Swaziland Day 7
Another busy day. I wish I could say that it was day filled with good news and hope. It was a day when we heard of challenge after challenge that are confronting the Anglican Church in Swaziland and the people of Swaziland as they respond to the rising death toll and attendant problems of HIV/AIDS.
We traveled north this morning in the direction of Piggs Peak to the parish of St. Alban‚Äôs. We were accompanied by Glenda and ‚ÄúG‚Äù who have been serving as our guides and our interpreters as we travel around the Kingdom. St. Alban‚Äôs is parish that is on the same grounds as the Enkabah primary and high schools. It is the only church in for some distance in this rural region. It functions as the community parish for the area ‚Äì in a way that sounds similar to the function of English parish churches in the countryside of England.
Along the way I finally saw some native African wildlife. So far all I have seen is a couple of lizards, herds of cattle and cats and dogs. Oh yes, there were two huge spiders (size of my fist) in my hotel room last night‚Ä¶ Grin. But on the way north we saw a couple of Impalas by the road side and a number of antelopes. I still haven‚Äôt seen the Southern Cross because of the rain, but at least I can say that I‚Äôve seen some of the biodiversity that is Africa.
We were met at St. Alban‚Äôs by Sandra, who is the program coordinator for the parish based health care teams. We talked for a couple of hours about how the program is working in the parish, and about the ways that the parish is not working. Sandra is one of many care workers that have been trained by the local Faith based organizations. She and her fellow parishioners have counterparts in the other denominations in Swaziland. There is another, governmental group of community based care givers called the RHM‚Äôs (Rural Health Motivators.) These two groups work in the Kingdom to provide training about HIV/AIDS transmission, care of patients and available services for those who need help.
The work that Sandra and her fellow care giver in the parish is heroic in the truest sense of the word. She is caring for the sick and the dying in the community. She looks after the orphans in the region and children who are now living in child-headed households. (We learned of the distinction between children who are considered double orphans (both parents dead) single orphans (one parent deceased) and ‚Äúvulnerable‚Äù (who have one or the other parent sick and in the end stages of the AIDS disease).) She told us of how she asks the parishioners of St. Alban‚Äôs to donate a little cornmeal, a pumpkin or maybe a can of fish. She uses that to supplement the meager foods that the orphan children can find from other sources.
The problems come about when she tries to get others in the parish to help her. While she is committed, there were originally 17 parishioners given the training by Glenda and the Diocesan HIV/AIDS committee. There are only two still working in the parish. The others are not able to do the work because they can not afford to take time off work or can not afford to pay the transport expenses or to buy food and medicine for the sick of the parish. The RHM workers in the region are paid a small stipend to cover their expenses, but they are not working nearly as efficiently as the faith based care workers. This has caused some resentment among the faith based workers and they are as a result less willing to go out and about in the community. In a later conversation with Bishop Mabuzza he reminded all of us that this work is a ministry not a job. It is part of our response to the Jesus call on every follower to ‚ÄúLove you neighbor as yourself.‚Äù Hopefully in further conversation with the government agencies that support the work of the RHM‚Äôs and the various faith based groups around the Kingdom a program of proper coordination between the two networks can be developed.
We talked about ways to recognize the extraordinary ministry of the people who are providing the parish care. They are doing so much with so little that it seems only fitting to find some way to hold them up as examples to the rest of us who have not as yet managed to make the same commitment of our own time and treasure.
From St. Alban‚Äôs we traveled south again to Mbabane where we met with Bishop Meshack at the Diocesan Convention Center. We had a traditional Swazi lunch of meali-meal and gravy, beets, cabbage, and juice. Over lunch Ned, Glenda, ‚ÄúG.‚Äù, Lucy, Bishop Meshack and myself had a chance to debrief and discuss what had happened during the week. We worked our way backwards through the week reporting on our visit to St. Albans, the Mother‚Äôs Union facility, the Clinic and parish in Leyango, St. Margaret‚Äôs and the Usuthu Mission parish. I was able to report to the Bishop on conversations that I had earlier in the week with the owners of one of the largest computer companies in Mbabane and some research that I had managed to do on the present communications and internet infrastructure in Swaziland. We worked up with a list of next steps for all of us as I travel back to the US on Sunday morning. We finished the meeting receiving the Bishop‚Äôs thanks for us, for our families who have allowed us to travel, the parish and diocese and all who have contributed to our travel costs ‚Äì and most especially to those who are already committing themselves to working with us on our return to try to implement some responses to what we have seen here.
Ned and I took an hour following the meeting to have a conversation about next steps for ourselves. We tried to prioritize what should happen and who should be responsible for what is next. It‚Äôs good to start making the transition from data gathering to reflection. It‚Äôs even more exciting to begin contemplating the more meaningful transition from reflection to action that is soon coming.
We ended the day with a long meeting at the offices of NERCHA (the National Emergency Response Council on HIV/AIDS). NERCHA is the governmental agency (under the Ministry of Health in Swaziland) that is charged with the coordination of the Kingdom‚Äôs response to the disease, and with the gathering and distribution of the aid and financial support that NGO‚Äôs and Governments around the world are contributing to this work. It is headed by Swazi‚Äôs and according to Ned it is one of the most effective organizations that he has ever witnessed in the years that he‚Äôs been working in public health in the developing world.
We had the honor of meeting with Derek Von Wissell, the National Director of the agency and with Sibusiso Dlamini the National Coordinator for Care and Support. (I believe Ned knows Sibusiso from his work at Swazi Hospice at Home. Sibusiso and I met earlier in the week at the Rotary meeting in Malkerns.)
Mr. Von Wissell gave us a briefing on the present status of the disease in Swaziland. We started from the commonly known number of an infection rate of about 40% among pregnant women in the Kingdom. He gave us further information that the disease had infected almost 50% of adults in the Kingdom who are presently in their mid to late twenties. We talked about the fact that the infection rate still has not shown evidence of leveling off among this cohort of the population, though there is some promise of hope being seen with younger people. He walked us through the implications of the disease as far as what can be expected in terms of the rapidly rising number of deaths from HIV ‚Äì and the later rise in the numbers of orphaned children that will have to be cared for in the Kingdom.
He was very clear about the need that faith based organizations have to work to create a social vaccine to the disease. He pointed out that government groups and church groups have been teaching for years about the causes and transmission mechanisms for HIV/AIDS ‚Äì but as of this moment it has not made any measurable difference in Swaziland. He contrasted that with the experience of Uganda. In Uganda there came a point where the entire society rose up to change its expectations of what is normal and what is acceptable behavior. He said the ABC method taught in Uganda was critically important, but more important was the role of faith based groups in creating a climate of morality for the entire nation. When I asked him what the church in the states could do to help, he was clear that our role was to support the work of the people of the churches and community organizations in Swaziland as they work together on the so called ‚Äúsocial vaccine‚Äù for the disease.
Mr. Von Wissell excused himself from the meeting and we continued our conversation with Sibusiso. The conversation took a more practical turn. We talked about the specific challenges facing the community based care givers that we had heard about earlier that morning. None of this was news to Sibusiso. He told us that it is one of the most urgent priorities of the Ministry of Health. They are working on trying to find a way to motivate all the community workers ‚Äì and to provide them with needed transportation and supplies for the work they are trying to do. He told of us of the way that the system was designed to work. We were accompanied in this meeting by G. and Glenda ‚Äì and they had a long and very frank conversation with Sibusiso about what the situation really was like out there in the field. They told him of what we had been told of empty supply rooms and lack of food for children. It sounds to me like there are adequate supplies for the moment, but there are issues surrounding the adequate distribution of these supplies to depots and store rooms around the Kingdom. It‚Äôs a difficult problem, but a solvable one as we say in Physics.
More troubling was the report that Sibusiso shared that the Kingdom was running out of food. The southern region (where we are traveling early tomorrow morning) is a place that has not received adequate rain in the past years. As a result the harvest has been much less than is needed, and this year‚Äôs crop has already failed. The Kingdom needs to import more food to feed its people, but at the same time the rising level of unemployment and the disappearance manufacturing jobs. I asked Sibusiso if the situation might rise to the level of a famine. He said it already has.
This was totally unexpected news for me. Imagine the consequences of a nation that has 2000 hospital beds in total and 20,000 people in the end stages of AIDS also suffering the lack of proper nutrition and hunger. This is not a place that is going to be able to feed itself in the immediate future. It is going to require significant assistance from around the world so that this does not become a region of even greater devastation.
I was so hoping to be able to end the week on a note of hope. I guess I do have hope ‚Äì it is a fundamental quality of the Christian life ‚Äì but this is going to be a profoundly difficult situation for a very long time it appears.