Happy

I took a video this afternoon of some of the boys playing along the sidelines at the football match. If this doesn't make you smile, I'm pretty sure nothing will.

ZEHRP United

ZEHRP United is the "official" football of the project in Lusaka. Every few months, several of the guys from the project put together a team of project employees and a few friends to play other teams in the area. Today, they had a match against the Mimosa Football Club.
Unfortunately, the other team was "youthful and more fit", as one of my coworkers who played described them to me. I wasn't quite sure what "youthful" meant since the guys on our team were my age or a few years older, this was explained to me too. It wasn't just the fact that they were in their late teens and early twenties, but apparently it really just meant that they played more often. Our guys still put in a good effort, but by the second half, most were drinking water on the field and running a little less than at the beginning of the match. Needless to say, we lost.

There was quite a crowd of spectators at the match, both in the fields and on the sidelines, and even on the field during halftime.
Last year, one of our expat employees organized a donation of soccer cleats for the team, so all of our guys would have shoes to wear when they play. At the end of the match, a group of boys were excited to carry the trunk of shoes back to the truck.

RZHRG in 'The Lancet'

This week, RZHRG published an article in 'The Lancet', one of the oldest and most well-respected, peer-reviewed medical journals, that strongly supports the argument to expand couples' voluntary HIV counseling and testing services. Since the article is quite long, I've only pasted its summary here.

Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year.

Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001–02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year.

Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55·1% to 92·7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60·3% to 94·2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35·7% to 60·3% of heterosexually transmitted HIV infections that would otherwise occur.

Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples.

Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative.

National HIV Testing Day

Do you know your HIV status? I don't mean, "do you think you know your HIV status?" or "are you pretty sure you know your HIV status?" I mean, "have you been tested and are you sure you know your HIV status?"

The CDC estimates that approximately 25% of American infected with HIV are unaware of their status. That's 180,000 to 280,000 people. And it's not just black women or homosexual men or poor African or Hispanic immigrants; HIV isn't a disease that only affects a particular group. Did you know that while the South represents a little more than one-third of the U.S. population, it accounts for 40% of people who have AIDS and 46% of new cases?

If you don't know your HIV status, you can visit http://www.hivtest.org/index.cfm to find a testing site near you. There are a number of locations that offer free, confidential testing. In Greenville, one is AID Upstate and, in Atlanta, one is AID Atlanta.

To quote this year's theme - "Take the test. Take control."

Pictures of ZEHRP

This week I took a few pictures around ZEHRP that I wanted to share, and I realized that I never did the same in Kigali, so I'll be sure to take some pictures there when I return.

ZEHRP has two sites, just like PSF, one for clinical trials and one for other studies. The former is referred to as "IAVI", after its major funder, and the latter is referred to as "main site". Unlike PSF, ZEHRP's main site is consolidated within a single compound that contains the administrative building, lab, clinic, etc.

This is our administrative building, which houses the administration department, data department and offices for several others.
As I mentioned, the data department is housed within the administrative building. (I know it looks like a mess in these pictures; I've been trying to get things in better order!)
The main site lab is just to the right of the administrative building.And, finally, this is the clinic building, which is just behind the administrative building. The tented area in front is where lunch is served every day at the project. The second picture is the back of the building, just outside the phlebotomy room.

Knowing your blood type

Friday morning, I got to work, checked my email, printed some documents to the main printer in the other room, walked to pick up those documents and was greeted not with "Good morning!" or "How are you?" but "What's your blood type?" I hate to admit it, but my answer was "I don't know. But it's written on my blood donor card at the flat. What's going on?"

"The blood bank just called. There's a woman hemorrhaging at UTH [University Teaching Hospital] and they need plasma from someone who's AB+."

We began asking everyone at the project if they knew their blood type. Within a couple hours, since we still hadn't found a match, two representatives from the blood bank showed up to test blood types. Since the AB blood type is even more rare in the Zambian population than in the American population, our expatriate staff quickly lined up to be tested.

At the end of the day, we still hadn't found a match, and, unfortunately, it was likely that it would have been too late for the patient at that point even if we had. Still, the situation reminded me of (1) the importance of knowing one's blood type, (2) the many challenges met in the medical setting of developing countries, and (3) how interlinked ZEHRP is to the medical community of Lusaka.

Guard dogs

In addition to the two dogs and two cats that live at the flats, ZEHRP has two guard dogs at the main site - Suki and Diego. With their size and their barks, they make great guard dogs, but they really just act like overgrown puppies.

Garbage Alley

The road on which I live is Mwembelelo Road, and it runs parallel to the road where the project is located. The shortest way to get from one to the other is to walk down a dirt road that has been nicknamed "Garbage Alley".

In Zambia, you have to pay to have your garbage picked up from your house or your office, so most people, particularly those who can't afford this service, burn their waste instead. Garbage Alley is apparently a popular site for this activity. On any given day there will be at least one fire burning on the side of the road, an array of trash scattered across the road and a few people picking through the burnt piles, looking for any remnants of value.

"It's a hand towel!"

This sign is on the wall in the women's bathroom at my office. It makes me laugh every time I read it.

Controversial soap opera

An interesting article was posted on the BBC today about a controversial soap opera in Rwanda that deals with sexual health issues.

Rwandan sex soap opera wins award
from: BBC News

A Rwandan radio soap opera that takes on controversial issues about sexual health has won a prestigious One World Media Award at a ceremony in the UK.

Urunana follows life in the fictional village of Nyarurembo and each week has an estimate audience of 10 million.

Narcisse Kalisa, Urunana's director, says the show is not afraid of taking on taboos by making people laugh.

"Our most controversial story was when a wife asked her [cheating] husband to use a condom," he told the BBC.

"People can laugh at the way the issues are addressed and the language we are using. It's an entertainment - a blend of education and entertainment," he says.

The show's writer Samuel Kyambagidwa says the main characters are Bushombe, a comic figure who has recently gone back to school at the age of 50, and Mariyana, a respected health worker.

Urunana, which means hand in hand in Kinyarwandan, won the One World Special Achievement Award for Development Media on Thursday night in London and takes on subjects from HIV/Aids to infertility.

"Before the programme it was taboo to talk about sexuality - and things like wet dreams and menstruation," Mr Kyambagidwa told the BBC's Network Africa programme.

"Now it gives people a starting point; for example, it gives a grandparent courage to discuss things with their grandchild that they have heard on Urunana," he says.

Figures from the World Bank last year put the prevalence of AIDS in Rwanda at about 3%, down from 11% in 2000.

The World Bank report suggested that education at a grassroots level played an important role in slowing down the spread of AIDS in the country.

The soap, which was started in 1999 by UK charity Health Unlimited, is broadcast twice a week in 15-minute episodes on the BBC's Great Lakes Service.

The current storyline is about a student who drops out of secondary school to marry a shop owner, but then discovers she is HIV positive.

Mr Kalisa says the audience has been kept on tenterhooks about whether the wedding would go ahead.

For those not tuning in...

"He did marry her at the end of the day," Mr Kalisa says.

My flat

I realized it was about time for me to post some pictures of where I live and work here in Lusaka. First off, the flats.

The project maintains four flats that each have three bedrooms. Right now, they're getting close to being full, with a total of twelve of us living here.
The first room you enter in my flat is the living/dining room. Unfortunately, since the three of us living in this flat are all only here temporarily, it's pretty bare.
Just off this room is the kitchen.
Between the kitchen and the living/dining room, there is a small hallway that leads to the bedrooms. There are two bedrooms on the right and one at the end of the hall on the left.
Where the hallway turns to the left is the bathroom. Further down the hall, the last door on the right is my bedroom.
And voila! That's where I'm living now.

Access to Life Exhibition

If you live in the D.C. area, I have to encourage you to visit the Access to Life Exhibition. It's going to be at the Corcoran Gallery of Art from 14 June through 20 July. Here's a description of the exhibition:

Eight extraordinarily engaged artists from Magnum Photos have ventured far from home to visualize some of the external aspects of individual lives marked by AIDS and its consequences. Supported by the Global Fund on the ground, Jonas Bendiksen, Jim Goldberg, Alex Majoli, Steve McCurry, Paolo Pellegrin, Gilles Peress, Eli Reed, and Larry Towell each embraced the responsibility to document with objectivity and compassion the role of medical intervention in the fight against a life-threatening illness. Their new work appears for the first time in Access to Life.

These photographers interacted with many communities throughout around the world. Their connections extended beyond those directly suffering from AIDS, to include loved ones, children, parents, and literal families, no less than families of affinity and choice. In bringing all these people together for this project, Access to Life proposes that these citizens of nine separate countries are united across political and geographic borders by their common struggle to forestall mortality and to participate in global networks of compassion and solicitude.

One important goal of this exhibition is to recognize the many individuals who participated in this project. Together they have allowed us a lyrical and bracing glimpse into the lives of people stirred to care for the bodies and souls of those they love.

The website for the exhibition is impressive too. It's: http://accesstolife.theglobalfund.org/exhibition

HIV tests and ARVs

I recently discovered two interesting cases among individuals enrolled in studies at PSF. I was working on a query for a publication and noticed that there were two individuals who were HIV-negative but reported a date on which they began anti-retroviral (ARV) therapy, the treatment used for individuals who are HIV-positive. I assumed an error had been made during data entry, but, as I investigated these cases further, I became really concerned.

The first individual tested positive at PSF's couples' voluntary counseling and testing center on two out of three rapid tests, which, according to the national algorithm for HIV-testing, identifies this individual as HIV-positive. (It is not at all uncommon for individuals to have different results on different tests.) For several months, this individual continued to test positive. When a CD4 count (the test used as a diagnostic for HIV treatment) was ordered, it was found to be very low, so the individual began ARV treatment. At this point there was no indication that something was strange, no red flag that something was wrong, no indication that a protocol that had been followed incorrectly. But then, the individual began to test HIV-negative, and with more sophisticated laboratory tests, it was resolved that the individual was indeed HIV-negative.

The second individual had a similar testing history.

Were these individuals were cured by ARV therapy? No. Had an error been made in their lab tests or results? No.

Both of these cases were what we call "seroreverters", individuals who test HIV-positive for some period of time before reverting to HIV-negative test results. It is a curious situation that is not yet well-understood, but false-positive HIV test results are not uncommon. In fact, it is fairly common for HIV-negative individuals to test positive on a single rapid test, somewhat less common to test positive on multiple tests. Yet there are individuals who have separate infections or cross-reacting viruses that cause positive results on HIV tests even though the individuals are not actually infected with HIV. When the individuals' immune systems later clear this cross-reacting virus, they revert to negative HIV test results. This is what happened in both of these cases.

As for these individuals' low CD4 counts that indicated a need to begin ARV therapy, it is purely coincidence. Some individuals just have naturally low CD4 counts.

Even though there have only been two individuals for which this has happened at PSF, I feel like the implications of these facts are significant.

While we follow a strict testing algorithm at PSF and ZEHRP that involves diagnosis based on three rapid tests followed by more sensitive ELISA tests in cases of discrepant results, we have seen in Rwanda that most health centers use only a single rapid test for HIV diagnosis. Nurses and counselors report that there are just too many clients and too little time to do even one confirmatory test. Yet the single rapid test that they use is one that has shown a particularly high number of false positive results at PSF. While we at PSF can identify these false positive results by use of confirmatory tests, if the health centers are not using any confirmatory tests, then how many HIV-negative individuals are receiving positive diagnoses? The numbers must be high. And how many of these then have naturally low CD4 counts?

A whole series of questions and concerns then fills my mind - How many individuals are on ARVs who are actually HIV-negative? What effects do intense ARVs have on the bodies of individuals who are not infected with HIV? What are the economic implications when expensive ARVs are wasted on individuals who are actually HIV-negative? How does providing ARV therapy to HIV-negative individuals contribute to drug resistance if these individuals are later exposed to the HIV virus? What effect does this have on the community's understanding of HIV and ARV therapy when these individuals later receive HIV-negative results? Does the community believe they have been cured or do they believe HIV is a myth made up by the Western world?

Chisholm

Data tech: “Is this your last name?”
Me: “Yes.”
Data tech: “Really?"
Me: "Yes."
Data tech: "It looks like an African name.”
Me: “Didn't you know that I’m African?”

And at that point everyone laughed. Though as soon as we had all regained our composure, my coworker who originally asked about my name spelled it out loud, "C-H-I-S-H-O-L-M", and everyone agreed that, when pronounced as they would pronounce it, my surname does sound like an African name.

Alcohol

A few days ago, I was trying to flag down a taxi on the main road near my flat, and when a cab pulled over, a man got out of the passenger seat holding a beer bottle in his hand. It was eleven o'clock in the morning.

On Saturday night, a group of us approached some taxis parked in the corner of a gas station. Noticing that one of the men there had a bottle in his hand, we asked "Who's been drinking?" One quickly stepped forward and proudly announced, "I have been", while another stumbled away.

The trash piles are filled with cartons that an outsider might assume had been used for milk, except that in this part of the world, milk comes in bags. The local brew, a maize/millet beer called Chibuku Shake Shake, comes in the cartons.

It seems alcohol has a much greater presence and tighter hold on Zambia than it did on Rwanda.

Pitiful pets

Our pets are looking pretty pitiful right now. Both of the dogs and one of the cats were spayed and the other cat was hit by a car and had to have one of her legs amputated. So right now they're all wandering around the flats with giant cones around their necks. It's a pretty sad sight.

About ZEHRP

I realized that some of you may be wondering about my sudden move to Zambia, or perhaps why the organization for which I work has projects in Rwanda and Zambia, of all countries.

As I've mentioned previously (see 'About RZHRG and PSF' posted in September 2007), Projet San Francisco (PSF), where I was working in Kigali, Rwanda, was founded in 1986. Its sister project in Lusaka, Zambia, was later established in 1994, when Dr. Allen, the founder of the organization, and many of her staff fled to Zambia for safety during the Rwandan genocide. Rather than give up their work, those who made it to Zambia established a sister project here that is now known as the Zambia Emory HIV Research Group (ZEHRP).

Since 1994, the project has offered couples' voluntary counseling and testing (CVCT) services to over 20,000 couples in Lusaka. Among these 20,000 couples, over 13,000 HIV-infections have been diagnosed and 6,000 syphilis infections have been treated. Like PSF, ZERHP has couples' voluntary counseling and testing facilities, two medical clinics, laboratories and a pharmacy. The project employs around 150 Zambian medical and support staff and 5 to 10 expatriate staff.

The most recent news for ZEHRP was the awarding of a large grant from the Centers for Disease Control and Prevention (CDC) to expand CVCT services to a greater number of clinics in Lusaka and throughout the southern province of Zambia. With this grant, CVCT services have expanded over the last couple months from three fixed sites in Lusaka to more than twelve district health centers and other sites in the region. As exciting as this expansion has been and as many people as are benefiting from the new CVCT services, it's created lots and lots of work for ZEHRP staff, which is the reason I've come down here from Kigali for a couple months. Hopefully I'll be able to help set up and organize some of the systems for this expansion and will then be able to return to Kigali to help do the same as we look forward to expansion there as well.

Winter

I don't know whether it's officially winter yet in Zambia, but it certainly feels like it. All week, the skies have been gray, the winds have been blowing and the temperature has been dropping. I think I'll be wearing the only three sweaters I have every single day until whenever I leave this country!

Zambia is not Rwanda

It’s true. Zambia is not Rwanda. In fact, in many ways, the two are about as different as night and day. I thought I would share a few comparisons:

Rwanda: With a population of over 10 million and a size of 26,798 sq. km., Rwanda has a population density of 343 people per square kilometer.
Zambia: With a population of 11 million and a size of 752,618 sq. km., Zambia has a population density of 16 people per square kilometer.

Rwanda: Flying into Kigali, you would hardly know you were about to land in a capital city of 850,000 people. From the plane window, the land below is green and fertile, covered with hills. The buildings of the city seem more like those of a small town, none higher than just a couple stories, and only visible just before landing.
Zambia: Approaching the city, the land below is brown and bare. The city itself is visible before you've even begun to prepare for landing. It stretches on and on in every direction with a central downtown area with tall buildings and a crowded grid of streets.

Rwanda: Only about 20 percent of the population lives in urban areas.
Zambia: Just over 35 percent of the population lives in urban areas.

Rwanda: After you've landed in the airport, you proceed inside to one of three small counters where there is no need to purchase a visa.
Zambia: At the airport, all Americans are charged a $135 visa fee.

Rwanda: Leaving the airport, the drive to the project takes about 15 minutes, maybe 20 if there is a lot of traffic. It's just about the longest possible drive across the city. Drive any farther and you'd be halfway to the next town before you knew it.
Zambia: From the airport to the project is a 40-45 minute drive and there's still much of the city remaining further ahead.

Rwanda: In Kigali, I live in a four-bedroom house with a nice yard and a garden. I live by myself.
Zambia: In Lusaka, I live in the third of four connected flats. Each flat has three bedrooms, so I live with a total of eleven other girls. The "yard" is a concrete driveway with a small patch of grass on the side.

Rwanda: My "pets" include fruit flies, lizards and a mouse.
Zambia: There are two dogs - Foxy Brown and Lil' Kim - that live at the flats.

Rwanda: At night, when I'm going to sleep, the neighborhood is usually silent.
Zambia: Every night of the week, it sounds like there's a dance club right outside my window.

Rwanda: Rwanda is home of a tropical climate that is warm and sunny with occasional rains year-round.
Zambia: May (just the time I arrived) through July (just the time I'll leave) is winter in Zambia - cold, dry, windy winter.

Rwanda: Kigali is the capital of a nation made up of two ethnic groups that both speak the same language (Kinyarwanda).
Zambia: Lusaka is the capital of a nation made up of at least 72 different groups, most of which speak one of nine languages (Bemba, Nyanja, Tonga, Tumbuka, Lunda, Luvale, Kaonde, Nkoya, Lozi).

Rwanda: The most common Western language is French.
Zambia: The most common Western language is English.

Rwanda: I hold my breathe every time I turn on the water, wondering if there will be any.
Zambia: I hold my breathe every time I turn on the lights, wondering if there will be electricity.

Rwanda: I shop for groceries at the local market or from women with baskets of fruit on their head.
Zambia: I shop for groceries at a South African supermarket in a strip mall.

Rwanda: I sleep on Rwandafoam, a squishy piece of foam approximately 4-6 inches thick.
Zambia: I sleep on a real mattress.

Rwanda: HIV prevalence is between 3.4 and 7.6 percent.
Zambia: HIV prevalence is between 13.5 and 20.0 percent.

Rwanda: There are 170,000 to 380,000 people living with HIV/AIDS.
Zambia: There are 730,000 to 1,100,000 people living with HIV/AIDS.

And a few ways in which the countries aren't all that different:

Rwanda: Approximately 60% of the population lives below the poverty line.
Zambia: Approximately 68% of the population lives below the poverty line.

Rwanda: Gross national income per capita is $1,270.
Zambia: Gross national income per capita is $1,000.

Rwanda: Life expectancy is 51 for males and 53 for females.
Zambia: Life expectancy is 42 for males and 43 for females.

Rwanda: For ever 1,000 live births, 160 children will die before their fifth birthday.
Zambia: For ever 1,000 live births, 182 children will die before their fifth birthday.

Need for a vaccine

Another article was published this week that only further supports the need for an HIV vaccine.

UN: New HIV infections outpaces drug treatment
by: John Heilprin

Despite a stepped up global battle against AIDS, the numbers of people newly infected with HIV are far and away outpacing the numbers beginning antiretroviral drug treatments, U.N. officials said Monday.

Secretary-General Ban Ki-moon, opening several days of U.N. debate on AIDS prevention, told world leaders that 2.5 million people became infected with HIV last year compared with 1 million who started using important antiretroviral drugs.

"Unless greater and swifter advances are made in reaching those who need essential services, the epidemic's burden on households, communities and societies will continue to mount," Ban said.

Some 2.1 million people died of AIDS last year and at least 33 million people world wide have the HIV infection, according to U.N. figures.

In addition, people with weakened immune systems from HIV are up to 50 times more likely to develop tuberculosis, U.N. officials say.

"We cannot separate the fight against HIV/AIDS from the fight against TB," said General Assembly President Srgjan Kerim, who will preside over a two-day meeting on AIDS starting Tuesday.

Former President Bill Clinton pointed out ramifications that rising oil prices have on battling the disease.

"This oil price spike has taken away 100 percent of the value of foreign aid and debt relief to very many countries," he told the U.N. "It has dramatically increased the cost of producing food, and it has increased therefore the number of people who are at risk of these diseases."

Dr. Peter Piot, executive director of UNAIDS, said 2 million people were getting antiretroviral drugs in Africa.

Antiretroviral drugs have made HIV a manageable illness for many patients and prolonged their lives beyond what once seemed possible.

The U.N.-backed Global Fund to Fight AIDS Tuberculosis and Malaria announced Monday it helped 1.75 million get antiretroviral treatment — a 59 percent increase over last year.

But slightly more than two-thirds of people with HIV globally are not getting any such treatment, according to U.N. figures.

Power rationing

Zambia, like other countries in southern Africa, has been hit by a serious power shortage. To compensate, the country has been rationing power to its civilians. Usually twice a day - once from noon until two in the afternoon and once from six until eight in the evening - electrical power is turned off, meaning lots of cold, candlelit meals. At the end of last week, the state utility company, Zesco Ltd., announced that it would deepen rationing to civilians in order to maintain supplies to the copper and cobalt mines in the north of the country, which are the backbone of the nation's economy. It sounds like there are many more peanut butter and jelly sandwiches and salads in my near future.

Lusaka Polo Club

Today I went to a polo match at the Lusaka Polo Club. It was certainly something I never expected when I thought about the things I might do in Zambia, but it made for an interesting day. I'd never seen polo before, so the match itself was interesting to watch. The atmosphere was perhaps even more interesting, if not, disturbingly, a little reminiscent of the days of colonialism.

The "g-word"

I just finished reading the speech Barack Obama gave earlier this week and was quite inspired. The quote that stuck with me most, though, was his definition of "the common threats of the 21st century - terrorism and nuclear weapons; climate change and poverty; genocide and disease."

He said it. The "g-word". Genocide. A word that is rarely uttered by the leaders of the United States. A word describing events and actions that this nation has ignored over and over again. A word that our government emphatically refused to use in 1994.

On the 11th of May 1994, over a month into the Rwandan genocide, State Department representative Mike McCurry was asked in a press briefing, "Has this government been able to determine whether any of the acts committed in Rwanda since April 6 constitute genocide?" He answered, "I don't know that they've made any legal determination on that."

On May 17th, the United Nations Security Council finally admitted "acts of genocide may have been committed." Over a month after this admission, on June 10th, the United States continued to refuse to describe the events occurring in Rwanda as "genocide". Note that at this point, over sixty-five days had passed since "acts of genocide" had begun in Rwanda. In this time, hundreds of thousands had been killed. Since the UN had used the term "acts of genocide", State Department spokesperson Christine Shelley was asked in a briefing "How many acts of genocide does it take to make genocide?" She responded, "That's just not a question that I'm in a position to answer." The follow-up question was asked, "Well, is it true that you have specific guidance not to use the word 'genocide' in isolation, but always to preface it with these words 'acts of'?" Her response was a jumble of excuses.

Four years later, in March of 1998, President Clinton finally admitted, "We did not immediately call these crimes by their rightful name: genocide."

Now, fourteen years after the Rwandan genocide, a candidate for the office of President of the United States has not only used the "g-word", but he has mentioned genocide as one of "the common threats of the 21st century." In this nation that has refused to acknowledge genocide so often in its past, even this mention of the "g-word" gives me hope that possibly, just maybe, there is the slightest chance that next time events like those that took place in Rwanda in 1994 occur, our government might choose to acknowledge them appropriately and take action. While I know there is no guarantee, even the mention of the word "genocide" is a step forward in my mind.

For the rest of Barack Obama's speech from 3 June, visit: http://abcnews.go.com/Politics/Vote2008/story?id=4988344&page=1.
It's a read I would recommend.

Sex and the City

Last night I went to the movie theatre to see the new 'Sex and the City' movie with several of the girls with whom I work. Now, there are a few factors you may need to consider to understand how truly exciting this event really was:

1. There is no movie theatre in Kigali (or Rwanda, for that matter) so I haven't been to see a movie in at least nine months.

2. Not only is there a movie theatre in Lusaka, but it has stadium seating and comfortable chairs.

3. The theatre served popcorn (another thing I haven't had in at least nine months) and, even though they didn't have that gross, melted, movie-theatre butter, they did have delicious flavored salts.

4. The theatre was showing 'Sex and the City', which is significant in two ways. First of all, because it isn't eight months or eight years old. It came out here the same day it came out in the U.S. Secondly, it's a movie that I really wanted to see, rather than one that I would just go to see because it was playing and I wanted to go to the theatre.

5. They showed previews with the movie, which are usually my favorite part anyway.

It was a really nice night. I actually forgot I was in Africa for a little while. And the movie, even if it wasn't quite as good as I wanted it to be, was cute and fun.