What follows is an essay I just wrote for a Diocese of Arizona project which is collecting reflections from people who have been involved in various MDG projects over the past. Our diocesan MDG committee is going to publish these both in hope that other in the diocese might be inspired to get involved, and also so that local parish and mission committees might use them to guide their own decision making process. (I’ll try to remember to share a link to the full collection once we have them collated.)
My first startling impression of Swaziland came when I stepped out of the airport into the darkness of the night into which we had landed. The car to pick us up was not there waiting for us, and the airport was closing down for the night. The guards told us that we could not wait inside the compound, so we gathered up our luggage and started walking out to the main road hoping to either meet our ride there, or find a phone to make a call.
In the darkness, with gravel crunching underfoot, I looked up. It’s something I do reflexively as a former stargazer. Seeing the stars in the familiar positions makes me feel centered no matter what is happening around me. Their slow progress across the sky is always a touchstone of stability for me when I’m not feeling particularly secure. Except this time. When I looked up, things were all our of sorts. It was a combination of my first time to the Southern Hemisphere, with new constellations, and the effect of seeing all the familiar constellations upside down. It took me moment to recognize Orion. There he was, warding off Taurus the Bull, backed up by his faithful dogs, but he was standing on his head!
The idea of the familiar standing on its head became sort of repeated theme during my visit. Things that appeared familiar turned out, when more closely examined, to be topsy-turvy according to my expectations. Things that seemed totally foreign to me turned out to actually be closely to related to things I recognized once I took the time to see.
This was driven home as I began to speak to people around the country-side who were involved in Swazi Hospice at Home, the NGO I had come to support during visit. The program allows people who are dying of HIV and AIDS to die relatively comfortably at home surrounded by their family and friends. This is not just important to them, but to the whole health care system in the country because if the dying are not cared for at home, the all too few hospital beds in the country would be wholly given over to these patients and not by people who, frankly speaking, have a chance of recovery. In a country where 250,000 people have access to only one small clinic (a two room 1500 square foot affair) with 2 beds, this is a matter of life and death for many.
My immediate response to seeing this desperate shortage of hospital beds was to begin to plan some sort of response that would raise sufficient money to open clinics all across the country. But that wouldn’t be much help without trained medical personnel, medicines, equipment, transportation, or just electricity… In speaking with the local healthcare providers, and with the local committee who were charged with expanding the existing clinic, I learned how great the challenges were, and how little effectiveness throwing money at the problem would have. Much important was to listen to them explain why a Hospice program made so much more sense to their community.
There were numerous reasons. First and foremost was that by a number of different methodologies, it appeared that something between 35 to 45% of the adult population was HIV positive, and expected to develop full blown AIDS and likely die within the decade. The anti retro-virus drugs simply aren’t available in the Swazi countryside, and even if they were, the people suffering from AIDS couldn’t afford them, and wouldn’t have access to the necessary medical monitoring. Better people should live out their last days as comfortably as possible, and give those who are not infected with the disease, especially the children, an opportunity to access what health care is available, than to have even more people die unnecessarily because the inadequate health care system becomes overwhelmed. The second reason was not one I would have ever imagined…
Most of the land in Swaziland belongs not the individual but to the tribe. Families are allowed to live on plots of land as long as they are farming it and giving a portion of the crops to the chief, the King and to the tribal council. If they are not able to produce from the land, it is taken away from them and given to someone who can. Most often it is given to a member of the chief’s family. As long as an adult with children is able to remain on the land, the children can farm the land. If the adult leaves, the children would mostly likely have to as well, which would mean they would lose their families land and any means of independent support. There is no effective social safety net in Swaziland so losing the ability to raise their own food means that the families children are likely to die soon after their parent or parents.
Caring for people at home rather than in the hospital in Swaziland is less about the emotional needs and dignity of the dying as is the case in the developed world and more about trying to keep the whole of society from collapsing.
I only learned this by learning to listen to the local people who were doing the actual hands on work that our MDG group was supporting. It was the quintessential experience of the familiar standing on its head. I think my reflection on these sorts of experiences have informed my own continuing work on the Diocesan MDG committee and my coordination with that of the Cathedral’s committee. We must learn to allow the people on site to propose their own appropriate solutions. Our western solutions won’t alway work, and will sometimes make the situation much more dire.
Learning to listen in this way was for me one of the great and primary gifts that I received from my involvement in that project back in 2002.