The blaring Land Rover’s horn signals the beginning of my umpteenth journey along the long road from The Gambia, through Senegal and into Guinea Bissau.  Although the familiar border crossings and check-point guards do not change and the vehicle ferry is always predictably unpredictable, circumstances alter on each trip.  What I have learned from facing the complications encountered on each journey, has made my attempts to unravel the role of the immune system in the attenuated disease course of HIV-2 infection seem less daunting.

            The road is dotted with landmarks that serve as street signs where maps do not exist.  Out of The Gambia and into the Southern part of Senegal, the Casamance, we pass the first landmark where once our 1000 liter empty water tank tumbled from the Land Rover’s roof rack.  It’s high tide in Ziguinchor and to get into the city, we first need to transverse the waters that submerge the cobble stone highway.  We’re lucky, the Land Rover is a sturdy vehicle and can handle any terrain, the Peugeot 504 Sept-Place local taxis are not so fortunate and need to wait for the estuary water to recede.  Next stop, Casamance River ferry crossing – it’s lunch time.  Luckily, the unreliable ferry is working today and we are spared the additional 10-hour drive around the river.  During the 2-hour wait in mid-day sun, I do my usual routine: grab a blunt knife and carve out oysters from their hot, freshly smoked shells with the women working at the muddy river bank, add a close-up photo to my pig snout collection, and buy 5 packs of cashew nuts (fresh, unprocessed, beyond coffee shop standards).  We make it onto the first ferry after the lunch break, with the Land Rover strategically balanced with its back wheels suspended off the edge of the ferry’s landing ramp.  Once on the other side of the river, we come across the next landmark, the place where with the aid of rope and light from our mobile phones, we repaired the steering of the truck that transported our laboratory equipment.  We’re close now, the next turn-off leads to the last village in the mangrove swamp before the Atlantic, our destination!  The last leg of the journey is the most spectacular, with the rows of impressive mahogany trees planted by the Portuguese lining a red dirt road scattered with cows enjoying the late afternoon warmth.  During the rainy season, driving on this dirt road in a Land Rover is an experience: it’s the closest one can get to Willy Wonka’s adventures while driving through chocolate milk-like puddle lakes. 

Guinea Bissau is a small country of 1.5 million inhabitants on the West coast of Africa, with a mainly rural population distribution.  It is one of the 5 poorest countries in the world - according to the 2005 UN figures, the gross national income per capita was £90, less than £0.25/day.  Civil unrest has affected the nation since it won independence from Portugal in 1974.  In 1999, a ferocious civil war changed the lives of many people; thousands were killed, wounded, or displaced.  However, despite the grim past and the present political and economic difficulties, the isolated country is rich in mystic traditions and music.

            Over the past 25 years, more than 60 million people have been infected by HIV.  Even though the epidemic is rampant in parts of Sub-Saharan Africa, its spread has not affected West Africa to the same extent.  In Guinea Bissau, an estimated 4-7% of the population is HIV-positive.  Antiretroviral therapy is widely available in developed world and much of Africa.  Guinea Bissau, however is among the few countries where therapy has not reached outskirts of the capital.  Medication from the Brazilian government has been available in the capital for 2 years, yet the dismal health care infrastructure and the low numbers of physicians in the rural areas have caused a long delay on the plans for drug distribution.  The HIV-positive people of Caio are fortunate to be included the first roll-out of the drugs as Caio is one of the few villages with a permanent physician and the patients are amongst the minority for whom HIV diagnosis is available.

            The atmosphere in Caio today is festive; children are competing and singing in tune with Dulce Neves, a local pop star, while adults cheer them on.  Life in the village is like this on a daily basis.  Families share everything although they have so little.  All plastic waste can be reincarnated for a new purpose.  Even at night, when the village is at complete peace, or in the early morning, no children’s cries can be heard.

            On my first visit to Guinea Bissau, I did not experience the peace that I now associate with the country as it is difficult to see past its external poverty.  The capital has a strong colonial aftertaste with deteriorating architecture reminiscent of the past mix of Afro-Portuguese culture.  What remains is decaying buildings, bullet hole-ridden palaces, and a new flavor of design like the State House financed by the Chinese government.  However, the reservation I initially experienced has changed into a deep appreciation of the citizens of Guinea Bissau who despite staggering unemployment, illiteracy, and high childhood mortality rates redefine the meaning of carpe diem.

            The religious beliefs of Caio’s inhabitants have largely remained free from influence from the outside world.  Conversion to organized religious practices (Islam and Catholicism) is uncommon as 99% of the population believes in Earth spirits and ancestral cults.  The preservation of traditional customs likely results from the limited influx of outside impact as transportation to the village is relatively inaccessible, infrequent, and long.  In addition, to date, there is no land-line phone communication and a mobile network can only be accessed under a handful of mango trees, where one can only make outgoing calls.  No one has access to electricity unless a generator is owned by the family, making television and telecommunication a sci-fi fantasy.  Yet as foreign as the use of Western gadgets is to the people of Caio (mobile phones, ipods, digital cameras, computers, plasma screen TVs), so is to us their faith in the forces of Nature. 

            After the AIDS Day festivities are over, preparations begin for appeasing the spirits.  On our next visit, the study on which my PhD depends will begin and prior to its commencement we must keep the local tradition of providing an offering to Iran, the greatest spirit.  Staff of the field station have arranged for two pigs for the sacrificial ceremony and each will meet the blade of a medicine man tonight.  I am requested to be present at the first ritual but forbidden at the second that will take place in the sacred forest where only males are allowed to enter.  After the symbolic pouring of red wine and palm wine over a sacrificial post accompanied by Manjako chants, in one stroke of the machete blade the pig’s throat oozes blood over the white post.  The pig ends its life and darkness ensues as the blazing sun sets past the rice field horizon.  The men proceed to scorching the pig’s hair off and partitioning the meat and leave the cooking to the women.  Everyone present respects the fact I am vegetarian, I must respect the fact I am obliged to participate and eat the pig’s heart.

            Ceremonies form a fundamental component of the Manjako culture.  When seeking revenge or protection from illness, sacrificing a chicken to the bush spirits may suffice.  More substantial offerings of dozens of goats, pigs, and cows are reserved for sacred rituals such as male initiation rites that take place every 10 years over 3 month period with an exclusively male participation.  Funerals, especially those of “kings” (headmen of a family court), call for celebrating the life of the deceased person with the age of the departed determining the extent of the celebration.  However, since the average life expectancy in Guinea Bissau is under 45 years, funerals of elders are rare.  The ceremonies are of symbolic importance but they are also a perfect excuse for feasting and dancing.