Acute Illness Profiles

The Condom Woman of the Cape Coast

In Ghana, where HIV/AIDs is on the increase and sex education focuses on abstinence, one 59-year-old woman walks the beaches, dancing and using props to get people interested in safe sex.

When I tell people about my friend Martha Jonah, I like to lead with the fact that she spends holidays on a beach in Ghana, handing out condoms and showing people pictures of what sexually transmitted diseases can do.

She has this book of photos of male and female genitalia in the full ravages of syphilis or gonorrhea.  The book shocks people: those Martha shows it to raise their hands to their mouths, bulging their eyes in disbelief.

Martha isn’t just trying to gross people out, though. She wants them to ask themselves a question: if you aren’t using a condom, how do you know you aren’t sleeping with someone with an STD?

“The lights are out,” she’ll say. “How can you know for sure?”

On public holidays and on weekends, the short, energetic 59-year-old heads to the beach in Ola, Cape Coast with a box of condoms, her book and her warm, welcoming way of engaging revelers. She is offering lessons and advice they wouldn’t have had at school, where a frank discussion of sex–let alone sex education–is often taboo.

There’s not many people who could so easily get away with handing out condoms in a socially conservative part of the world like Ghana, but Martha has it down to an art.

“As you hold the box you are chatting, dancing, being part of the fun,” she says. “You say you need to show them something, then you bring a condom out, and give it to them. Some don’t know how to use a condom, so they don’t take it. If you see two or three people are interested, we have a book given to use by the Ghana AIDs Commission, where there are all these photographs of STIs. Those who are interested, we say ‘this is what happens when we really don’t protect ourselves’.”

It’s a gruesome attraction, but it works.

It’s a gruesome attraction, but it works.

Ghana is in the midst of an HIV epidemic. As of 2016, round 2% of the country’s adults have HIV, and according to UNAIDS, Ghana’s has 20,000 new infections every year. Other STDs, like syphillis and gonorrhea, are just as much—if not more—rampant.

According to Martha, the problem is a lack of understanding about sexual education in Ghana, as well as most Ghanaian’s inability to afford condoms. The socially conservative political environment doesn’t help: a 2017 Guttmacher Institute study found that sexual education was largely focused on abstinence in senior high schools in Ghana, with fewer than half the students ever learning about contraception.

Religion also has its part to play in low condom patronage. Martha finds some people will shun her offer of free condoms, suggesting it would be irreligious to take them. Churches in Ghana will often preach that HIV, AIDs, and other STIs “only affect sinners–people who are cursed by God.”

I met Martha five years ago when I first moved to Cape Coast in Ghana. Surrounded by trees, her house was just down the road from where I was staying. We became fast friends, and have remained so ever since.

Martha Jones. Photo: Stacey Knott

She takes in children and teenagers from across the region to live with her, while they attend local schools. Often these kids come from hard backgrounds, where their educations aren’t prioritized. Under Martha, school is mandatory, and she even lobbies locals and businesses for the money to pay their school fees.

Over the years, sitting around with this big cobbled-together family, I’ve absorbed her life story, but on a recent visit, I wanted to get it all down in writing: how this tiny, jovial lady earned the reputation as the “condom woman”.

It started in 2008, when Martha realized that her region had some of the highest STD rates in the country. She had recently set up her Care Love Charity Foundation for fighting poverty, and through it, was trying to educate young Ghanaians about their sexual health. Groups of beach revelers near her house seemed like a good place to start. With her box of condoms, a penis replica and picturebook, she would walk the few minutes to the coconut tree-lined beach, weaving through groups making the most of a day off.

At first, the people Martha approached were suspicious, but soon, with her picture book and penis stick, she got people’s attention, demonstrating to them how to wear a condom safely and effectively.

With her picture book and penis stick, [Martha] got people’s attention, demonstrating to them how to wear a condom safely and effectively.

With funding from the Ghana AIDS Commission, Martha’s charity has worked through Ghana’s Central Region, running programs to reduce stigma around safe sex in villages, townships, and schools. She also arranges for STD testing, and links up people with appropriate counseling and health services.

And in a country where people with HIV are routinely shunned, Martha emphasizes the importance of compassion, even as she educates people about the realities of AIDS transmission. “We let them know you can’t contract HIV or AIDS by eating with people,” she says. “You cannot contact it when they live with you.”

What’s interesting about Martha’s mission is that once she gets people talking to her, she finds that most people are actually happy to use condoms. “You have to tell them it’s good, and good for you to protect yourself from STIs and STDs. Then they ask how they use it.”

Ultimately, Martha wants to see condoms distributed freely through Ghana, and for the country to move away from abstinence-only education. But even when she’s not on duty as the Condom Woman of the Cape Coast, Martha says people will come up to her and ask her for a new supply.  “Sometimes I will be at home and someone will call me and say ‘do you have the stuff’,” she says, throwing her head back with a hearty laugh.

Something she’s doing must be working.

Chronic Pain Histories

A Lion In The Day

How Katherine Mansfield, one of New Zealand's most prolific storytellers, found strength to deal with her chronic pain through her fiction.

I’m a lion all day, darling, but with the last point of daylight I begin to turn into a lamb and by midnight—mon Dieu! by midnight the whole world has turned into a butcher.”

– Katherine Mansfield, in a letter to her husband, 1913.

Katherine Mansfield is considered one of New Zealand’s most famous writers, despite leaving the country in 1908 when she was barely nineteen, and never being able to return.

While the stories that form her legacy as a prominent modernist author are undeniably significant it is Katherine’s life itself that is remains compelling to millions of readers. Both Vanessa Redgrave and Kate Elliott have portrayed her in recent years in movie and television adaptations of her works: first in 1974’s BBC miniseries, A Picture of Katherine Mansfield, and then again in 2011, in the biopic Bliss.

Actress Vanessa Redgrave as Katherine Mansfield.

Actress Vanessa Redgrave as Katherine Mansfield.

Small wonder. Now lauded as a woman ahead of her time, she was an openly bisexual teenager, her activities driving a wedge between the defiant writer and her socially respectable family. Her early years would see her suffer at least one miscarriage, a rushed marriage which ended on the same night it began, excommunication from her mother, and her eventual settlement in Europe, far from home.

In 1909, she contracted gonorrhoea, which Claire Tomalin argues in her biography A Secret Life was responsible for Katherine’s susceptibility to the tuberculosis which eventually killed her. Certainly, the sexually transmitted infection was the catalyst for the many debilitating illnesses she experienced afterwards, including peritonitis, pericarditis, pleurisy, and gonococcal arthritis.

Portrait of Katherine Mansfield by Anne Estelle Rice.

Portrait of Katherine Mansfield by Anne Estelle Rice.

She was diagnosed with tuberculosis in 1917, when she was 27. She would eventually live another six years.  Tomalin’s biography describes her as a “chronic invalid” from 1910 onward, throughout her writing life.

Despite this, her mastery and the volume of her work are renowned, and she was celebrated among her contemporaries. Virginia Woolf, a great friend of Katherine’s, is recorded as having said that hers was the only writing she was ever jealous of. She published three short story collections during her life, as well as creating a legacy of innumerable poems, letters, and notebooks. Sixteen different collections have been released since her death, and three major biographies.

Her letters and journal entries, many of which were published posthumously by her second husband John Middleton Murry, give unique and deeply personal insight into what that life was really like.

As a researcher and a sufferer of arthritis myself, it was this particular affliction that drew me closer to Katherine. Her letters detail her pain, both physical and emotional, but also reveal a relentless spirit and sharp wit. Katherine never stopped believing that she would be cured. But, she confesses to a friend; “I feel about 800, Koteliansky, for I can hardly walk at all—nor turn in my bed without crying out against my bones.”

Under such conditions – the fevers, joint and abdominal pain, inflammation in her hands and rashes from arthritis, and the fatigue, coughing, and loss of appetite and weight caused by tuberculosis, it seems nothing short of a miracle she managed to be so prolific.

I scoured her words for some clue to her strength of character and tenacity.

In strange foreshadowing of my search, she says in a letter in 1922; “’I think the only way to live as a writer is to draw upon one’s real familiar life – to find the treasure in that.…And the curious thing is that if we describe this which seems to us so intensely personal, other people take it to themselves and understand it as if it were their own.”

A rare photograph of Katherine Mansfield during her life.

A rare photograph of Katherine Mansfield during her life.

In October 1922, desperate for relief from her failing body, she moved to Georges Gurdjieff’s “Institute for the Harmonious Development of Man.” She had decided her health was the result of a sickness in her soul and that the highly questionable Gurdjieff could help to “cleanse” her. His rigorous routines included hard physical labour, denial of heating, and instruction for her to sleep in a loft above a pen of cows. Unsurprisingly, these measures did not improve her condition.

Murry arrived at the Institute in January 1923, and found her in strangely good spirits. In fact, it has been written that these last months were the happiest of her life. Perhaps at least she had found a place to calm her intensely restless nature.

But, following dinner with her husband after his arrival, she bounded up the stairs – and caused the final pulmonary haemorrhage that at last took her life. She was 34 years old.  

Recently, a previously unpublished folder of Katherine’s poems was discovered. While she was never really known as a poet, Mansfield’s work is certainly lyrical, and these works, written when she was 22, show deep promise and bring into sharp focus how much was lost by her untimely death.  

One of the works, unsettlingly entitled “To KM,” as if Katherine were addressing herself, appears an unnerving but strangely soothing prediction of her swift final bow.  

“A moment – a moment … I die.”

“Up and up beat her wings.”