EXCLUSIVE CONVERSATION
An exclusive conversation between Madonna and Dr. Jim Yong Kim
Madonna talks with Dr. Jim Yong Kim, a Harvard professor whose work has led to greatly improved aids treatment in Africa.

Madonna first visited Malawi in April 2006. She's been there twice since, including a trip last October to adopt her son, David, who was then suffering from malaria and pneumonia. Through her Raising Malawi organization, Madonna is helping to foster sustainable solutions for the Malawian people, especially its most defenseless children. She's also working on a documentary about the orphans of Malawi.

Below are excerpts from her conversation with Dr. Jim Yong Kim, a founder of Partners in Health, which provides medical care and social services to the world's poorest patients. Dr. Kim is currently based at Brigham and Women's Hospital and Harvard University. He works to bring good medicine to people without access; his campaigns have helped increase aids treatment in Africa eightfold.
Madonna: A lot of people ask me, "Why did you choose Malawi?" I always say that Malawi chose me. Victoria Keelan, a businesswoman who was born and raised in Malawi, contacted me through a mutual friend and said, "Look, if you're in the business of helping children, we have over a million orphans here in Malawi, and the problem is insane. It's an emergency. They need your help." She reached out to me because I do a lot of fund-raising for an organization called Spirituality for Kids, which helps children in impoverished conditions everywhere in the world, whether it's Palestine, or East L.A., or New Orleans after Hurricane Katrina, or the Bronx, Miami, Mexico City—all over the place.
I must admit that I didn't really know where Malawi was when I first heard about the situation there. I had certainly heard about the aids pandemic in sub-Saharan Africa, and in more well-known countries like Ethiopia and Rwanda. But not Malawi. So I educated myself, and I couldn't say no, and it just seemed like a good idea. I sort of dove in.
Dr. Kim: When was your first trip?
Madonna: A year ago April. I've only been there three times, but so much has happened in a year. I'm thrilled because, as you know, it takes a lot of time and a lot of work to get things done. It was great to go back and see so many things manifested. But once you start turning over rocks and reaching out to help people, there's a whole avalanche coming right behind it. And it seems never-ending. But when you see the fruits of your labor, you feel like it's possible.
Dr. Kim: One of the things we've learned is that you've got to take lots of joy out of small victories. That's what keeps you going.
Madonna: Yes, and you have to stop fixating on things, too. I found myself getting really angry when I went into [the slums] and was visiting families or single people living with aids who we're supposed to be helping with home-based care. I would talk to people through translators and find out that they were getting all the wrong medication. That drove me bonkers, and I almost ripped my hair out. Those little things get me down, but then you realize there are all these other great things happening: the Millennium Villages have surplus crops, and orphan-care centers are being built. So you have to focus on the things that are getting done.

There are some kids you can help by building orphan-care centers they can visit during the day. It's a place to go, and there's food; they can have their health needs taken care of, and they can get an education. And then they can go home and sleep with their extended family. There are other orphans who are in such dire straits—they're living on the streets, and you need to find foster homes for them, or you need to send them to private schools. And some kids just need psychosocial support to deal with the fact that they're living with their extended family. But no one's addressing what it feels like to lose your parents, and what's going on in the heads and hearts of these kids. If they're the future of the country, then we need to do something about it.

I know that you're dealing with everything from alcoholism to orphans. There are just so many issues that need to be dealt with to raise up the level of someone's existence.
Dr. Kim: You mentioned alcoholism. We deal with that a lot in Russia—it happens to be one of the biggest complications in treating TB there. We're doing a lot of research on alcoholism and TB.
Madonna: I think there's very little difference between Moscow and Africa in some respects. Have you heard about the orphanages there?
Dr. Kim: Oh, God. They're just terrible.
Madonna: It's way more depressing in a way.
Dr. Kim: When I was at W.H.O. [the World Health Organization], the director general had been to every single depressing place in the world. And the one place that just ripped his heart out was an aids orphanage in Moscow. It was the most emotionally troubling place he'd ever been to. He started a fund-raising campaign—he sold all the gifts that had been given to him by all these different presidents. He put all the money into a Russian orphanage.
Madonna: Oh, well, God bless him.
Dr. Kim: Orphanages in general, Madonna, I have to tell you … I have a child. And it's just the most painful thing in the world even walking in there.
Madonna: I can't take it. I can't take it. It's difficult to watch people suffer, but it's so hard to watch children suffer. To see children lying on the ground in a daze, in a pool of urine with flies buzzing around their heads. It's unfathomable, and this is what the orphanage that David came from was like. I'm very happy to say it's not like that now, but it's just devastating. And there's another nursery we go to where a lot of the children are H.I.V.-positive, and they all weigh about three pounds, and they're all a year old. You hold these children and you think, How can I save them all, how can I make their lives better, what is their future. It's an unforgettable experience. I feel like everybody needs to take a sabbatical and go to Russia and Africa and work in orphanages and really witness true suffering. And then you'll just feel ridiculous for ever complaining about anything. Everybody needs that kind of reality check.
Dr. Kim: I think the second-worst thing I see on a regular basis is when parents can't feed their children.
Madonna: Yes, when they can't feed their kids—and then what they're pushed to do to feed their kids. Or just to sit and watch your child die of starvation. It's unthinkable when you consider how much we have.

Orphans are sort of my main focus—children are my main focus—so I have a question for you. From a health-care perspective, what is your approach for helping orphans?
Dr. Kim: Over time people have gone from just building orphanages around the aids epidemic. They're focusing more on preventing a generation of orphans. When people say, "What do orphans need the most?," I sometimes say, tongue in cheek, "Well, they need their parents more than anything else." So many children are being orphaned because of aids. That's why we push so hard for aids treatment.

Not too long ago, probably in 2000 or 2001, there were a lot of people who were still saying, "H.I.V. treatment is just not possible in Africa. All those 30 million people are just going to have to die." These are very nice, well-meaning people who sort of said, "It's not going to happen. Just forget about it and let them die." That's one of the things that we took on. We insist that people get treated. The other thing is that people need the whole range of services—not just basic health care, but help related to early childhood development, and whether they have a loving household. Those things are also really important.

The bad news is that there are a lot of orphans, and we have a lot of work to do. There isn't a single straightforward answer: "Well, if they just had orphanages …" No, it's going to be a little bit more complicated.

But the really, really good news is that there's plenty of money in the world to do these things. It just takes a small percentage of the money we spend on junk—and then we can invest it. There's more than enough money to do these things.
Madonna: If we would just stop spending money on killing people and start spending money on saving people?
Dr. Kim: Why not?
Madonna: [Laughs] It seems so simple.
Dr. Kim: I've looked at what you're doing with Raising Malawi. What would you like to see happen in the next five years? What do you want to see there as a result of the work of Raising Malawi?
Madonna, left, stands next to Malawian men as she tour the U.N. Millennium village, in Mtanga, Malawi, Monday, April 16, 2007. Madonna toured U.N.-backed development projects in the small village of Mtanga, where farmers are being helped to grow maize and start fish farming. (AP Photo/Karel Prinsloo)
Madonna: First of all, I'd like to know that we're getting a handle on the aids epidemic. Some people say that we've stabilized it, that the numbers are not increasing. I spoke to a woman who is the director of the ministry responsible for women and children's development, and she said that, according to studies, it's impossible to really know how many are sick, because there's such a stigma attached to being H.I.V.-positive. If people know they have it, they don't tell you. And the other thing is, it's so hard for a lot of people to get tested. If you go into most villages and orphanages and ask, "How many of the people in this village are infected?," they'll say, "Oh, 70 to 75 percent." Then you ask, "Well, how many people have actually been tested?," and they say, "Not even one!" So it's very hard to gauge, and there are a lot of elements that work against it.

It's not enough to just make ARVs [anti-retrovirals] more accessible; it's not enough to help diversify their crops; it's not enough to bring in the educational component, whether it's health education or just education in general. You still have to deal with traditional practices, which, especially in the more remote of Malawian places, have a huge stronghold. Some people still think that their illnesses are curses and spells that other people have put on them. Even if you give them a cure and they get better, they'll still insist it was a spell somebody put on them.
Dr. Kim: Paul [Farmer, the medical anthropologist who works to raise the standard of health care for the world's destitute] tells this great story about a woman he was treating for TB. She came every day, took all her medicines, and got better. Being an anthropologist, he was compelled to ask her, "What do you think caused your tuberculosis?" And she had this long explanation that had everything to do with sorcery. So Paul said, "But if you believe sorcery caused your TB, why did you take all your medicines?" And she put her hand on her hip and said, "My dear, are you incapable of complexity?" People think that if medicines are making them better, you should do that and talk to the voodoo priest. Cover all your bases.
Madonna: To me, the most important thing—aside from meeting people's physical needs, whether that's education, health care, clothing, food, a roof over their heads—is changing the mind-set and educating people. And most of all, most important, is empowering people and making them self-sustaining.

I want to continue to see that aspect changing and flourishing and growing. I want to see girls with educations. I think women are the future of Africa. I hate to sound like I'm being sexist, but I interviewed a lot of women, and found, while watching a rough cut of my documentary, which is very far from being finished, that the people who are really doing the most to effect change in Africa right now are all women. They're the future. So I want girls everywhere to get an education.

After the English came and went in Malawi, after three decades of dictatorship and several more years of corrupt government, I feel like everyone in Malawi is walking around with this feeling like, "How can I make a difference in my country? How can my point of view be heard? I'm a nobody, I don't have any say, I don't have a point of view." I want to get rid of this inferiority complex. I want to help them to believe in themselves, to empower them. That's really what I want to see in the next five years. I'd love to see growth in all areas. You can't just go into a place and say, "O.K., I'm going to fix it with this one solution." That's naïve and impossible.
Dr. Kim: What do you think it's going to take to get more Americans engaged with all these problems?
Madonna: That's part of the reason I'm making the documentary. I want people to be moved, to feel called to action. That's what I want to do.
Americans live in a bubble, for the most part. I say that from my house in London. [Laughs] But obviously I'm an American, and I've spent most of my life there. We're very privileged as Americans—it's easy to forget about the rest of the world and to think that your problems are the most important problems. Even poor people in America live better than poor people most everywhere else. I can remember being poor and living on the streets in New York back in the day. But you could still scrounge up a dollar and go to Kentucky Fried Chicken, you know what I mean?

Being poor in Africa is something people in America can't relate to. Part of the challenge is bringing that reality to people and moving them. You have to arouse compassion. But, like Al Gore's movie, An Inconvenient Truth, it's not enough to raise awareness. You have to give people solutions, and you have to invite them to get involved in whatever way they can, whether that's doing volunteer work or taking a portion of their salary and figuring out where they want that money to go. You have to find ways to inspire people to get involved.

Look, it happened with me. Obviously, I know what's going on in Africa, and I've contributed money to various funds over the years. But until you go there and you see it and experience it, it just feels like a problem that's somewhere in the distance, and it doesn't really affect you. So you're not moved to do anything about it.
Dr. Kim: How are you going to bring your art together with this? Do you see the two efforts coming together somehow?
Madonna: I'm making a documentary about the orphans in Malawi. And it's not really about just Malawi; it's about all of Africa, because Malawi shares a lot of the same problems with other countries. Making a film is an expression of my art, and I believe I'm going to connect to people that way, as a parent and a human being of this world. I want to appeal to people's sense of humanity and interconnectedness. I feel like I have the platform I'm standing on for a reason. It's not just to make people happy and get people to dance and sing, to feel an escape. It's also to get people to listen and to bring important issues to the forefront. With the success I've had and the position I've earned in the world, people are listening to me, so I'd better have something important to say.
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Source: vanityfair.com / Posted: 6.5.2007
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