John Sparrow and Selma Bernardi in Silele, Swaziland
Around 30 per cent of Swaziland’s population will need humanitarian aid this year, even more than in 2002 when famine threatened Southern Africa. Driven by the AIDS pandemic, the crisis extends beyond food and drought to breakdowns of community and the coping capacities of families. Red Cross health clinics and their home-based care services provide essential support for those most at risk. A week in the lives in the hard-hit south shows why the International Federation is appealing for US$10 million to strengthen a safety net for vulnerable people across the region.
Mummsy Sithebe is thinking about tomorrow’s funeral as she sets off on her rounds in southern Swaziland. Funerals are more and more frequent in this mountain kingdom of 980,000 people and Mummsy, a 38-year-old Red Cross volunteer, is seeing more than her share of them. She has lost another client.
Her unpaid job providing home care to her scattered rural community, particularly to people infected and affected by HIV/AIDS, brings Mummsy face to face with tragedy. It isn’t clear what caused the latest death but most of those she has dealt with have been AIDS-related. Since official statistics reveal close to 40 per cent of the adult population is HIV positive - almost certainly an underestimation - it is understandable. AIDS deaths are growing daily.
Mummsy walks down a rocky hillside track to a homestead of earth and stone dwellings she visits daily. An old woman is waiting. Her name is Grace and since March her world has been devastated. AIDS has claimed her children and her grandchildren.
Like thousands of others in Swaziland, when AIDS began to debilitate them, son Abraham, 45, and daughter Ntombikayise, 29, returned to the homestead they were born in. Care could be found more easily there, and the funerals would be cheaper. Ntombikayise brought her own children, Muzi, 3, a gaunt little boy already ill, and five-month-old Valesa, who soon would be.
Abraham died on a clear March morning. While Grace and the family mourned around his body in one hut, Ntombikayise and the youngsters lay chronically ill in another. Valesa, her little body wasted, died the very same day. Muzi went a week later.
Their mother, once close to death, survived. Through the long dark weeks that followed Mummsy cared for her. She nursed, cooked, cleaned, listened and counselled. She helped the stricken Grace through her anguish. She brought Red Cross food and hygiene parcels, ensured that Ntombikayise had essential medicines. And, just as she did this morning, saw to it she took them on time.
Three months on, the woman can stand again. There are good days and bad, and her steps are measured as she leaves the homestead. But this morning she will take a bus to the nearest hospital. She will visit a doctor and be dispensed a month’s supply of her drugs.
It isn’t a miracle. What laid her low was tuberculosis, the opportunistic infection that accounts for a third of AIDS deaths worldwide. Up to 50 per cent of people living with HIV/AIDS develop it, but treatment is effective if timely and consistent. It needs to be. Tuberculosis and HIV feed one another, and HIV is largely responsible for the accelerated spread of TB in sub-Saharan Africa. In the course of a year, one case of open pulmonary tuberculosis can, if untreated, affect another ten to 15 people.
It calls for vigilance and the home-based care programme the Swaziland Red Cross has introduced to this region has made care facilitators like Mummsy the eyes and ears of the community. Besides providing care, she is helping to prevent the spread of both diseases. Ntombikayise’s case is a graphic example of why the Red Cross and Red Crescent insist that TB and HIV interventions should go hand in hand. They are, the World Health Organization says, “mutually reinforcing”. Even in seemingly hopeless situations people living with HIV/AIDS and TB can regain strength, and improve the quality and length of their lives. Mummsy watches Ntombikayise leave for the hospital. Such knowledge keeps her going.
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