The Question of What is Appropriate

This is the first of several posts by Kelli Donley. She will be joining me for about 2 weeks. For more about Kelli, see here. Thanks for joining me, Kelli!

I’ve worked with Chad in Mozambique. We are both volunteers/health care workers/concerned people interested in doing something to improve the state of health in this far-from-home country. While Chad is a doctor in middle-America, I work for a small non-profit in Phoenix. We are privately funded and specifically do not have any programs concerning family planning or sexual practices.
It’s just too “political.”
As a small non-profit, it is difficult to take a moral stand on an issue such as birth control when you know you’ll isolate so many people (read: donors) who could help you tackle other important health issues that also need some attention. During my first trip to Mozambique, I was determined to gather information to change my boss’s mind about this topic. I wanted condom distribution. I wanted sex-education courses for women and girls. I wanted family planning courses. I wanted every tool possible to slow the fiery rates of HIV storming across the Mozambican plains.
This lasted until I landed in Beira – a large port city 1,000 miles north of the nation’s capital, Maputo. Then I saw it with my own eyes. There is no lack of knowledge about condoms in Beira, nor a lack of supply. There are condoms in the streets, the markets, the shops, the restaurants, the hotels and even hanging from the arms of young girls – their plastic rims used as colorful bracelets and signs of defiance. It wasn’t that people here didn’t have condoms, or didn’t understand their use. It was that they had decided not to use them – a problem I hadn’t had two seconds to consider. I realized naively that I wouldn’t be responsible for bringing condoms or sex education to Mozambique. These had arrived a long time ago.
I’ve been to Moz twice. Both times I had native people tell me that condoms were endorsed because the white man didn’t want the black to enjoy sex. It is startling to come from a PC American culture and have others put things in such terms: white vs. black.
I had women tell me they didn’t have the power to tell their lover that they must use protection. I had both men and women tell me they didn’t want to be tested because they simply couldn’t have “the sickness.” Chad and I both saw men and women dying in their homes because their families didn’t want them tested, didn’t want to be associated with the stigma, didn’t want to address the bone-thin bodies grasping for breath in the corner.
Public health is entirely about behavior change. How do we encourage people to make healthier choices, whether this is to prevent obesity in America, malaria in Brazil or AIDS in Mozambique?
Leading by example is the first step. Finding community leaders who belief in your mission is the next. Finding a compassionate and charming spokesperson helps too.
Have you made changes in your daily routine to improve your health? Why did you decide to do this? What was your motivation?