HEALTH-ZIMBABWE: Providing a Ray of Hope

By IPS Correspondents Reprint | | Print |

Wilson Johwa

HARARE, Jul 29 2003 (IPS) - "When we started in 2001, we used to move from door-to-door looking for AIDS patients," explains the matronly MaSibanda.

"But now, because the stigma is slowly dying many are seeking our help," she adds.

As a volunteer in Rival of Hope, one of many community groups that give home-care to the scores of bedridden AIDS patients in urban Zimbabwe, MaSibanda is at the forefront in the fight against the pandemic.

Years since HIV was first detected in the 1980s, news of a death "from a short illness" is now greeted by a knowing understanding and quiet acknowledgement of the epidemic’s worsening onslaught.

"When we hear that there is someone ill who’s at home we go over to help," MaSibanda says. "If they do not want our help we leave. Some, unwilling to own up to their illness due to shame, turn us away."

According to the United Nations the HIV-AIDS infection among Zimbabwe’s 12 million population stands at 34 percent, although the government says the rate of infection has slowed to 26 percent.

Yet the numbers of those dying is no less staggering. It is estimated that 2 000 die as a result of AIDS-related infections every week.

The local authority in Bulawayo, the country’s second largest city of one million people where MaSibanda operates, says at 15 percent the city’s death rate has more than doubled since the late 1980’s. She blames the increase on AIDS.

With such a high rate of infection, hospitals are swamped with terminally-ill patients. But since they have to make way for others, they discharge those that are beyond saving, referring them to home care – which is where ‘home-based care’ groups like Rival of Hope come in.

Established in 2001, Rival of Hope operates in almost all the former townships, or working class areas, in the city. MaSibanda is part of a group of 20 volunteers who work in the sprawling suburb of Mpopoma where her group co-exists with several others.

Presently, she is helping care for three people living with terminal illnesses in her neighbourhood. Pairing up with another volunteer, she visits the patients regularly to provide the care which entails counseling and, where they exist, helping the patients’ primary care givers with moral support as well as health tips. She also, when possible, helps to provide essentials such as linen, antiseptic liquids and protective gloves.

MaSibanda says protective gloves are presently in short supply resulting in risk-conscious care givers to improvise with plastic bags.

Touted in some quarters as a home-grown response to the pandemic, home-based care has emerged as the answer to an out-of-control AIDS pandemic and the State’s failure to deal with it.

Zimbabwe which, like several other countries has downplayed and even denied the HIV prevalence in the initial period, has been criticised as having been too slow to respond to the pandemic.

Early last year, the country was poised to become the first of five African countries to accept Thai technology transfer to begin manufacturing the generic equivalent of the drug Fluconazole, a broad spectrum of anti-fungal medicine for use against thrush.

This drug was to sell at 13 United States cents per tablet – almost 10 times cheaper than the patent pharmaceutical price.

A few months later, in May, the government decided to override patent protection on anti-retrovirals, allowing the price of first-line AIDS cocktails recommended by the World Health Organization to plummet from 1168 dollars to 412 dollars.

The move, which lasted for a period of six months, marked the first time that a desperate government had gone beyond using the threat of compulsory licensing as a negotiating tool, and actually declared that it would override patents to increase access to needed medicines where prices were too high due to patent protection.

The move came at a time when the popularity of the 23-year-old government was at its lowest due to economic and political turmoil engulfing the Southern African country and so the much publicized gestures to make drugs affordable were seen as mere populist attempts aimed at shoring up support.

Andrew Moyo of the Matabeleland AIDS Council in Bulawayo says the government’s announcements on AIDS drugs have not translated into improved availability or access to cheaper drugs for people living with the HIV virus.

"Access is still an issue, affordability is an issue, availability is an issue," he says. "In other words, in those six months that the government spoke about overriding patent protection there wasn’t – and there still isn’ t – an increase of say, anti-fungal drugs or anti-biotics within the nearest clinic."

Anti-retroviral drugs are available, but only at the few pilot sites spread around the country.

Zimbabwe’s untenable political situation and worsening economic conditions have given rise to food shortages, a three-figure inflation rate and 70 percent unemployment. This means very few people have been able to take advantage of cheaper drugs, not least those living in the rural areas and impoverished farming compounds.

A fact-finding mission by the UN’s Food and Agriculture Organisation and the World Food Programme to Zimbabwe in May this year concluded that 5,5 million of the country’s 12 million people are in need of food aid.

For a cocktail of drugs, people living with AIDS in Zimbabwe need more than Z$200 000 (200 dollars) a month, when few are earning close to the living wage of Z$123 000.

With 43 people having died of malnutrition in Bulawayo between January and April and the WFP announcing recently that it might start giving food aid in urban areas, there is no doubt that drug-needy AIDS patients are facing a doubled edged sword.

The government has declared HIV-AIDS a national emergency, allowing containment measures to receive priority in the allocation of resources. But in a country with no foreign exchange to import fuel and power, procuring the much-needed AIDS drugs cannot be first priority.

Meanwhile as the government struggles to deal with the impact of AIDS, worsened by the economic climate, thousands of poor Zimbabweans whose lives could have been prolonged by immune-boosting drugs have to look death in the eye.

In such a situation where the system cannot cope, it is foot soldiers like MaSibanda who, despite not providing any medication themselves with the exception of painkillers, have stepped in to try to make a difference.

The only other meaningful window of hope for the majority of patients comes through the Aids levy which all Zimbabweans in formal employment have been paying since 1999 at a rate of 2,4 percent of their salaries.

The takings are placed in a centralized fund managed and administered by the government through the National Aids Council.

The ultimate aim of the fund is to secure a pool of cash that will go towards cushioning the impact of the AIDS pandemic on individuals by providing them with a dedicated source of income which would go towards people whose lives have been affected by HIV-AIDS.

NAC director Herbert Zimudzi says Z$400 million (200 000 dollars) is collected each month, out of which 30 percent goes towards treatment and home-based care, providing kits, other support and sometimes food for the ill or the care-givers, especially where they are very old or mere children.

However, whatever drugs patients receive through this fund are meant only to fight opportunistic infections and are not the expensive immunity-boosting drugs.

Zimudzi distinguishes between home-based care at the level of the household and at community-level. "There is home-based care at the household level where we are saying one of us in the family is now terminally ill and how do we cope with that," he says. "He has gone to a hospital and for medical reasons they have discharged him for home care. How do we as a family then cope and care for that person."

Apart from the mental pressures and disregarding cultural niceties through, for instance, wearing gloves to avoid being infected by the patient, living with a stricken relative is presenting families with other new challenges, such as having to bath a parent.

Zimudzi points out that culturally, women have always been the givers of care hence where the wife gets ill first, the husband often abandons the family leaving the wife to go back to her original home for support.

"If I become ill, not many of my sons will come and bath me," he says, adding: "But it’s taboo in my culture for a daughter to bath me yet they can ‘t just leave me."

In such situations, the volunteer steps in, proffering advice and if necessary doing the work herself. At the community level, explains Zimudzi, "we are saying if your neighbour is sick how do you relate with them without stigmatising him. In some instance you have a situation where the two parents have died and the traditional extended support network does not work and neighbours contribute towards the upkeep of children."

Meanwhile, as MaSibanda and her group meet each month, they ponder how best to do more for the growing number of terminally ill who need their assistance. (ENDS/IPS/ AF/SA/HE/WJ/SM/03)

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