Red Ribbon Express

Because I promised to rave next time in my blog that I am posting this.
I started this last April and then completely forgot about it.

I was glad to have caught the Red Ribbon Express that arrived in Chennai Central on April 1, 2010. Chennai Central is the largest railway station in Tamil Nadu, with tens of thousands of passengers coming and going from different parts of India every day and night. It’s a strategic location for the Red Ribbon Express.

The Red Ribbon Express (RRE) is a 7-coach train, touted as world's largest social mobilization campaign against HIV, launched by the National AIDS Control Organiztion (NACO) in 2007. It is now on its second phase that flagged off in Delhi during the World AIDS Day (December 1) last year and had been to states of Rajasthan, Gujarat, Maharashtra, Karnataka and Kerala before reaching Tamil Nadu.

The train was stationed at platform 11 for two days. Unlike the other trains i've been on, this one didn't have bunks to sleep on and was not meant to ferry passengers from one point of India to another. The train was transformed into an integrated venue for information and education, counselling and testing center. At least three coaches were bedecked with multi-media HIV awareness materials, posters, pictures, videos, and my favorite, telephones that when you lift the handset you could listen to canned messages explaining more about HIV. There were at least 6 phones and each one catered to specific needs of young professionals, familied person, women, and others. There was also counselling and testing center in one of the coaches. Anyone who needed counselling and wanted to be tested for HIV could go right there and then.

Unfortunately, everything was in Tamil, I could have raved more about it had I been able to comprehend their messages. What’s amazing is how much sweat and preparation were put into it by NACO, other HIV organizations and volunteers, because all the materials were produced in different languages and scripts and appropirate materials would be mounted for every state.

Outside the train, over 50 booths were set up for various organizations engaged in HIV issues. The entire platform 11 was a market of condoms, contraceptives, info materials, and some knick-knacks produced and sold by people with HIV. I didn’t know there was that much organizations concerned with HIV in Tamil Nadu.

But that’s not all, medical practitioners and volunteers also went to proximate districts and villages while the RRE was stationed in Chennai Central, to reach more people. They also brought with them HIV testing kits. According to a report in The Hindu, Chennai edition since phase 1 of this campaign, over 16,000 people have voluntarily submitted to testing and about 50% were identified as positive.


There’s an estimated 2.6 million cases of HIV in India, half of this has already been identified and recorded in NACO. I am not sure how many of them are in Tamil Nadu, but this is definitely one state with high prevalence of HIV. Years of arduous advocacy and networking with government, and education at grassroots level helped curb further HIV transmission in this state.

It was interesting to note that in Chennai Central Railway, throngs of people came to see the RRE and came in close contact with people in HIV manning (don’t know a gender neutral synonym, apologies) the booths, a good indication that there is reduced stigma and discrimination, the main adversary of the people with HIV.

Photo from http://www.tribuneindia.com/2008/20081108/aplus.html

more photos later

Warning: I'm in a foul mood today

During our Preparing for Change training (PFC) in VSO, soon after we passed the assessment, we were told that volunteers are a rare breed of people. For one, it is not easy to decide to just leave your country and live among people in a cultural setting that one is not used to. One thing that was given so much focus was the aspect of culture, how to be sensitive, how to handle culture shock, how to be adapatable. Rare might we be but volunteers are not saints.

Enough of disclaimer, I am simply in a foul mood today and I want to rant.(I promise to rave next time) For a valid reason I cannot talk about what’s making me feel short-tempered but I do need to vent , and I’ve decided to pick on the construction workers in our compound as my hapless victims.

There’s a construction going on in our compound. The landlord is building three more apartment units in the second floor. It was started by two sari-clad women carrying 15 to 20 kilos of cement bricks each on their heads. The bricks were stacked outside the compound and transferred to what used to be our rooftop. Then more women came, and then men came, maybe not in that order. Now there are about 10 people working in the compound everyday; the construction according to my landlord will take three months.

I must thank these people who work so fast that in just a couple of days they’ve erected the walls that insulated our apartments from the scorching summer heat. It doesn’t feel like an oven anymore and I’ve stopped using my air-conditioner every night.

Now just as fast as they build the second floor the garbage accumulates faster. Our junkyard, er, our front yard already looked like a junkyard even before the construction began. There are steel bars that might have been used as scaffolding when our part of the building was constructed, slabs of wood, surplus bricks, a corroded motorbike, a guava tree, a coconut tree, and dry fallen leaves, all of them forms the landscape of our junkyard, er front yard.

The construction workers have their lunch in our walkway, right in front of Francesca’s (the other volunteer) flat. I want to digress for a moment, F and I often come home for lunch and every time we give them cold water, whoever gets home first. We’re volunteers, we’re a rare breed of people so we don’t complain if we must supply them with drinking water daily which we buy from the landlord‘s store. If only they could be more polite and request rather than always command us to get them cold water.

About the trash, some of them (the workers, not the trash) bring food from home packed in stainless metal containers that is common in India. Others buy food from the hotels (restaurants). A typical Tamil Nadu lunch you get from hotels is ¼ kilo of cooked rice wrapped either in plastic bag or banana leaf, sambar (a tasty mix of smothered vegetables), wrapped in small cellophane bag, rasam (clear soup with coriander and I dunno what else) wrapped in small cellophane bag, a dahl also wrapped in cellophane bag, and curd (diluted milk with onion, coriander, chili) yes another cellophane bag. Curd helps in digestion, rasam cools the body. Sometimes there’s an extra treat of papad, wrapped in old newspaper. These come in set and contained in a bigger plastic bag. So if at least half of them (the workers, not the trash) didn’t bring lunch from home and throw their garbage in our front yard, that’s 5 banana leaves, 20 to 30 plastic bags and 5 sheets of old newspaper flung haphazardly in our front yard e-very single day. And I’m not even counting the disposable tea cups (morning and afternoon, they each have a cup of tea).

One morning during the first week of construction, I wore my pink rubber mitts and picked up all their rubbish. I made sure they saw me did it with a grimace. The women, with cement bricks on their heads, stopped to watch me and chattered in Tamil. Soon I realised they wanted me to stop and told me they’d clean up later. I didn’t. One woman who just deposited her bricks on the second floor joined me and quickly reaped all litters she could. I gave them an old bucket they could use to collect their garbage, “deyavu seda” (please). For a good two days there was no visible trash. But soon enough, more rubbish piled up, now this time with cement bags, empty tins, more slabs of wood, more metals. F talked to the landlord that he should have it cleaned, he said ‘uh, yes maybe after construction’. MAYBE???? Now tell me if I shouldn’t rant.

My Indian friends and colleagues will pardon me when I say that lack of environmental sanitation is an obnoxious characteristic in India, and this is true anywhere. I hear some of them who complain about these themselves and said that educated or not, majority of Indians don’t care about sanitation.

I come from a developing country and garbage collection system is never at its best. In fact annual inundation in some parts of Manila during the rainy season, are partly to be blamed on uncollected solid wastes. But the difference is that people in the Philippines would always at least think twice before disposing their garbage just anywhere, and try not to get caught doing it. There are huge garbage bins in the major streets here but are often only half-full (or half-empty, depends on the type of person you are) while around it are piles of litters. What is so hard about making sure a small plastic tea cup they throw lands inside the bin and if they missed pick it up and try shooting again? This and the frenzied streets of India are two things I’ll never get accustomed to.

Oh, I feel better now, enough of ranting for tonight. I have to save some so I’ll have an excuse to rant the next time I feel down again. Apologies to the construction workers in our compound, more cold drinking water coming up.

A brief trip back to the Philippines on Election Day

For the first time since I came of legal age to vote I am waiving my right of suffrage in exchange of a volunteer service in India. It’s one right that I have always enjoyed to exercise despite the fact that not of one of my choices emerged as winner. For some reason I am glad not to be in my country today and unable to vote because of the stultifying inanity in the conduct of this year’s elections. I’d start with the outgoing president running for Congress, two notch lower than her current position. Many sincerely believed that with her unquenchable thirst for power, this is a ploy so that if she made it to congress she, along with her would-be congressional cohorts can amend the constitution and orchestrate a shift from presidential to parliamentary system that would catapult her to the position of prime minister. Others think that this is an attempt to still still hide from the cloak of impunity, elude the copious charges of corruption that will be thrown at her feet once she is no longer in power.

Then there’s a former president ousted less than a decade ago and is trying to stage a comeback even after being jailed, convicted of plunder, then pardoned and released. There’s also the candidate overtly supported by the administration but all indications show that there is another candidate who woos the voters with his rags-to-riches story, who has the clandestine backing of the administration. And then there’s the former president’s son not known for stellar performance in the senate but banks on the legacy of his parents. There are other candidates vying for presidential post but surveys showed their poor ranking as people’s choice. That they sling filthy mud at one another needs no mention . Sadly, this is a norm rather than an exception.

For another reason I feel that I want to be there and be part of the historic national elections. It is yet the most crucial election since 1985 when I was a year short of the age to vote. Today, my country decides on its plight through an automated election, something that people have been clamoring for years, weary of the constant cheating and protracted canvassing that keeps filipinos in suspended animation and anticipation of whether those who were expected to rig the results could actually carry it out .

It is also a crucial day because the country has been muddled in deep political and economic crises for the last nine years that many Filipinos, and this is just my own take, have been worn out with actions to replace an unwanted government through another people power. Today, Filipinos decide with a glimpse of hope for genuine change thru reviving virtues and morals that eluded us for the last couple of years.

Doubts about the cleanliness of this election still looms but people are more engaged and vigilant now. I don’t know what will happen 36 hours after the polls officially close and the new president is announced. Talks about another people power are floating, just as I was writing this I saw a video of a former military officer, now at large, one of those who staged mutiny against the current government announced that they will support another people power, if the election results do not turn out the way the people want it. Other more popular leaders however disapproves of another marching on the streets.

I am not registered as an absentee voter. I am simply not a voter this year, period. All I could do now is hope that this year election is clean and that the true voices of the people will emerge. Together with the Filipinos casting their votes today I dream with them that we have a new government that will genuinely lift the country from economic and political despondency.

Go with the flow

As someone who is used to going against the tide I was surprised with myself that during the last three days I just went with the flow. I’ve heard some volunteers say “go with the flow” referring to how they dealt with happenings in their placements. I couldn’t really grasp it until the retreat our organization had last week.

It was called a retreat but it didn’t fall under my category so I’d rather call it a welcome break from monotony of work. The departure from office was set at 3 pm, Thursday; went to office in the morning and did whatever work I could finish before we took a three-day off. I already packed in the morning but left my luggage at home as my flat is one-minute walk away so I just picked it up right after lunch at 2 pm. I was back in the office by 2:30. Two maxi-cabs were waiting outside, everyone was just getting tidied up and prepping to go. I smiled at the thought that we might just leave on time. Alas, we didn’t.

For some reason, even as we have all loaded up our bags in the vans we just didn’t leave right away. Most of us were either standing next to the vans or at the front door of the office, waiting… waiting… No one appeared impatient but I and F, the other volunteer. The time that passed seemed like eternity because we didn’t know what we were waiting for. We found out later that some people went some place to get a few more things we’d need for the retreat. (took a deep breath, no use grumbling).

Fast forward to the retreat up in Yelagiri Hills. (A post about Yelagiri Hills coming up soon, or you can just google)

April 29, 8:30 pm. With the one hour delay in departure time the planned agenda instantly changed. After dinner we had a brief orientation and postponed playing Tambola till the following day. Tambola is an Italian game like BINGO, but without the letters B-I-N-G-O, and the numbers to be drawn were up to 90 instead of 75.

April 30, At 6:30 am the men were already in the field readying for our cricket match when I and F got there. Indians are passionate about cricket and know the sport by heart. While I, being a Filipino, am utterly ignorant of how the game is played, and couldn’t make a sense out of it even after trying to watch the IPL. Still unacquainted with the rules I found myself a member of one team. Asking about the rules didn’t help because no one explained. They know the game and it was enough. Just go with the flow.

I took the bat and positioned myself in the base, I didn’t know that I had to protect the wicket behind me (three poles standing at the base) and just tried to hit the ball thrown at me by the bowler (the pitcher in baseball). I managed to hit a no-run ball a few times, and one when I was told to run and exchange places with one of our team players standing next to the bowler. Run I did. My Indian colleagues seemed to be enjoying the game, some of them shouting words that didn’t mean anything to me, “5 balls, 7 runs”, “over”, “four”. I didn’t know what was happening but at least I knew who were my team mates. I cheered for them regardless if it was called for or not. My team lost the game, how and why I had no inkling at all.

After breakfast we went to the session hall, located in the basement of our hostel, to play Tambola. This time, because not every one knew how the game is played, there was an instruction. Cool. What I couldn’t understand was why D who directed the game after every number was called, kept blowing the whistle with great intensity in a large almost empty room that a whisper would be amplified ten times. I was sitting next to him. Remember that there were 90 tiles to be drawn, winner emerged only after one managed to block out all 15 numbers in his/her ticket. There was no winner until the 85th tile, that meant 85 times he blew the whistle. If ever I won, the prize wouldn’t have been enough to pay for the ear doctor.

When one round of Tambola was over, F and I ran an activity on communication. We divided the group into 3 and asked each of them to complete their puzzles as quickly as possible. We were given an hour for the entire activity, including a short discussion afterwards. Half an hour passed and the teams were still struggling with their puzzles (for kids aged 3++). What made it difficult was we had the pieces mixed up, and didn’t tell them, so each team needed to negotiate with another if they wanted to complete their puzzles. The activity took longer than expected because no one wanted to stop. No amount of whistling from F helped, they just did what they wanted to do. Everything I learned about facilitation of group dynamics exercise vanished. Well, they were having fun and it was a rest and recreation for them. Just go with the flow.

The power was on and off the entire day, towards the afternoon the sky dimmed and it started raining, the bonfire in the evening was out of the question now. Other plans changed as well and I didn’t know why. Going to the local market was not in the to-do list but after lunch we went anyway, it being Yelagiri’s market day. The market day meant producers from all over the town assmebled in one place. We saw enormous jackfruits and homemade honey, other than that there was nothing to fancy.

It seemed like we were taking each hour at a time, did whatever was convenient at the given time. From the market we proceeded to Nature Park, though the YMCA compound where we stayed looked more natural . It was basically a huge fenced garden with few benches and a tea stall. The fun thing to do was skipping your way around the park dodging the sprinklers which were all turned on the time we visited.

We wanted to check out a waterfall downhill but from where we were standing we could not see water falling. A visit to Wikitravel confirms that April is not a good time to see the falls, which I just found out is called Jalagamaparai. In fact any time of the year may not be a good time because again, according to Wikitravel, there has been no water in the falls for the last five years.

Power was still out when we came back to YMCA, right in time for tea. I had no idea what we’d do next. I don’t know if it’s because my colleagues spoke Tamil most of the time that I could barely make out what they were discussing. I had a copy of the 3-day program with me but that seemed to be completely useless at the time. Obviously the plan was being revised every hour but no one would explain to me and F unless we asked. And often, even if we asked the reply we’d get was “polama” (let’s go) . When it got dark, I followed some colleagues as they walked towards the chartered maxi-cab. K, the ever-efficient staff was counting the people standing next to the vehicle, next thing I knew we were boarding the maxi-cab to go back to the market. Oh well, I could use another bottle of Sprite and a bar of Kitkat.

May 1. Back in the field at 6:30, tomatoes and water in sachets were laid on the ground like a maze, the original cricket players were there. We would play a game called Boys versus Girls (i wonder if there was any debate before they arrived at the best name for the game). Only one person knew what was the game about so there was an instruction in Tamil and English, thank goodness. All men in one team, all women in another. One at a time, a team member was blindfolded, the rest of the team will guide him/her through the maze. The objective is to get to the other side of the maze without stepping on the tomatoes and packets of water. Men scored 3, we scored 2.

To my delight, there were very specific instructions today. After the Boys versus girls, there’s breakfast, “pack all your things, we meet at nine am”. “Where do we put our bags?”, asked F. “Pack your things and I will tell you later”, was the reply. Aghh, was it too much to ask?

Someone said we’d depart at 9, but we gathered at the basement instead. Half of us were already there, the other half… waiting..waiting.. faces gloomy now. Half an hour later everyone finally came. there was an awarding ceremony for the game winners. If I knew it, I would have joined more games. (I missed the volleyball match). Then time to go, move out, go for boating and a biryani lunch on the way back to Chennai. The trip back to the city was uneventful, and so was the waiting before we actually left YMCA. For a good one hour we were just sitting inside the vans waiting…waiting… by this time I no longer cared what was keeping us.

I didn’t pack a good amount of patience from home, being here in India however the little supply I have seemed to be multiplying on a daily basis. Months of being here taught me that there is no sense of urgency here. I think this is what is meant when they say life is slow in India.

The other thing is lack of fluency in the spoken language inhibits me from fully grasping t the minute details. I feel my colleagues have become well acquainted with me that they tend to forget I can’t understand their language, without meaning to exclude me from any discussion.

As a volunteer i know that in some ways i have to create a flow, but there are times when the best thing to do is to just go with the flow. It makes life bearable and i don't miss the fun.

health insurance for people with HIV

What insurance company will not insure people with HIV? One that does not understand the virus and the people living with it.

A month back I was called by my line manager to his office, we discussed about health insurance project that my organization implemented last year and their intention to continue and expand the project. The previous project was in collaboration with two non-profit organizations, donor agency and a private insurance company. An insurance product was developed specifically for people with HIV with CD4 count not lower than 300. As we know it, insurance is never free. The project allowed people living with HIV (PLHIV) to pay half of the Rs1,500 annual premium ($34), the other half was shouldered by one of the partners. Through this more than 1000 PLHIVs were able to avail of a health insurance.

There are about 2.3 million cases of HIV in India. PLHIVs need this insurance because although Anti-retroviral treatment (ART) is covered by the Indian government, it is not the only health-related expense they have. Eighty per cent of health expenses in India are out of pocket and only 20% is covered by the government; a household with one PLHIV spends 3 to 6 times higher than the general population because of opportunistic infections as a result of their weakened immune system.

I need to help the project manager extract from our MIS relevant data to determine mortality and morbidity rate of the people with HIV. A meeting with the one of the partners weeks later made the data requirements clear and for what. We need to produce numerical evidences that will convince insurance companies that designing health insurance product for PLHIV is feasible. The partner wanted us to determine the life expectancy of a person living with HIV.

No insurance company with all its business sense intact will offer any product to individuals with already one foot in the grave. This is the challenge we have, to prove that people with HIV are not dead people walking and are still viable clients. But none of us in the organization has the expertise to calculate life expectancy and will require resources to get people to do that for us. The partner was rational enough to accept our proposition that the organization will produce substantial information to establish evidence that people with HIV don’t just drop dead the minute they contract the virus, and in fact can survive many more years with adequate health services.

I don’t blame the insurance companies for their ignorance of the virus. For almost three decades now there is still the stigma that accompanies HIV and the mistaken belief that it is the same thing as AIDS. I, myself, was guilty of that. It was only after meeting people with HIV in the Philippines and hearing their testimonies that my perception changed.

As the project is yet to begin I don’t have the figures to show that there are so and so number of people who have been living with HIV for the past 5, 10, 15 or 20 years. But I do know of Indians, real people who were infected with the virus and yet looking haler than I am.

There’s Senthil, the person I mentioned in my previous post. When he tested positive for HIV some 8 or 9 years ago his CD4 count was 14. He was ready to die. But upon detection of the virus his doctor immediately put him on anti-retroviral therapy, started having proper nutrition; his CD4 steadily rose, now at 800. He is now one of the most active and most committed members of the PLHIV network. He is featured in educational poster wearing a suit and looking suave.


Nandhini was a staff of the organization, a chubby woman who ambled in the office everyday dressed in her smile and colourful sari. One day I saw her with great effort and almost distorted face, taking milk curd. I could emphatise with her because I don’t like curd. “What’s that?” I asked. “Curd, curd, increase CD4”. Had she not divulged to me her HIV status I wouldn’t have guessed at all. She contracted the virus over 5 years ago. She said she maintains her CD4 count above 1000, lower than that and she could get cancer. Consistent with my role in monitoring and evaluation, every week I would ask, “CD4 count?” And she would proudly update me with her progress, last I heard before she resigned from her job to attend to her store her CD4 was 1300.

There’s also N, another staff. He is not as open about his HIV status like the others but he religiously nibbles on amla, a yellowish round fruit with an acrid taste, rich in vitamins and helps increase CD4. (I know because they made me taste it. Oh, they will make me taste everything.)

Of course, there’s the indefatigable KK. Abraham who founded the network with Ashok Pillai and 10 others, back in 1997; he remains an active advocate for the rights of “positive people” (this is not the politically correct term, I must admit). And oh, the first man in India, who was identified to have HIV back in 1986, just passed by as I wrote this! He’s gained weight since the last time I saw him.

There are so many others I’ve met whose names are too difficult for me to remember or pronounce. One thing common to all of them is they are all on ART, getting proper nutrition, living healthy lifestyles. They succumb to illness more often than sometimes. But many of us do, even sans the virus.

It’s premature to say whether private companies would agree to the creation of special health insurance product for these people. If any one does, it is not to say that it will become fashionable to be HIV positive, and it is not even an assurance that all of the estimated 2.3 million PLHIVs in India will be able to buy the product because majority of them are from low-income groups. But if something like this becomes available it is a step forward to changing the view towards HIV and the people living with it. I believe it will, aside from ease the burden of accessing medical services, significantly reduce the stigma that accompanies the virus considering that insurance companies are very prudent in choosing their clients. It should also boost the morale of people with HIV who have not only suffered from discrimination from others but also from self-stigma. And as insurance becomes available, more people may have the courage to get themselves tested, and if positive can come out, disclose their status, get counseling and advices, help prevent possible transmission.

I may be dreaming now, but that’s where many realities start anyway.

photo posted with permission from senthil

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Remembering Ashok Pillai (1968-2002)

My online chatting with a good friend, Yhen, in the Philippines, was interrupted by a colleague in my organization. He said we were going to the meeting hall for five minutes of prayer. The immediate thought that came to mind was that one PLHIV has just succumbed to AIDS. I have come to learn here that when a member of network passes away due to complications of AIDS, they pause for five minutes of prayer to pay their last respect and then get back to their busy schedules. There is so much to do that if they take days to grieve for a late PLHIV will mean a lot of time taken away from those who are still living and striving to survive.

In the meeting hall all the staffs were gathered, on an oval glass table were two photos. One was a poster of a tall and fit young professional, in polished black leather shoes, slacks and white buttoned shirt and suspenders, hands in the pockets of his trousers, flashing a big smile his back leaning on an invisible wall. The poster said, "i'm 31, i have a successful career, i work out in a gym, i love to dance, i miss my flight sometimes and i have HIV for the last 11 years". The other is a framed portrait of an older man who seemed lost in thoughts, with just a hint of a smile in his face. His hands were clasped under his chin.

I've not met these two men but i have become familiar with their faces because both the poster and framed photo were displayed in the meeting hall. I knew that both men were living with HIV but i didn't know that the one in the poster and the other in the picture frame was one and the same man. The pictures were taken two years apart but there was a sharp contrast in his miens. It was Ashok Pillai, one of the founders and the second president of Indian Network of People Living with HIV (INP+) who passed away on April 19, 2002. In 2000 Ashok Pillai was very healthy, but the virus eventually damaged his immune system entirely. At 1 pm on that day in 2002 he had a seizure while working at his desk and perished at 4:30 pm. He was 33.

I soon realized that we were commemorating his death. Senthil, the vice president of INP+, himself living with HIV for the last 8 or 9 years now gave a short speech in Tamil about Ashok Pillai, then he invited everyone to bow our heads and say our silent prayers. ( As an atheist, i couldn't pray, don't know how to pray but i bowed in silence as well). Then each of the staff were handed white candle for us to light and offered to Ashok Pillai. (I think that was the meaning of it). Senthil asked one staff to say something about Ashok Pillai in English, for the benefit of us two VSO volunteers.

Bit of what he said: "I have heard of Ashok Pillai and I didn't know what he looked like... When I joined INP+ i was led to what was going to be my desk, I was told that it was Ashok Pillai's. It was where he worked and died. At the time Ashok Pillai died anti-retroviral therapy (ART) was already available in India but not for free. ART then cost from Rs15,000 to Rs.50,000. Although he could afford it, Ashok Pillai refused to take ART even when his CD4 count dropped to and all-time low of 10, and vowed that he wouldn't for as long as the government was not giving free ART to millions of Indians with HIV who could not afford the cost. Seven years after his death, with continuing advocacy efforts of INP+ about 2 lakhs of the members (200,000) are getting free ART from the government."

The staff then sang solemnly "we shall overcome, we shall overcome one day. we shall overcome, i do believe in my heart we shall overcome one day". The ritual ended with sweets distributed to all the staff.



file photo from INP+