Creating fellowing with AIDS/HIV patients in Tanzania

One of the most difficult things Rebecca Haffajee witnessed early in her post-graduate fellowship in Tanzania was a woman dying from HIV/AIDS.

"I traveled to her house to conduct an interview, and it was literally a dilapidated mud and stick structure consisting of one room for her, her two young children and her father," she recalled.

The interview was conducted in the dark because the light hurt the woman's eyes. "Her body looked like nothing more than skin covering her bones, and I kept wondering if it was appropriate to actually be there conducting an interview," said Haffajee, a 2002 Duke graduate.

But the most disturbing thing about seeing those suffering with HIV/AIDS was the normalization of their circumstances over time, she said. "By the end of my 10 months, I was no longer shocked by seeing a person like that woman, and it scared me to think that I had accepted that as a part of life in Tanzania."

Haffajee was a participant in the Hart Fellows Program, the post-graduate component of Duke's Hart Leadership Program, part of the Terry Sanford Institute of Public Policy. Through the program, 47 recent graduates have traveled to 26 different countries across five continents to work with communities that face social, political, and humanitarian challenges. This year, there are Hart Fellows in India, Cambodia, and Tanzania. They see first-hand the effects of some of the world's most pressing problems.

For Haffajee, her fellowship brought the HIV/AIDS pandemic into sharper focus. Of the approximately 42 million people living globally with HIV/AIDS, 29.4 million live in Sub-Saharan Africa and 1.5 to 2.2 million live in Tanzania.

After graduating from Duke, Haffajee worked in the Kilimanjaro region of Tanzania from July 2002-April 2003. She was a project associate for HIV/AIDS research, predominantly working on a Duke pilot study concerning the psychosocial impact of HIV/AIDS. Haffajee worked with an organization called KIWAKKUKI (the Swahili acronym for Women Against AIDS in Kilimanjaro), which was founded by Tanzanian women in 1991.

Dafrosa Itemba, executive coordinator of KIWAKKUKI, said the organization's main function is to perform HIV/AIDS outreach services to men and women in both urban areas and small villages. In KIWAKKUKI's main center, there are daily HIV/AIDS awareness education sessions that include video, puppet theater and discussion for anyone who wants to drop by, Itemba said. The organization also provides voluntary counseling, home visits, testing services and material assistance to people with HIV/AIDS, their families and orphans in the region.

Haffajee helped KIWAKKUKI by drafting grant proposals in English and operating technological devices like computers and digital cameras.

Her main obligations were interviewing orphaned children affected by HIV/AIDS, studying their institutional environments and interviewing 13 women leaders of KIWAKKUKI to assess the organization's role in the context of Kilimanjaro and HIV/AIDS. The interviews with the orphaned children were inspiring, Haffajee said.

Even though the children were sick, scared and outfitted in tattered clothing, their faces would light up when they got to play with building blocks and toys, she said. Despite their situations, they managed to stay hopeful and become excited about life activities. In both the institutions and home-based care environments for the orphans, crowding and lack of resources were the main dilemmas. "This was not an 'ideal' situation for a child who recently lost his or her parents."

Haffajee, who is from Southborough, Mass., said she wanted to work abroad in the public health sector before entering law school, and was looking for an opportunity to work in a local sub-Saharan organization specializing in HIV/AIDS public health work.

Kathryn Whetten, a Duke professor and director of the Hart Fellows program, knew Haffajee as a dedicated student and encouraged her to apply to the program. "Hart Fellows need to be able to think for themselves, find their own structure and go into situations not knowing what jobs will need to be done," she said. "I thought Rebecca could do that."

Haffajee decided to accept the fellowship.

"The opportunity was one I could not pass up, and law school could wait," she said.

The experience has made her more confident in herself and in her ability to thrive in different situations and environments. "I am more committed to working with international health and human rights than before, and hope to have many more local working experiences in the future."

Haffajee currently attends Harvard Law School, and hopes eventually to focus on international and human rights. She also may apply to a school of public health to build upon the skills she learned at Duke and with the Hart Fellows Program.

"My Duke education introduced me to many themes integral to my experience and interests in the program," Haffajee said. She majored in Women's Studies, received a certificate in Health Policy, and enrolled in classes and clinical/volunteer experiences that sparked her interest in cross-cultural feminisms, health gender inequalities and HIV/AIDS impact and policy issues.

Haffajee said she also learned deeper lessons about working within communities to bring about change. "My fellowship taught me that knowledge and leadership are not to be obtained simply from studying and thinking; they are qualities obtained from hands-on experience and from working with people."

Haffajee said she values the time she spent in Tanzania working with the women of KIWAKKUKI. "Nilifunza vitu vyingi kuhusu utamaduni wao na mimi mwenyewe!" (Translated as "I learned many things about their culture, and about myself!")

Written by Lindsey Daniels, a senior from Heath, Texas