The Breathing “K”

What’s the difference between a guinea fowl and the possessive “my”? It’s the “h” that comes right after the “k”. Spoken language not uncommonly includes sounds that are not indicated in the written form. The “h” after the “k” is one such sound in English. Put the back of your hand right up close to your open mouth and say the word “Coke”. Feel the puff of air against your hand after the “c”? That’s the “h” (unwritten in English) that follows the “k” sound. “K” sounds in English when followed by a vowel, whether represented in writing with a “k” or a “c”, have that “h” behind them. We learn it as a part of the “k” sound without ever being told it’s there. So it doesn’t have to be written. “K” sounds at the end of words, however, such as the “k” in “coke” may or may not have the “h” after them! (Bruce doesn’t, Beth does. How about you?) And we learn that (whichever way we do it) without being told either.

For Chichewa, however, the national language of Malawi which we are learning to speak, there about as many “k’s” without the “h” as there are with it, even in the middle of words, and all are followed by vowels. So when a “k” appears you have to indicate whether you want the “h” with it, or not, (and, of course, say it) and the difference can be crucial. For example, the word for guinea fowl, nkhanga, has the “h” after the “k”, but an almost identical word without the “h” is one of the eight different ways you can say “my” or “mine” in Chichewa. (Yes, eight different ways, each with its own particular place! But that’s another story.) If you’re not getting the “h” right, though, there always the “n” before the “k” in nkhanga to distinguish “yours” from the fowl. But that’s another story too.

So try saying both “k” sounds in “coke” (or “cake”) without creating the puff of air which follows. I call it “swallowing” the “k”. You simply put the middle of your tongue up against your palate and pull it off just before making the vowel. It’s almost a quieter form of the cuckle or click you do when you pull the front of your tongue sharply away from your palate, and just one of a wide number of new sounds we’re learning to make. Instant regression to one year old! But also a reminder of the terrible frustration that must come to little ones when their sounds are not understood. It probably won’t take us 2-3 years to be saying sentences, understanding and being understood, or will it? Please pray that it won’t.

The Lava Bugs

I was staring at the ceiling reciting a sentence from the “opening prayer” I am memorizing for use on Sunday morning (in Chichewa, of course), when an ill-defined shape on the ceiling caught my attention. It looked somewhat like a balloon, maybe six to ten inches in diameter, somewhat ovoid, somewhat transparent with a fuzzy demarcation of its outer limits, and it “oozed” its way around the ceiling. As I watched several other blobs with ill-defined borders appeared and disappeared. Some moved faster than other, some even seeming to dart, while most seemed to slide or roll, “ooze” is the best way I can say it, around and around.

It rained today, very, very hard. And some of the stains on the ceiling are a little larger than they were this morning, so I thought maybe I was seeing bubbles easing through a reservoir on the other side of the sheetrock. But these shapes moved forward and back, and always in somewhat of a circle on the ceiling. I then began searching for the source of the circle, as I realized these were shadows, and saw the bright light in the middle of the circle criss-crossed by lines, with a somewhat lesser light fading away from the darker circle in which the shapes moved. I was looking at the projection of the lampshade on the ceiling.

We (Beth had joined my observations) have recently been invaded by little orange beetles with pearly blue-black wings, and with today’s rains they had renewed their efforts to take our house by storm. At least thirty of the pesky little critters ( their wings work, but their flight paths are not always in agreement with those of us who presume that we manage the house) were crawling all over the lampshade, and those who walked on the upper rim were well-illuminated against the ceiling, magnified many times.

The projection on the ceiling reminded of those “lava” lamps whose oil and water contents (or whatever it is) are in constant flux. But our lamp had no such features. Just little orange bugs, like most of the rest of our living room (including the computer screen, and keyboard, and the front of my shirt, and sometimes the back of my hand. They really look wild walking across the upper rim of my glasses. No, I don’t eat them—see our newsletter at www.HIVemSA.org.) We laughed about our immediate choice of entertainment, perhaps excusable what with a limited selection of books (though we haven’t read all at our fingertips), no movies (some are on the boat), and an extremely intermittent and slow-when-its-there internet. But do we really need an excuse for enjoying the “nature show” projected on the ceiling while we work on Chichewa. No, we’re not going crazy, just making do quite nicely with what we have while being encouraged to work on what we’re here for.

Tiwonana (see you later)

Nsima and Finger Bowls—An Inadvertent Compliment?

I noticed it first in the gas station. I’d gone in to buy water while adding a little diesel to the truck’s tank (yes, large bottles of potable water are sold in the gas station next to our favorite spot for doing internet), and the clerk stood up with an ear-to-ear grin to ask me in Chichewa if I wanted to buy water. Then at the airport the next afternoon, the agent at the fee booth rattled off a string of Chichewa phrases when I walked up to pay. In both cases I’d told them at a previous time that I was studying Chichewa and asked them to correct me if I made a mistake. I’d even carried on a considerable conversation at the fee booth at the airport, telling Joram (I remember his name after the third or fourth time) a little about my children, grandchildren and wife. Both had remembered me the next time I returned, and were taking me up on my implicit offer. I was studying Chichewa, and they were going to take their chance to teach me a thing or two. They both stretched me, and that was good. Thanks to the LAMP system devised by Dr. Betty Brewster of Fuller Theological Seminary, and her now deceased husband, the world is becoming my teacher, and the rest of them are enjoying it a little more than I am. But this is good.

The supreme compliment came at the airport restaurant, however, a place we’d also frequented to send an e-mail or two (no, we don’t have any internet access at our house). We’d also talked with the waitress a time or two, and she probably also remembered that I was studying Chichewa. I had ordered a vegetable curry with Nsima (a large patty of finely ground corn meal mush boiled down to a solid), while my friend had ordered the same curry with rice. When the two came, they didn’t look much alike at all. On his plate the curry was on a bed of rice which rose around the curry in a protective surrounding mound with cole slaw sprinkled around the outside. My vegetable curry came as a stew-like dish laid to one side of a normal dinner plate, with a relatively small amount of broth. On the other half of the plate were two slightly overlapping mattress-shaped patties of nsima. But the big surprise was that my friend had a fork and knife wrapped with a napkin, while I was brought only a rather large fingerbowl. I was expected to eat with my fingers.

Traditionally, nsima is eaten with the bare right hand, scraping off a small portion from the patty on one’s plate (or in the large central common bowl for the table) rolling it around the hand into the correct shape (or until it loses enough temperature to hold still, at least in my case), then opening a hollow in the ball with the thumb into which the vegetables and sauce of the curry are pushed before shepherding the whole mess to your mouth. Every three of four morsels it is necessary (for me) to rinse my hand in the bowl that is provided, or lick my fingers, though finger-licking is probably less acceptable in Malawi than in the US—I’ve never seen anyone else do it.

I’ve eaten nsima with a fork before, just last week at a banquet at a hotel was the last time, and I think all the others at the table ate it with their forks also. And while the airport restaurant is not quite as nice as that at the hotel where the banquet was held, “niceness” wasn’t the point. Nsima is a finger food, just like fried chicken is in the south and much of the rest of the U.S.A. So my waitress had assumed that if I wanted nsima that I would want to eat it the normal way, with my fingers.

We actually don’t eat that much nsima. This is only the third time I’ve had it since I’ve been here, which would say to most Malawians that I am extremely deficient somewhere, perhaps between the ears: nsima is eaten at every typical meal. Malawians often say, “Nsima is food. Whatever else you have is just relish." If you haven’t had nsima, you haven’t eaten.

I really can’t say for sure whether the absence of a fork and knife had anything to do with my language learning, but I like to think it did, that as the others have appreciated my efforts, were willing to include me, to stretch me, this waitress was also willing to include me, to treat me “normally” to serve me nsima without a fork. I would eat with my hands just like her father, her brother, her husband, and her sons. Just like she would. And that in itself is a little encouragement (I’ll take it where I can get it) to get back out there and play the two year old in the community, stumbling over words and laughing with all the others at who-knows-what I’ve just said. And, God willing, it will come.

Tiwonana (See you later!)

Slammed by Technology--But Why???

With tele-medicine and the world wide web transforming the way business is done across the globe, including patient care, access to such marvels is of course of interest to us. Our own access to world-wide communications is multi-media: not really, it just seems that way. Actually, all our eggs are in one basket. It’s name is Zain, and for us it’s three cell phones.

One of the larger cell phone groups here in Malawi, advertised in a daunting hot pink color, offers a variety of services. First, the usual cell phone package. Though I’ve been told monthly contracts are available, almost everyone buys time as they go and adds it to their account via the self-same cell phone. The cost of a local call is not too bad, but calling the other end of the country can be costly, and calling the U.S., it’s prohibitive.

When I tried to call the States a few days ago, I went through most of my $10.00 allotment in just a very few minutes. We didn’t put a stop-watch to it, but we estimate the rate at $2.00 to $4.00 a minute. And when we called our colleague on the other end of the country (we’re talking about less distance than LA to San Fran.) the same sum disappeared in about 20 minutes. We were thus relieved to learn from that same colleague, Mark Thiesen and his wife Era, of a service in the US whose rates are about $0.27 per minute. I think we can live with that.

GlobalPhone pulls it off like this. You call on your phone to a US number and let it ring once, and only once, and then hang up. Detecting the “missed call”, the machinery on the States-side calls you back (at low-due-to-competition U.S. rates) and asks for the number you want, and then proceeds to connect you. They deduct up to a pre-authorized amount per month from your credit card at a fraction of the cost we’re now paying.

Zain, our current one for all, also sells modems which plug into your computer with a USB connection, but actually are their own little cell phones. When you connect to the internet you first plug in the modem and “activate” it via your computer, and voila! You’re connected! The neat thing is that it appears that the machine only counts units when you’re actively down-loading. So, connection is not a costly thing unless info-packets are actually coming down or up the wire. But you have to watch your account balance. Again, we buy about $10.00 worth of units (about 1,000 units) and “load” them via our computer. But they can run out. And the modems are decidedly not fast. (The estimate on downloading a printer driver for the printer, which was already here and driven by another computer e’er we got here—was 4 hours. No thank you. We’ll be talking about a disk with the next visitor, Jeremy.)

Needing to contact several of you whom we’ve invited to partner with us in our our project around transportation, and hearing of GlobalPhone, we fired off an application via internet, received a confirmation request asking for photocopies of identity documents to be faxed in. We got that all ready, ran down to the airport and sent those in last Saturday afternoon (at almost $10.00 per page, mind you!), and wondered when they’d get it up and going. Well, GlobalPhone apparently honors the Sabbath and Sunday too, because it wasn’t until sometime Monday that our e-mail came in with some important little access characters. We were in business, at least for a while.

So, we dashed off a test call of a very few seconds to our missions minister, and it worked! (Mark wasn’t sure that cell phones would handle it.) Then we called “one of you”, only to find you out to lunch, but coming back in 30 minutes. It’s bed-time here, mind you, but around noon where you are, but we’re going to get this communication thing worked out. We had some questions about our tax return, so we rang up the accountant and hashed through all that. Wonderful, though near the end of the call a pleasantly haunting voice chimed in: “You have only one minute remaining.” And then it got dicey.

I’d promised your assistant I’d call “you” back, and I’ve been trying to get in touch with you for weeks. We last talked three weeks ago, two weeks before I left the States, and we’ve played quite a bit of phone tag, so I didn’t want to be cut off in the middle of the call. Beth and I searched for the paperwork about the system. Somewhere it seemed I’d read something about security systems and “pro-rated rates of use”. Never found those explanatory papers, but did find an invitation to call a U.S. 800 number or fire off an e-mail if ever we needed a little more cash on our account. Now our internet modem is down to 37 units, about out of gas. We finally got into the new telephone account's information over the web. We’d spent four dollars of our fifty for the month, but we had only $0.31 available. (And only 3 units left of internet.) Security!!Call "you" and risk getting cut off . . . or call customer service for GlobalPhone. We chose the latter.

I heard the ring indicator sound on the other end and I hung up. About 10 seconds later the phone began to vibrate and ring. I answered, dialed the 800 number on prompt, and then that haunting, sweet voice: “You have less than one minute.” A menu is presented, another menu.Surely they won’t hang up while I’m asking them for access to a few more of the dollars I’ve already paid them! A voice comes on the line, “How can we help you?” overlapping at the end with the haunting lady: “You’re out of time. Click.”

Tomorrow I can run by the airport, literally, unless the driver brings the other key fob back in the morning. The keyless entry/security system on the pick-up has a dead battery. We got into the car, but can’t start it without a working “clicker”. (Now you see why we need transportation.) (As it turns out, though the keyless entry is weakening, I had left the lights on Sunday, draining the battery. Someone else is lamenting shared transportation.) At the airport I can pick up internet minutes and contact GlobalPhone, and maybe I can call “you” tomorrow night. Or maybe not. We’ll see. And we hear broadband is coming this year.

[We finally got in touch with "you", and you sent sent us $1500 toward the vehicle we will need. Thank you so much for your generosity, your patience, and your care for what we are doing. And, we've talked with folks who think they can reach us in six weeks or less with 1 megabyte/second internet speed at rates comparable to the U.S. Yes!]

Mentors in Missions: A Tribute to Henry Farrar

I was about 14 and had decided I would be a physician. My seventh grade science teacher (and my Sunday school teacher) Margaret Beene had told us about her aunt who had a strange, little-understood disease called scleroderma in which the skin, inside and out, hardened to make the affected organs barely functional. In one form fingers could be resorbed from the tips due to the pressure of the skin on the bones, and internal organs such as the digestive tract and heart had major functional problems as their own “skins” hardened. Then Mrs. Beene got the disease, and I was going to find a cure for it: I was going to be a doctor.

We had traveled 50 miles from our small town to Tyler, the closest thing to a city nearby, to attend a service of an evangelistic meeting at the Omen Road Church of Christ. We met some friends, Howard and Betty Waldrip, there and were going to their home for a bit after the service. My parents had split up to assist in finding the Waldrip home, and I had ridden with the ladies. We were sitting in the parking lot about to head for their house when Sister Waldrip turned to me in the back seat:

“What are you going to be when you grow up, Bruce?”

“I’m going to be a doctor,” I answered from the back seat.

“And be a medical missionary like Henry Farrar?” she queried.

I thought, “No way! I’m going to do research and find a cure for Mrs. Beene’s scleroderma.” I had no idea who Henry Farrar was, but I was pretty sure that the kind of research I wanted to do and medical missions didn’t go hand in hand. But a seed had been planted.

A few years later my older sister married a latino evangelist, Victor Rodriguez, and the idea of missions came a little closer to home as they discussed possible work in Spain or Latin America. The seed had been watered just a little, and was ready for the warm sun of the missions youth rally which my dad organized. David Gatewood, already working through forays behind the “iron curtain”, spoke along with Kenny Sinclair who was finishing graduate work toward a long life of service in Malaysia, as well as a young lady whose name now escapes me. On a card that bares David’s name, along with that of Maurice Hall, I pledged a life of medical mission service to Spanish-speaking people. The seed planted with the name of “Henry Farrar” was germinating.

Dr. Farrar continued to appear in my life. First, on arriving at Harding and discovering the library, I read about him in the Christian Chronicle, his establishment of the Nigerian Christian Hospital, and the troubles that institution had during the Biafran war. I heard stories of his making his way through war lines to check on the hospital and serve the people he loved, of slipping an old, invalid passport with an otherwise valid visa inside a new passport that lacked those stamps and signatures and by God’s grace making it work, getting through to do God’s work.

Most recently I’ve been impressed that Dr. Farrar has read and can discuss in detail or is even teaching from every book that I’ve read or been recommended on spiritual growth and development. His mind is still racing to know and to live under the lordship and teaching of Jesus Christ. The arthritis that has bent his tall frame in recent years belies the sharp mind that operates behind eyes keen once again after cataract surgery and under the blooming almond tree of white hair that foretells the wisdom to come from his lips. But his intelligence, sharp as it is and has always been, and his wisdom pale beside this man’s most marked characteristic, his faithfulness, the incredible trust that Henry Farrar has in his God, the Father of us all, and in Jesus Christ, our model as God’s only son, himself a medical missionary, as Henry has always reminded us.

I’m pretty sure Dr. Farrar was present at the first Medical Missions Seminar held by Churches of Christ in the fall of 1968 or the spring of ‘69 at Harding, though his quiet demeanor pales in my memory beside Joe Cannon’s more bombastic faithfulness and charges to physicians on that occasion: “You don’t go to the mission field because you’re worried about your 401K’s and your retirement funds. Why don’t you work until you’re done and then just die and go to heaven?” If it was Joe who said it, Henry Farrar has lived it. The closest to a word of complaint I ever heard from Doctor Farrar was that he was “underworked and overpayed” when he returned to practice in the States. I know nothing of his financial affairs, but he educated several children, one a surgeon, one a doctoral level RN, and one a missionary, and he has continued to give liberally to others who work faithfully in Nigeria and other places. Money never seemed to be a concern of his: the Lord cared for him and for others through him.

At other medical missions seminars that unfolded over the years Henry encouraged successive generations of candidates to just finish medical school and get on the boat, go to the mission field. He seemed to disdain the urging of others to study culture and language, which they said was necessary so that inter-personal ministry on the field could be enhanced. But when my wife and I spent a few weeks at his hospital during my senior year in medical school, staying in what had been his home, I was pleasantly surprised to see an Ibo grammar as one of only two or three books remaining on the bookshelf of the mostly empty house. And he was not just respected in that part of Nigeria where he worked, but truly loved by the people there. He had not ignored language or culture, but his gentle servant spirit, his personal sensitivity, had been the primary catalyst for developing close cross-cultural sensitivity and relationships.

I think Dr. Farrar’s “get with it” advice may have been motivated by the fact that more than 90% of those who said during pre-med years that they were going to do medical mission work ended up in a private practice in the U.S., never doing any long-term work. The acculturation to American private practice and its seemingly intractable pull on mission candidates was probably discouraging to Dr. Farrar, and it remains a challenge to the needs of medical missions around the world. Henry’s practical answer was “just do it”, the sooner the better.

When various circumstances suggested that the Farrar family return to the States for an indefinite period, Dr. Farrar flexibly “reinvented missions”, leading a wave of itinerant service by multitudes of physicians and surgeons, beginning at Nigerian Christian Hospital and expanding to numerous other facilities, a growth that continues today among some perhaps ignorant of its original inspiration. It is probably not an overstatement to say that these methodologies, itinerant surgical missions, owe their practice in Churches of Christ to Henry’s need to be here and be there, a need he has heeded up until the present. Thus he was able to not only continue to meet his own family’s needs and serve in Nigeria, but also to involve many of those who had said they would go, only to find themselves somehow unable or in some way unsuited after finishing their residencies. At least in some sense, a sense that has been a blessing on both sides of the service, the seemingly betrayed intentions of many have been fulfilled through imitation of the latter part of Dr. Farrar’s life, and not uncommonly through his personal invitation.

The influence of Dr. Henry Farrar in medical missions in Churches of Christ would be difficult to overstate. Though he is probably too humble to say the words, what he has done and the Christ-like spirit with which he has done everything cry in the words of the apostle for us to “follow me as I follow Christ”. It is at least fair to say that none of the rest of us might have ever been there had he not gone, so that Sunday school teachers, visiting missionaries, and Bible professors across the nation could invite those of us considering the practice of medicine to be medical missionaries “like Henry Farrar”, and thus like Jesus Christ.

P.S. Dr. Farrar fell Tuesday morning on arriving at his work, suffering a concussion and a fracture of his first cervical vertebra. He has awakened and is lucid and communicating, but is paralyzed from the neck down and is unable to breathe on his own. The family appreciates your prayers.

Any errors in the above stories are mine, as I remember them.

Margaret Beene lived to be 90 years old by the grace of God and the good care of many able physicians, some of whom she surely outlived. She always encouraged my decision to be a medical missionary, to the last years of her life.

Shame: HIV, Death, and the Body of Christ

He glided behind me as he passed the front desk. I didn't have to be there, and he didn't need to stop there, but he seemed to avoid being seen. Somehow I knew he was my last patient of the day. We hadn't met, but as I perused his slim chart, it was evident there were problems. We'll call him Mr. P. The amount of HIV virus in Mr. P's blood had dropped, but not nearly as fast or far as it should have. There were suggestions that he had been on several medications since his infection was discovered, but the documentation was not all there. Then there were his current meds. All of them, nearly a month's worth in most of the bottles, had been last filled seven weeks ago: one bottle was nearly full, another was dosed at half the amount it should have been, and there was only one pill left of one of the meds. "And I don't get paid until Friday," he said from under the bill of his cap. "That's when I can refill it." Three more days. Missing a single dose of your HIV meds each month can increase the risk of resistance developing over the year by 10-15 percentage points. This man, like many of our patients, needed help taking his meds.

He looked to be in his 60's or 70's, but he said he was only 45. As we talked about his disease and what was going on, he wouldn't look at me. On several occasions I asked him to, and he did. Briefly. And then the head was down again, the bill on the cap shading his eyes, hiding his face from my attempt to know him.

"How has this disease affected your life?"

"It's affected me a lot. I'm angry. Angry a lot. I don't know how I got it," the voice spoke from behind the cap.

"Does anyone else know about your disease?"
"My sisters. They know."

"And they've handled that OK?"

"Uuuuh-húh. Oh-Kay. One of them is ok. One of them, she has me drink out of a plastic cup." There was a silence.

"And then . . . she throws it away?"

"Uuuuh-húh," the voice swung up in affirmation.

"But my other sister, she's ok. She feeds me. Lives across the road from me."

His brother-in-law had brought him to the clinic, the husband of the sister "across the road". Without lifting his face Mr. P affirmed that the in-law knew of his disease and that he would sign a release for me to talk with the brother-in-law and sister. I went over a number of things with them, separately, in person with the brother-in-law in Mr. P's presence, and then on the phone with his sister after he'd left. We talked about the CD4 lymphocyte, what that white blood cell normally does, how HIV infects it, then destroys it while diverting the CD4 from its primary mission of protecting us to the role of producing more HIV viruses. We talked about resistance, and the need for adherence to the medication regimen, the need to use a pill box, and possibly for someone to assist him. Then I mentioned to Mr. P's sister his hidden eyes.

"He won't look at me," I began.
"No. He won't look at anybody. Me neither."

"Has he always been this way, or just since he knew he was infected?"

"Just since he's been infected."

Then it hit me! He's ashamed! He's ashamed to be infected with HIV. He's so ashamed that he can't look at anyone. For those who don't know, he's afraid they'll learn, as if by looking into his eyes they would see deep within his brain the "HIV" in red letters, stenciled on the gray matter of his mind. For those who do know, he's ashamed. I was almost overcome with anger and sadness at this man's situation, this man who is now almost Gollum-like, shriveled and be-deviled, his "image-of-God" humanity defaced more than usual because of this disease, the way others deal with him because of the disease, and his fears of what he might receive. Head down he tries to hide in his own dark cave between the bill of his cap and the flaps of his partially zippered jacket. It may be that some of his shame is due to his guilt for how he caught the disease, but that is not my impression. Yes, few know, but of those who do, only two treat him well, treat him . . . normally. And he is overcome with anger, fear, and shame.

This shame, and the fear of it, immobilizes people around the world, keeping them from getting tested in a timely fashion when treatment is most affective and complications are least likely, driving them into caves of despair when they know they are infected, afraid of rejection, loneliness and death, not the stopping of that pumping muscle in their chests, but the death of their spirits through loss of interaction with the rest of us who've been imparted spirits from the One who is Spirit. These fearful ones have not known Him, except through those whom He has created, those He seems to have given life, and now the "living" will, thinks Mr. P, withdraw and leave him absolutely alone, dead. Those who claim to live forget that it is their privilege, their responsibility, at precisely this moment to offer life.

I praised Mr. P's sister and praised God in her presence because she is accepting him, affirming him, loving him, she and her husband. When I see him again I will inquire about shame and if it is confirmed I'll discuss the possible why's of it. If he is guilty, I will offer him the forgiveness that God has given me. "Your sins are forgiven you." "Neither do I condemn you. Go, and cease your life of sin." That is how the Lord dealt with shame. And he has sent us to do the same.

Meanwhile, I am saddened and angered by the way we are, "we" being what too often passes for church, community, and even family in this man's life. That which should be gracious, loving, offering forgiveness, even at the cost of its own life, but rather is too often, especially in this situation, proud, exclusive, condemning: polished, beautifully painted gift boxes full of dead men's bones. "If you were blind, you would not be guilty of sin; but now that you claim you can see, your guilt remains."

Lord, do what is necessary to open eyes, minds and hearts, to impart fear where it needs to be, and courage where it needs to be, so that this disease may be stopped not just in its destruction of bodies, but in its destruction of souls, its defacing of your image in those you made to bear it. Teach the church to be your body, courageous not only in righteous living but also in gracious offering of forgiveness, love and hope, that men and women may know they are loved by you, and can truly live in you.

And What About the Barber Shop?

The topic has come up at almost every seminar we've done: "What about the barbershop?" Do barbers, through their scissors clippers and other instruments for cutting hair, pass HIV? For many of us this requires some cultural awareness, if not sensitivity. The folks at our seminars generally have very short hair. Some of them shave their heads to avoid the problem of those little, curly hairs heading back toward their point of origin and causing all sorts of problems. And when folks get their heads shaved, they almost invariably get cuts. "Couldn't this spread HIV?"

Well, surely someone has thought of this, but I've never read anything about it. So in Zambia, in 2005, I went to the barber shop one afternoon in downtown Lusaka for a cultural awareness session. With the head barber's permission, I just sat there and watched two or three men get their hair cut by the same barber. Straight razors were not used, but clippers, electric clippers (there are also similar hand-powered clippers used in the bush) consisting of a row of tiny fixed blades coming to a not-so-sharp point, paired with a set of moving blades crossing over their fixed partners very rapidly. Think of 10-15 (I didn't count them) pairs of tiny, adjacent scissors with one blade moving really fast.

Now, these scissors, the blades on the clippers, are normally not just hanging out there. Usually they are separated from the scalp by a plastic guard which can be from either a fraction of an inch to several inches long such that they only cut hair. But, when the objective is a truly shaved head, then the guard must go. Now the blades are directly on the scalp, and any irregularities in that scalp might find themselves in the teeth. And so they do.

As the barber worked across the scalp, first using the shortest guard, then going over once leisurely without the guard, then carefully and tightly trying to get all remaining stubble off the scalp, I periodically saw the customer flinch, jump, express through total body language not unlike being electrically shocked his very short-lived but very evident pain at being cut. Usually two to three times per hair cut. When the customer was finished, after payment was made, the barber picked up a squirt bottle of purple liquid and sprayed the blades, then wiped them with a towel.

"Could I see your bottle?" I asked as he handed it to me. ("Methylated Spirits" it read, and I'm thinking quickly, going back in history and chemistry, "spirits" are drinking alcohol, ethyl alcohol, and the "methyl" is one carbon with three other hydrogens attached, so "methlyated spirits" would be isopropyl alcohol, what we call "rubbing alcohol", or the alcohol on those little pads that is used to clean the arm before you get a shot.) But is isopropyl alcohol deemed adequate for HIV prevention? No. [It turns out I'm probably wrong, with apologies to my professor of organic chemistry, Dr. England. "Methylated spririts" is denatured alcohol, that kind of drinking alcohol that's sold in shot glasses and fifths but with a little methanol, a highly toxic alcohol, added to it to render the ethanol undrinkable. But that combination is not recommended for killing HIV either.]

So ever since that day I've asked of the public health types who should know, and they've assured me that the barber shop is not a problem. And, we would probably expect more men to be infected than women if the barber shop were a significant source. Except that women also get their hair cut with the same kinds of clippers. In Swaziland we were able to ask the epidemiologist whose work was the first to show that circumcision was protective against catching HIV, leading to the current revival of circumcision (men are lining up for a 50% reduction in risk) in Africa. He assured us that the barber shop was not a significant risk, but he may have been distracted by his enthusiasm over shaving another set of heads. The problem is, I've never heard of a study where the question was truly addressed.

Then this year, in Tanzania, an Infectious Disease doc on the scene admitted that he thought it couldn't be brushed off so easily. It is for this reason that you can't get a shave in a U.S. barber shop anymore. At least not in southern California (I haven't asked here in Alabama). When AIDS hit, the cost of adequate sterilization of straight razors outweighed any possible benefit of continuing the services. And while the multiple tiny blades of the clipper may not inflict as deep a cut as the straight razor could, they can cut. They can cause bleeding. They just might transfer HIV. So they are never used "guard-less" in a U.S. barbershop.

The upshot of all this is that while we know a lot about HIV, and about its transmission from human to human, there are many questions that remain unanswered, not even addressed in any formal sense. And Beth has our personal barber clippers, unused for 20 years of California life, in one of those boxes marked "TO GO". One spouse/one barber/one clippers. And always with a guard.