While she was working at the United Nations, a coworker once asked Dr. Ruth Bamela Engo if she would give $50 to support a child with AIDS in Uganda. Yes, "I could give $50," she recounted to her audience of Tufts students at a lecture on Oct. 23, "but then what?" How much would that money do for one child? And how much would it do for the millions of other children with AIDS or orphaned by the disease? Was it the best way to empower people?
Dr. Engo decided to give $50 and then sponsor five African students through boarding school and college. Years later, she met them: a lawyer, an accountant, a deputy director of an orphanage and a carpenter.
Today, this practice of investing in children and their education so that they, in turn, can invest in themselves has evolved into African Action on AIDS (AAA). Dr. Engo is president and executive director of the organization, which builds on existing extended-family support networks to provide food, education, healthcare and security to orphaned children. During her lecture, it became clear that Dr. Engo turned her belief that "no one is alone: When one parent dies, 10,000 will rise up" into action.
The organization currently supports more than 1,000 children in countries including Benin, Burkina Faso, Cameroon, Ethiopia, Mali, Senegal, Sierra Leone and Tanzania. Since its inception in 1991, AAA has enabled more than 2,000 young people to complete six years of schooling and 50 to graduate from college or other vocational training.
After 20 years of working for the UN Department of Economic and Social Affairs and a decade of being Director of Labor in the government of Cameroon, and after starting and running a non-governmental organization, Dr. Engo finally made it over to Barnum 104. She gave the final lecture in the Luce Seminar Series on Science and Humanitarianism Oct. 23 on the importance of safe water, sanitation and hygiene for the prevention and treatment of AIDS.
In her lecture, Dr. Engo declared that every generation has a challenge, and "the challenge of this generation is to survive." To do so, she explained, means that individuals, communities and countries must fight the AIDS epidemic at multiple levels and with consideration for people's general environment: Do people have access to clean water? Are there latrines in the community, and do people use them? Are children encouraged to wash their hands after going to the bathroom?
The answer to these questions are related to AIDS: Safer sanitation and hygiene practices are not substitutes for anti-retroviral therapies or condoms, but with better general health, people are more able to resist illness and support others fighting it, Dr. Engo said.
In an interview after the lecture, Dr. Engo explained that, while the conditions in which people live are always key to ensuring general health and well-being, improving these conditions in areas affected by AIDS is especially important. People with AIDS and orphaned by it are typically more susceptible to malnourishment, sickness, discrimination and abuse. HIV weakens the immune system, hence the high rates of co-infection of AIDS and tuberculosis. Minimizing exposure to water-carried illness or infection is one important way to protect the immune system.
Of course, poverty, poor governance and weak infrastructure limit how much any individual, community or organization can do in the fight against AIDS. Yet Dr. Engo's vision is to empower people to make small differences in what they can control.
For example, AAA's "Just Know" campaign encourages people to be well-informed about HIV/AIDS and their own statuses and to maintain a positive attitude and practice safe habits. Dr. Engo explained that knowledge about the disease, which she called "the only pre-infection vaccine," brings confidence and understanding; it is the first step in stopping the spread of AIDS.
In addition to the "Just Know" campaign, the organization hopes to get today's youth thinking about the future in an effort to encourage better health practices now. To get people to visualize and eventually carry out their own safe actions, AAA asks young adults to write letters to their future children: The letters might explain that the young adults got tested for HIV before engaging in sexual activity.
Beyond addressing individuals, AAA changes people's physical environments through actions such as building latrines in communities. The organization aims to make safer water use possible and the norm.
Dr. Engo's group also works to reduce the stigma surrounding AIDS, a stigmatization that she says has real health consequences: Out of fear of discrimination or ostracism, many people do not get tested, disclose their status or treat the disease if they have it. The UNAIDS "2006 Report on the Global AIDS Epidemic" states that successfully fighting the disease "depends in large part on ... [changing] the social norms, attitudes and behaviors that drive it."
As Dr. Engo noted in her lecture, one strategy to reduce stigmatization is to hold conferences where people with AIDS, AIDS orphans and people unaffected by the disease can get to know each other. Through stronger immune systems and social networks, people will be more active and able to resist sickness, regardless of HIV status. Dr. Engo pointed out that reaching a "minimum common humanity level" for access to clean water and sanitation are important in a world where an estimated 38.6 million people are living with a preventable disease, according to the World Health Organization.
Additionally, Dr. Engo explained that a sick population demands more from public services and contributes less to economic development; thus, the more people who are able to resist debilitating diseases, the stronger the country will be as a whole. It is a positive cycle, currently spinning in the opposite direction in sub-Saharan Africa, where approximately 24.5 million people have AIDS, including 2 million children under age 15, according to UNAIDS.
At the UN World Summit in September of last year, world leaders promised to increase HIV prevention, treatment and care programs. But it is difficult to keep up with the 1,800 new children who are infected daily (most of whom are newborns in sub-Saharan Africa, according to the "2006 Report on the Global AIDS Epidemic") when political leadership is insufficient, prevention programs are weak, late or short-term, and people have limited access to testing services and anti-retroviral therapy.
Yet Dr. Engo's efforts have made a difference, and her first step was to reject the "doom" presented in such statistics and newspaper articles that focused only on decimated villages and over-stretched hospitals. "The world is the way it is today because people don't know their own power, don't know that they're the starting point of governance," she said.
According to Dr. Engo, all people can be actors, not victims. Her vision for the future has already encouraged people to take matters into their own - hopefully washed - hands.
