central that day. We had five sightings, and I saw at least two on the surface of the water. I felt like I definitely got my money's worth. It was amazing. Jack has better stories to tell from swimming alongside the big guys. I was in the water with a shark, which is apparently enough for me. What can I say? I'm an air sign, and I hate choking on saltwater.

We did a pretty good job of avoiding sunburns and still getting in great beach time. The water was gorgeous, and Tofo remains surprisingly low-key and un-built-up (that is an awful hyphenate. What's the word I'm not using here?) The street market turned into a big party on New Year's Day, and that was fun to see. You can also buy plastic 500-mL bottles of Tipo Tinto rum for 50 meticals, which is less than $2 U.S. You might be getting what you pay for. The favored way to drink it is mixed with raspberry soda, which is just weird. Coca-Cola did us just fine.

We spent New Year's Eve day in the nearby town of Inhambane. It poured on us, which was unfortunate. We tried out the local public transportation, called choppas (shoppas?). These are like the minibuses in Swaziland, but WAY MORE people pack onto them. Cops in Swaziland will give tickets for overloading. It appears that this isn't a thing in the Moz. There were 30 people on a 16-seater on our way back to Tofo. We were speeding through driving rain when the vehicle slowed to a stop on the roadside. There were few English speakers on board, but the man next to me managed to communicate that it was broken.

After a few minutes of waiting, I desperately wanted out. I figured we could hitch a ride the rest of the way to Tofo, and the steamy inside of a van full of people was the opposite of where I wanted to be.

"Can we get out?" I asked the man next to me.
"Sorry," he said. "I don't speak English. I speak Portuguese."
"Sorry," I said. "Umm ... out?" I gestured toward the door.
"You want to run?"
"Yes."

Heated discussion followed among passengers. I have no idea what they were saying, but the gist was clear: No one wanted to get out into the rain to let us crawl out of the back seat.

We asked again a few minutes later.
"Another car is coming," the man told me.

I writhed in frustration, feeling claustrophobic. About 10 minutes later, another vehicle showed up. This choppa turned off the road into the sand, promptly getting its back wheels stuck. As men left our choppa to help, I saw the opportunity and squeezed out past an old (and grumpy) grandmother. The rain was still pouring, and I pulled open our umbrellas. But once we were out, Jack felt obligated to help with the unsticking of the other vehicle. Men rolled it up to one side and jammed palm tree bark beneath the back wheels.

Jack and I tried halfheartedly to flag down a ride, but it wasn't happening. No one wanted to stop for two people next to a broken-down van. By this point, Jack was sopping wet, and the people on the bus were ready to punch us. Several minutes later, the rescue choppa popped free onto the road. Cue mad dash by the 30 people on the broken choppa. We mashed onto the new choppa and were on our way.

Lesson: transport is waaaaay easier in the SWZ than in this particular part of Mozambique.

We spent New Year's Eve dancing to DJs at Fatima's and chatting with new friends. The place is right on the beach, and it was lovely (if not the greatest service I've ever encountered).

After six days in Tofo, we were sad to leave but happy to get back to our comfort zone. Overall, it was glorious. I'd highly recommend it.

Since our return, Jack has started year two of teaching, and I've participated in a training of trainers for the Girls Leading Our World program. A counterpart in my community and I attended so she could learn how to be a camp counselor for GLOW. That was an inspirational week. The counselors were amazing (though someone might have walked away with my male condom model), and we capped it off with a phenomenal talent show.

This is, ladies and gents, the home stretch. Things are fixin' to get interesting.