The song,"Cholera—Chenjerawo," which translates as "Cholera—Beware," will be played on radio stations across the country every 30 minutes. Performed by a group of musicians calling themselves Artistes for Health, it's the brainchild of some of Zimbabwe's top performers including Tanga Wekwa Sando and Oliver and Sam Mtukudzi who wanted to do something to help stop the rapid spread of the epidemic—the country's largest recorded outbreak. Cholera has now affected every province in Zimbabwe. More than 33,000 suspected cases have been reported and the disease has taken more than 1,600 lives.
The first cholera case was reported in August in a suburb of Harare. This week, at a meeting attended by government ministers, provincial governors, traditional chiefs, health experts, the commander of Zimbabwe's defense forces, diplomats, and the media, the government announced what it called a nationwide blitz to control, cure, and eliminate the disease.
"Information is the greatest tool in fighting this epidemic," declared Dr. Edward Mabhiza, permanent secretary at the Ministry of Health and Child Welfare.
The plan is to recruit as many as 20,000 volunteers to help spread messages about good hygiene. Radio jingles and messages in the papers and on television will be used in the campaign. Pamphlets and posters carrying information on how to prevent cholera are to be distributed everywhere, from beer halls to church entrances, and everyone, from provincial chiefs to soldiers, is being urged to play a part in the national effort.
Theatre groups will be also enlisted. Oxfam is already using drama groups to promote key health messages as it distributes hygiene kits to vulnerable communities across the country.
Using music, theatre, dance and humor, the groups entertain the crowds. But it's entertainment with a message, as the shows also highlight the need for careful hand washing and food hygiene.
Yet even the government, which acknowledges there is still some way to go before it can declare the epidemic under control, concedes that it needs more than educational messages to fight the cholera epidemic.
The country's sewage systems have broken down. Rubbish is no longer collected and piles up rotting on streets. Hyperinflation has caused many health workers to stay away from work, unable to live on their salaries which are paid in rapidly devaluing Zimbabwean dollars. More boreholes need to be drilled to provide clean water sources for communities. And many Zimbabweans are struggling to feed themselves.
There are worries that the epidemic could spike with the approach of the peak season of heavy rains which could spread contamination to shallow wells. There are also concerns about flooding and the movement of infected people within Zimbabwe and to other neighboring countries.
Education, though, can go a long way. And the call for action to mobilize the nation is an important step forward.
]]>2008 was an especially grim year in Zimbabwe—and prospects for the coming year seem little better. The fact that Zimbabweans were celebrating the new year at all might seem surprising. But many people, or at least those with some money living in the cities, were in the mood to party, if only for a night and to forget their worries.
Zimbabwe is gripped by economic collapse. Hyperinflation, the worst in the world, has seen prices skyrocketing, making it hard for many to access food and fuel. Last month, the country's central bank introduced a 10 billion Zimbabwean dollar banknote, but its actual worth, about $10 US dollars on the black market, is rapidly decreasing day by day. Most shops now only accept foreign currency not Zimbabwean notes.
On top of the economic meltdown, which has seen doctors, teachers, and most government staffers staying away from work because their pay in local Zimbabwean dollars won't even cover their crippling transport costs, there is a serious and worsening humanitarian crisis.
A cholera outbreak in August has now affected more than 30,000 people, and claimed the lives of more than 1,600 people, with cases now being reported across every province in the country.
Cholera is an easily preventable and treatable waterborne disease. But its spread in Zimbabwe is being fuelled by the collapse of health, sanitation, and water services. There are limited medical supplies and many don't have access to clean drinking water or proper sanitation. The onset of heavy rains this month is worsening an already alarming situation.
A second humanitarian crisis, still under-reported, is the worsening malnutrition and food shortages. There have been several years of failed harvests; a serious shortage of seeds and fertilizers; and driving hunger is forcing many to eat seeds instead of planting them for next year's crops.
The UN has warned that around five million people, more than half of the population, will soon rely on food aid.
The country is also facing political deadlock. Efforts to form a power-sharing government between the ZANU-PF party of President Robert Mugabe, who has been in power since 1980, and the opposition Movement for Democratic Change, have stalled.
I got a somber insight into many of the problems the country was facing as I visited Kadoma city in central Zimbabwe, about 112 miles west of the capital, Harare.
Oxfam has been working in the area, drilling wells so that communities can access safe drinking water, distributing hygiene kits, and undertaking health promotion work.
The health authorities have reported nearly a thousand cholera cases since mid November, with 29 deaths. Unofficial statistics put the figure even higher.
Two people had died that day; and I was shown a tent containing the wrapped corpses of seven bodies, several of which had lain there for several days and were swelling. Fuel shortages and rocketing prices meant that there were no vehicles available to take the bodies to the local cemetery.
"Things aren't stabilizing," said one nurse. "They're getting worse. We're seeing more patients every day."
With early access to treatment—intravenous fluids and oral rehydration—patients can recover quickly and be discharged within days.
But a visit to a nearby housing estate—described as a cholera "time bomb" by a senior health official—made clear why the epidemic is sweeping across the country.
The sewage system had broken down, and residents were disposing of human and other waste in the narrow lanes around their homes.
Those images haunted me as I sat in the jazz bar that night. Zimbabweans might have little to celebrate, other than surviving another difficult year; but they are still pinning their hopes that the coming year might bring some change for the better.
]]>On this hot August morning in a small fishing village on Sri Lanka's southern coast, he is probing locals for a full understanding of what well-being means to them. He remains serene as they squabble a bit, call each other liars, and offer up whole new categories no one has mentioned before. When a group of men can't agree on a set of criteria, he announces a tie and allows both points to become part of the findings.
Such is the life of a researcher engaged in the ebb and flow of a study that allows its authors to enter into a direct dialogue with the community they are focusing on. The approach is called participatory action research—a method Weerackody believes in deeply. He is applying it to a piece of research intended to expand the understanding of mental health issues in Sri Lankan communities affected by natural disasters or long-term conflict. Funded partially by Oxfam, the study is part of a large, four-year project conducted by investigators from McGill University. This piece is being carried out by the People's Rural Development Association, McGill's local partner.
"People are never given a chance to participate in the decision-making process," says Weerackody. "And this is what we need"
That lesson became all too clear in an earlier study he had helped to conduct on the impact of the aid system on communities affected by the tsunami. People received goods that weren't relevant to their lives, that were of poor quality, that weren't useful, says Weerackody—all because no one had bothered to consult with the communities themselves.
"It's about attitude and the way the colonial system was established," he adds. That system says decisions should be made by technical experts or politicians. "They think people don't know what they want."
Weerackody thinks otherwise.
"If it is decided by someone else, people don't have any feeling it is part of their lives," he says. And aid agencies have enough experience building roads, community halls, culverts, and the like to know quite well what will happen if beneficiaries aren't involved from the start: As nice as the facilities are, they won't be maintained, says Weerackody.
A relocated fishing village in which he has been conducting research recently offers a case in point. The hillside homes, sturdy but small, now house 55 families formerly living near the sea, and a newly built community center at the top of the hill serves as gathering place for all.
"They have a house but they're not happy," says Weerackody. "That house was not spacious. They can't entertain their relatives. They don't have enough place to sleep. One woman said she can't even make love with her husband. The lesson we learn from the study is you may design houses, but what's needed by development workers is to take into consideration other aspects of well-being."
From a rural community himself, Weerackody, who has been working in participatory development since 1982, says he takes pleasure in meeting with local people to learn about their opinions and needs—an important perspective to understand since so much of the country's population is rural. About 80 percent of Sri Lankans live in rural areas, Weerackody points out. And whenever he's got a free moment, he heads out of Colombo, Sri Lanka's capital and his current home, to visit the village in which he was raised.
"I have a strong belief in community consultation," he says. "Development workers should respect the communities and should win the trust and confidence of communities."
]]>Oxfam visited the densely populated and poor northern province of Zambezia in Mozambique recently to see how PEPFAR and other US agencies work on the ground. At the sites we visited, we found a close level of collaboration between PEPFAR and the Mozambique Ministry of Health. Over the past two years, the Mozambican government has worked to integrate all donors into its national development plans. Donors like PEPFAR have been asked to make some changes in the way they operate. PEPFAR aid to Zambezia province reflects PEPFAR’s ensuing move to integrate AIDS care into the long-term health system. To fight HIV/AIDS in Zambezia, Population Services International (PSI) implements PEPFAR programs ranging from those preventing the transmission of HIV from mothers to babies during pregnancy, to providing HIV counseling and testing, to preventing HIV through theatre and classroom presentations.
Sixteen percent of the adult population of Mozambique is HIV positive. In some areas, infection rates are as high as 20 percent. In 2000, only 1,000 Mozambicans were on anti-retroviral therapy. PEPFAR programs have increased those numbers to nearly 160,000. PEPFAR funds have also financed care and support for about 800,000 people living with HIV and their families.
Development experts worry that PEPFAR may not be the kind of program that leads to long-term health and development. PEPFAR is often criticized as the textbook "vertical fund," which bypasses the government and creates a parallel health care system. Critics of these so-called vertical funds have pointed out that foreign aid donors sometimes pour all of their health funding into treatment of one disease. This can have the unintended result of neglecting basic care for the general population and hiring away health care workers from general medicine clinics to HIV clinics, leaving the general medicine clinics understaffed.
Donor resources for HIV have outpaced support for basic health care for all Mozambicans. In 2007, only 3 percent of US foreign aid to Mozambique was for child and maternal health, while 61 percent went to HIV/AIDS. But more people in Mozambique are affected by child and maternal mortality than by HIV, since 15 percent of Mozambican children do not reach their fifth birthday and the mother dies in one out of every 100 births in Mozambique.
In the small town of Maganja da Costa, there is a PSI building next to the government health clinic that used to offer free counseling and testing to people who suspect they have HIV. The building bears a freshly painted sign. The sign used to read "HIV Counseling and Testing," and now it reads "Health Testing Center." At the request of the Mozambique Ministry of Health, PSI has expanded services offered there to include cancer, diabetes, and tuberculosis screenings. The change is a result of a recent Ministry of Health policy of integrating stand-alone HIV "day clinics" into the general health system, including centers funded by donors. Integrating these HIV day clinics into the general health system reduces the stigma attached to getting tested, since it's no longer obvious that if you walk into that building, you are there to test for HIV and HIV only. Making the building a generic testing facility, and not just an HIV one, provides new testing capacity for the government health clinic.
PEPFAR is also working to integrate health care workers into government clinics, rather than hiring away the best staff for separate clinics. PSI has implemented this change on the front lines: its nurses are embedded within government clinics, wearing the same uniforms as government employees and providing the same services.
In the district hospital in urban Quelimane, PEPFAR's contributions to basic health are also on display. There, PSI uses PEPFAR money to fund two nurses and a physician's aide—a big addition to the original staff of eight. PSI also renovated the maternity ward, and Columbia University (using PEPFAR funds) transports blood samples to the lab, which is hours away. Support like this from PEPFAR makes it easier for the clinic to serve the more than 260,000 people depending on it for all their health care needs.
"PEPFAR support actually benefits other areas in the clinic. We now have pre-counseling in addition to testing, which we didn't have before, and we can now test for other sexually transmitted diseases as part of antenatal care because we have additional money for other testing." — Director of Government Clinic, Maganja da Costa
When we arrived in one town, PSI insisted that our first destination be the government clinic, where we asked the clinic's director for permission to visit. Visitors can be disruptive, preventing doctors, nurses, and health workers from seeing patients. Asking permission also reminds visitors and nongovernmental organizations that this is the government's clinic and that even though PSI may have outside money, its role is to help the government of Mozambique provide health care and not the other way around.
While we heard concerns from international donors based in Maputo that PEPFAR is not fully integrated into the Mozambique Ministry of Health and National AIDS Council, the experience of health care workers in the field appeared to be one of close collaboration and integration. The change is due to two key innovations:
PEPFAR's evolving role in Mozambique is a model for other PEPFAR focus countries, particularly the countries that have only just begun to hold donors like PEPFAR accountable to their national health priorities.
]]>There, on the shore behind what's left of a half-constructed mansion, the chug-chug-chug of a diesel pump holds the promise of clean water for 11,042 people at Buhimba camp. They are just some of more than one million villagers forced to flee their homes as conflict has swept across the eastern provinces of that vast country. A short distance away, a second pump, submerged deep in the lake, provides water for an additional 18,016 people in two other camps known as Mugunga I and II.
Without clean water, without decent sanitation, and without the public health outreach that helps people understand the link between the two, waterborne diseases could ripple through theses camps with devastating consequences. That's what Oxfam, together with its local partner, Action Santé Femme, or ASAF, was determined to prevent when it helped establish the water systems for these three camps—and a fourth, Bulengo—outside Goma, the capital of North Kivu province. Through a network of rigid plastic pipes, storage tanks, and outdoor faucets, water from Lake Kivu now gushes into the jerry cans of thousands of families with the turn of a tap.
At the top of a short but steep hill at Buhimba, where two massive water storage tanks frame the sprawling camp below, Helene Kanyere Ndakas stands ready with a notebook in hand. She is the manager of this storage station—and knows better than almost anybody the importance of making sure the system runs smoothly.
What gives her that special knowledge?
Ndakas herself relies on the water that flows from it. She and her family are among the thousands of people who are now making their homes temporarily at Buhimba.
Flipping her notebook open, Ndakas points to the careful records she keeps each time she opens the valves to refill the tanks with lake water. And she notes the amount of chlorine that goes in to guarantee its cleanliness. Hired by Oxfam, Ndakas is on water duty from 6am to 4pm each day—a job she takes very seriously.
"People are depending on her," says Charles Mampasu, an Oxfam program manager in Goma. "And they're happy with her job."
In a place where there was little or no infrastructure to support a water system, supplying tens of thousands of people with clean water on an emergency basis has been no small feat. And making sure they continue to have access to it when Oxfam moves on to its next project is one of the organization's central concerns. That's why Oxfam is working hand-in-hand with ASAF to help it build its ability to handle the water system on its own, particularly in Mugunga camps.
A tour through Mugunga I shows how important a steady supply of clean water can be—especially when people are struggling with such harsh living conditions. Built on fields of sharp volcanic rocks, the shelters many people now call home are not even tall enough in which to stand. Made from grasses and dried banana leaves flung over a frame of saplings and topped with a plastic sheet, the huts offer only minimal protection from the elements. To keep warm—and to drive the bugs out—many people cook on small wood fires inside their huts, the smoke curling into their lungs and out through the cracks in the shelter walls.
At the health clinic, the nurse on duty reports that respiratory infections are among the most common medical problems he sees. About 150 people a day flock to the clinic with a host of ailments that also include malaria, tuberculosis, and diarrhea. The latter is what the clean water—and scores of latrines that Oxfam has also installed—help to fight.
Snaking across the rocks, over roots, and through the mud, a network of wide black plastic pipes carries the water from Lake Kivu. It's replacing a temporary supply that another agency had been trucking in daily and storing in two plump water bladders—they look like giant egg yokes when full—at a cost of $3,500 a week. Nearby, the water blasts from faucets when kids turn on the taps to fill plastic jugs before lugging them home.
The water jug of choice for many kids has a familiar look: it's the container that once carried their family's allotment of cooking oil, doled out during the regular food distributions that displaced people have no choice but to depend on. Here at Mugunga, nothing goes to waste—not the jugs, and not the precious water they carry.
]]>Byakupita Wabinwa, president of the management committee that oversees the Kabimba health clinic, is standing below the sign. He is a small and serious man with a serious problem—one that plagues not only his community but that crops up frequently in this region of Democratic Republic of Congo: cholera.
Here, in the eastern provinces where years of conflict have taken a toll on social services, outbreaks of the waterborne disease are just one of the consequences of underinvestment in everything from roads, to health clinics, to clean water.
Sometimes, if maintenance of the simple delivery system has been lax, the water at this clinic doesn't run at all. That's why an enormous black cylinder is lying on its side in the clinic's front yard. It's a storage tank, waiting for installation as part of Oxfam's program to help ensure the clinic has a reliable reserve of water as well as decent sanitation facilities. In the back of the yard, a pair of pit latrines and two bathing stalls are under construction. And nearby, deep in the ground, lies the newly dug "placenta pit"—the local solution for disposing of hazardous medical wastes including afterbirth from the maternity ward.
Though it has no doctor and just five nurses, this is a busy place—serving an area with nearly 14,000 people. About 75 make their way here each week—some walking two hours down from the mountains—to receive treatment for malaria, to get tested for tuberculosis, to fight the cholera that erupts from time to time, especially during the rainy season.
Tacked to the door of one of the buildings is a sign, warning with explicit detail in Swahili, about the symptoms of cholera. It urges those who've got them to head for the nearest health clinic as soon as possible.
On this day, there are no cholera sufferers at the Kabimba clinic. But sometimes, during outbreaks, as many as 20 people a week come for treatment, though there is hardly the space for them. People lug their own bedding with them and spread it on the floor. A small building—about 30 feet long by 15 feet wide—serves as a quarantine area.
"But how can you put 20 people in that building and keep them healthy?" asks Wabinwa.
Inside, the walls are grimy with stains and the ceiling is collapsing. Of the original 10 cholera beds—mattresses with holes in the center beneath which buckets can be placed—only three remain. The plastic covering on one of the mattresses has pulled away, exposing the foam around the hole and leaving it like a sponge to sop up germs. A rickety wooden rack serves as a post for the intravenous drip.
As primitive and ill-supplied as the Kabimba clinic is by western standards, Trish Morrow, Oxfam's public health team leader for rural villages around Uvira, assures visitors that it's better than many that serve some of Congo's 62 million people, vast numbers of whom live in poverty. Few have the resources to pay for much medical care at all, but many live at risk of contracting serious diseases—like cholera—to which that poverty, with cruel irony, exposes them.
Nowhere is that more clear, perhaps, than along the stretch of land between the Mulongwe and Kavimvira rivers just outside of Uvira, South Kivu province.
It's there, between those two central sources of water, that the greatest number of cholera cases in the area erupt, says Jill Markvorsen, Oxfam's program manager for Uvira. During the first week of January, an outbreak almost reached epidemic proportions. At the cholera clinic in Uvira, workers charted 64 cases of the disease&mdasdh;one shy of the number that would have triggered the implementation of Uvira health zone's cholera contingency plan. Instead, officials, staffers from Oxfam and other aid groups, and volunteers from the Red Cross managed the flare-up by chlorinating water sources, making public health announcements on the radio, and providing information to people about measures they could take to improve hygiene and sanitation.
A few months later, in mid-March, both banks of the Mulongwe River are teeming with activity. Not far from one edge, a bare-bottomed boy dashes behind a bush and squats to relieve himself. Pigs root in a heap of rubbish that inches, black and slippery with mud, almost into the water. It rushes by filled with silt. Men wash their clothes. Others drive trucks and cars into the shallows to rinse off the dust and dirt. Up stream, a market crowded with people hugs the bank.
For those who have no other source, the Mulongwe River also serves as their supply for drinking water. It's no wonder then that cholera, caused by ingesting water or food contaminated by the bacterium vibrio cholerae, is one of the ugly facts of life for people living in this war-torn region.
At the Uvira cholera clinic, Oxfam helped to install a large tank that stores a backup supply of water—collected from the roof during rainstorms and precious for its relative purity. Two large rooms—one for men and the other for women—serve as sick wards. Simple beds—wood frames with sheets of rugged plastic stretched taut across and cut in the center with a hole—are scattered about the rooms. Others are piled outside.
The wards are empty on this mid-March day—a good sign.
Morrow, the public health team leader, says that the medical staff in Uvira has been trained well to provide patients with good care. Though there is not so much it can do to prevent people from contracting a disease that's so closely linked to the lack of public services—like potable water—the staff has been successful, says Morrow, in stemming the tide of cholera deaths.
And in a place where basic precautions take on ominous importance, blue buckets filled with a mixture of water and a heavy dose of chlorine dot the perimeter of the clinic's yard. All visitors are advised to scrub their hands with that solution before they leave. Most do—and duck out smelling like a swimming pool in the western world, but grateful for it.
]]>These community organizations are the leaders in an epic struggle against HIV and AIDS in South Africa. They are doing what the government cannot seem to do: deliver essential services that directly benefit the millions of people in the country infected and affected by HIV/AIDS.
"If the government of South Africa wants to address HIV issues, then it needs to strengthen community-based organizations," says Gerard Payne, who works for the AIDS Consortium, a national organization that supports thousands of community groups. He says that the HIV/AIDS crisis is the most significant challenge facing South Africa since the transition from apartheid.
The scale of the problem requires a local, grassroots response, and community organizations are doing their best to deliver it. Many are overcommitted and underfunded. "Whether it is through financial resources, whether it is through training, we need to strengthen them, so we can reduce the rate of HIV in this country," Payne says.
Payne has just been to visit one such community organization, where he stood in the dusty courtyard outside a two-room cinderblock house in South Africa's North West province as a dozen high-energy toddlers played and ran around him. Four of the organization's home-based care givers prepared to make their rounds, visiting patients in their homes to help cook, clean, and remind them to take their medication.
Payne's job at the AIDS Consortium is affiliate coordinator, so he visits the community-based organizations, assesses their needs and capabilities, and recommends a course of action to train the staff. Many must learn and implement procedures for raising and managing money, and develop a strategic vision for what the organization can be and where it can go. This helps the community organizations get past simply reacting to the HIV/AIDS crisis and working towards measures that will help improve the situation.
One example is in the care of orphans and vulnerable children in the community. The government of South Africa estimated last year that there are 1.5 million children under 17 directly affected by HIV: one or both parents are dead, or they are living with the virus themselves. With so many children now in need of a place to live, or at least hang out after school, get a meal, and stay out of trouble, it is the community organizations that are struggling to meet this need, many of them without specialized training or adequate funds. "They may be running a program, but have no idea how to really do it properly," Payne says. "So we will help them get training so they can provide counseling and other services that will help the children. We help them get to a level where they have good infrastructure and are rendering quality services." This can include a curriculum to teach "life skills" to young people so they can learn how to prevent HIV.
Another essential area where community groups can make a big difference is in helping people living with HIV and AIDS to understand what treatment is available and how to get it—a basic level of knowledge known as "treatment literacy." This is particularly helpful for women, who for reasons related to poverty and discrimination may be unable to get to a clinic or hospital—their families may not give them time, they may not have money to pay for transportation, or they may just simply not know that they are HIV positive and need medication.
Gerard Payne says that even if a patient can get to a hospital, he or she still may not understand what they need to do to stay alive. "Patients go there, the staff does a CD-4 count and gives them some medication, but they do not explain anything," Payne says. "Our objective is to educate organizations how to help patients understand the different treatments needed, and their rights to access treatment."
He adds that educating people about their right to treatment is a big step for many groups that are accustomed to delivering food and other care. "Community-based organizations respond to needs: if someone is sick, they go to them once or twice a week and take care of them," he explains. "We are saying they need to take it a step further. That patient is eventually going to get really ill, so they need to understand what care is available, where to access it, and that they must adhere to the treatment."
Seeing organizations grow and become more effective is one of the things that keeps Payne engaged in his work. "Last year I had one affiliate with no money, so I helped them get financial management systems in place," Payne says. "The first 1,000 rand [US $125] they raised was due to the fact that we showed them how to open up a bank account and write some letters to raise money."
"The joy and satisfaction I get comes when someone tells me that the work we do is making a difference," Payne says.
Payne says that South Africa is at a crucial stage in its history. "We have come a long was as a country, and struggled through many hardships," he says. "We are now in a different kind of struggle, and I want to be able to feel that I am contributing in the struggle against HIV."
]]>"Having secured an arrangement with government units to provide relief in remote areas, Oxfam's five relief teams are putting all of our resources into helping people stranded in rural areas away from the epicenter," said John Sayer, director general of Oxfam Hong Kong.
Oxfam has now committed more than $3.2 million to an initial effort that has commanded response from around the world as headlines continue to bear bad news: A week after the 7.9 magnitude quake struck, Reuters is reporting that 34,000 have died and 30,000 others remain missing; 4.8 million people have lost their homes; and Sichuan Province alone is facing $9.6 billion in economic losses. Hundreds of aftershocks and heavy rain have brought further devastation, including landslides that have reportedly killed 158 relief workers struggling to repair roads in recent days.
"Oxfam is teaming up with medical and hygiene professionals and working in and around the city of Mianyang to prevent an epidemic from starting," said Sayer. Oxfam is also carrying out disease monitoring, control, and prevention in Guangyuan and Zhenzhong.
The organization is concentrating on securing an adequate supply of drinking water for survivors as well as helping to provide safe sanitation services, and carrying out public health education.
Oxfam's first shipment of goods reached Dujiangyin and Guangyuan on Monday. A second shipment is due to reach Qingchuan on Tuesday.
Among the health-related goods Oxfam is sending into the region are portable toilets, intestinal drugs, first aid materials, face masks, and sanitary supplies for women. It has also provided clothing and high-energy biscuits.
Five villages in Gansu Province will also be getting a delivery of aid that will include tents, flour, oil, blankets, and milk powder. The goods will help meet the needs of 3,000 people in Wudu County.
Oxfam, which has more than 20 years experience working in mainland China, is now working alongside the Civil Affairs Department, the Poverty Alleviation and Development Office, several mainland-based aid groups, medical schools, and a variety of volunteer groups.
Additionally, the organization is preparing to reach remote areas of Aba Tibetan and Qiang Autonomous Prefecture.
]]>Oxfam has committed $1.55 million to this initial response. It is also preparing for longer-term projects such as helping to rebuild damaged infrastructure.
Oxfam colleagues based in the neighboring province of Yunnan are now traveling to Wenchuan County in Sichuan, the epicenter of the 7.8-magnitude quake, for assessment and coordination of the relief work. The organization is also planning to provide assistance in Gansu Province where it had been working on development projects prior to the disaster.
Based on our communication with local organizations in the affected areas, our initial assessment is that earthquake survivors need clean water, food, medicine, clothing, and blankets. We also anticipate that there will be a huge need for rehabilitation and reconstruction assistance. Damage to infrastructure and other facilities is significant and Oxfam expects it will take months for the region to recover.
"This is the worst earthquake in 30 years, with a huge impact on people's livelihoods," said John Sayer, director general of Oxfam Hong Kong. "With over 20 years of experience working in China on long-term development work and emergency relief, Oxfam Hong Kong is determined to help as quickly as possible, to guarantee people's safety in the short term, and in the end, as a long-term goal, to improve their livelihoods."
]]>Mogale, 37, is open about her status: she has been HIV positive for two years, and she is living with it. After all, she is doing better now and hopes the worst is behind her. "Now I am really fit compared to when I was sick—I can go a long distance walking now," she says. She regularly walks about one and a half miles to the headquarters of Pholo Modi Wa Sechaba, a community organization where she is part of a support group for people living with HIV/AIDS in her village of Welgavel.
Pholo Modi Wa Sechaba helped get Mogale out of bed and back on her feet. The organization sent a home-based care worker to nurse her, help her get to the hospital for treatment, teach her how to take her antiretroviral medication and manage her diet, and file for a government support grant—a source of money for disabled people.
Pholo Modi Wa Sechaba—meaning "health is the root of the nation" in Setswana, the local language—has about 21 caregivers serving 240 patients in four villages. They ensure that patients are taking their medication; they cook and clean, and disinfect and dress wounds from the many infections that bedevil those with an immune system compromised by HIV. In some cases they deliver food parcels to help families survive.
Pholo Modi Wa Sechaba is just one of thousands of local community based organizations helping the roughly 5.5 million people living with HIV/AIDS in South Africa. They are on the front line of the struggle, and play an essential role in providing services. "Community-based organizations are key in the fight against HIV/AIDS," says Gerard Payne the affiliate coordinator at the AIDS Consortium, an umbrella organization for the thousands of such community groups around South Africa. "Without them the fight against HIV and AIDS is a mere media campaign. They provide essential services in the community, they speak the language, and they understand the cultural issues in the communities."
Oxfam America is working with the AIDS Consortium to provide training and other support to community based organizations like Pholo Modi Wa Sechaba in South Africa's North West Province, one of the poorest areas of the country, with a high incidence of HIV/AIDS. The AIDS Consortium is working with 47 local community based organizations in the North West, and with funding from Oxfam it can expand its efforts to some of the 150 others struggling against HIV/AIDS in the province.
Pholo Mode Wa Sechaba helps patients get tested for HIV and, when patients test positive, counsels them on their treatment options and on how to "live positively." In addition to its home-based care program, it has a daycare for young children and an after-school program for orphans and others who need a place to do their homework and learn valuable life skills including how to prevent HIV.
Learning that you are HIV positive forces you to think about everything differently. Just having to share your status with your family is enough of a crisis for many newly diagnosed people. They then must struggle with how to live with what may at first seem a death sentence, how to make ends meet if they are too ill to work, how to endure the side effects of the medication, and how to manage the stigma of being HIV positive.
South Africa's health care system, while free, is overburdened and does not provide adequate social support for people living with HIV/AIDS. They can be tested, learn the result, and get a CD4 count (a measure of the blood cells that support their immune system). Many get free antiretroviral medication. But then they are really on their own—and if they lack a support system of family and friends, as many do in communities already ravaged by the disease, these patients are in crisis.
Pholo Modi Wa Sechaba helped Maria Mogale with these struggles, and helped her understand her treatment options. These are the most important lessons the organization teaches people in the community, particularly valuable to women who are sometimes excluded from health care options owing to poverty and discrimination—a violation of their right to health care. Family members may insist on traditional medicine, which frequently delays treatment, and can often hasten death.
Mogale learned this from Pholo Modi Wa Sechaba: "If people are sick, they need to go to the hospital, and not just stay at home and say they are bewitched," she says at her home, a three-room house made of metal sheets outside Welgavel. "I tell people, 'AIDS is there, but you can get better.'" She smiles as she speaks.
Mogale is a strong, positive example for members of her community—and this strength, tragically, is also a good example within her own family. Her daughter Portia, 18, learned she was HIV positive two months ago, and her 60-year-old mother Priscilla, who lives nearby, is also in treatment. Both are now thinking about their lives differently as well, and look to Mogale for advice on how to live and think about their future. Portia is in her second to last year of high school and is considering higher education, even as she is still learning what it means to be HIV positive.
For Maria Mogale, her future may involve helping others on a more formal basis: she wants to work with Pholo Modi Wa Sechaba. "I want to become a caregiver, and teach others what I have learned."
]]>Oxfam America was selected as one of only three organizations in the campaign based on input from the eBay Community. Funding from the campaign will support Oxfam?s work to: increase the number of people in rural areas of Ethiopia and Zambia who have access to clean water and sanitation; provide access to new, safer water supplies through upgrades to existing water sources; provide latrines for communities and schools; and train communities on how to manage the equipment and sustain the water supplies.
?The Community Gives campaign is an exceptional opportunity to raise awareness of Oxfam?s work in bringing clean water to poor communities,? said Raymond C. Offenheiser, president of Oxfam America.
?This initiative will make a significant difference in the communities Oxfam serves. Most of us take for granted the easy access we have to clean, safe drinking water and basic sanitation. In the communities we are working with, clean water and basic sanitation can prevent disease?it could mean a child makes it to her fifth birthday and gets to go to school.?
The goal of Community Gives is to encourage the eBay Community to make a donation to the nonprofit that inspires them, and then spread the word about the campaign. eBay Foundation kicked off the campaign by giving Oxfam a grant of just over $325,000. To help encourage giving, eBay Foundation will also give an additional dollar for every person who gives and waive all donation-related fees, so 100 percent of donations will go directly to the nonprofits.
?We are proud to launch the Community Gives campaign and work with an excellent organization like Oxfam,? said Julie Vennewitz-Pierce, program manager for eBay Foundation. ?The campaign will help Oxfam supply clean, safe water to tens of thousands of people in Zambia and Ethiopia.?
Through Community Gives, Oxfam is tapping into the power of online philanthropy thanks to a critical resource eBay Foundation is providing?an engaged Community eager to support concrete, on-the-ground projects that help solve critical social issues.
Anyone who wants to get involved in Community Gives can by donating through PayPal or buying or selling through eBay Giving Works. They can also join Oxfam America?s eCommunity and help spread the word about the campaign by using some of the tools on the website.
]]>A crowded camp sheltering 25,000 people from the horrific violence of Darfur's five-year-old conflict may seem an unlikely venue, but this is no ordinary pop concert. The tunes are traditional, but the lyrics talk of hygiene and explain how people can avoid fatal diseases. Kaltoum is one of a dozen women who have teamed up with Oxfam to hold weekly music festivals in Shangil Tobai in North Darfur. The concerts bring an afternoon of fun to people who have had fled attacks on nearby villages—but they educate as well as entertain.
"Singing is a part of our lives and we like to sing whenever and wherever we can," says Omer, sipping a small glass of extra sweet tea after the concert ends. "We enjoy it, and the people listening enjoy it, but most importantly our singing now helps change people's lives for the better."
"We take Oxfam's advice about good health and sanitation and put it to our own music," she continues. "You can see the songs changing listeners' behavior. The camp is much cleaner now and there are far fewer cases of malaria and diarrhea. Children wash their hands now without being told. When you tell young children to wash they don't always do as they're asked—but when we sing it to them they join in and have fun, and they really pay attention."
The songs change over time to reflect the needs in the camp, adds Zaharisa, another member of the group. "We used to sing about the need to clean the latrines regularly, but now people are doing this well so we no longer have to sing about it. At the moment my favourite song tells people how to safely and hygienically dispose of waste and get rid of rubbish."
Zainab Basher, an Oxfam health promoter in Shangil Tobai, helps the women organize the concerts. She says the impact has been enormous.
"We hear women and children singing the songs at home and work, and the communities keep asking us when the next performance will be," says Basher. "Now the women perform at weddings and religious festivals, as well as the weekly concerts. Each community has its favorite singers, and keeping latrines and water points clean has become a source of pride. Everyone wants to keep their area of the camp the cleanest. Participation in regular clean-up campaigns has increased greatly."
As the conflict has dragged on five long years, Basher says she and the Oxfam team have had to adapt their work. "We held committee meetings, we visited people's homes, and we trained individuals to become community health mobilizers, but the longer people are here in the camp, the more these methods become routine and ineffective. We needed something new and exciting, so we approached the women singers and they were very keen to help."
The concerts are held in different areas of the camp each week, attracting an audience of hundreds each time.
"We want as many people to hear the songs as possible," says Omer. "Oxfam gives us megaphones for the concerts, to make them louder. The next step is to get cassette recorders to tape the concerts, which we can hand out as gifts to neighbours and relatives so people can listen to the messages at home. Not everyone can sing but we still want to involve them somehow. Some of the women who can't sing are good at playing drums, while others help us write the lyrics."
All over the world, children like to imitate their favourite pop stars. Darfur is no different, and Kaltoum and the women have inspired a new generation of singers who meet every week at the Oxfam health centers in the camp. One popular chorus goes:
"Let us go to school to read,
Let us learn to be healthy,
Let us clean ourselves,
All children, let us do this."
Manahir, a 15-year-old girl from the camp, leads a group of children aged 5 to 16. Some sing, some bang on small drums, and others just clap and cheer. A chant of "clean the jerry can, clean the latrine" gradually gets faster and the drums louder, until the children lose their breath and burst into applause.
"We have great fun, and we learn at the same time," says Manahir. "My friends and I come to the center every day from all over the camp."
Nearby, as the women's concert reaches its finale, another singer named Mahasa takes the megaphone and leads a chorus in praise of Basher and the Oxfam team's recent distribution of blankets and jerry cans for carrying water.
"We thank the aid agencies and the people around the world who send us these things when we have nothing," she says. "If they didn't help us we wouldn't be able to stay here in the camp. We'd have to go home and be attacked all over again."
]]>This is where Asewe stays when she's in Goz Beida, a small town in eastern Chad whose outskirts are now flooded with about 52,000 people forced from their villages by factional fighting. But when it's safe, her home is a tent at Kerfi, one of several sites in the area that the displaced Chadians have temporarily settled.
"That's what my beneficiaries are using," says Asewe about her tent. "It's good to use what my beneficiaries are using."
It's there, at Kerfi, that Asewe likes to be best—in the midst of the people she has come to help. A registered nurse and trained midwife, she is a public health promoter for Oxfam, leading a team of three staffers and a committee of 15. Her job is to work closely with families, showing them how to prevent the spread of waterborne diseases. A musical voice, a warm smile, and an untempered passion are her tools.
Asewe came to this region of Chad in mid-July 2007—at the height of the rainy season—her second posting to the country in a long humanitarian career that has carried her around the world from the tsunami-ravaged coast of Indonesia to Afghanistan, Pakistan, Sierra Leone, Ethiopia and back to Chad. It was raining that first time here, too, back in 2004 when refugees from the Darfur region of Sudan were streaming across the border, many of them having walked for days to reach safety.
She was assigned to Bredjing, a camp that now has a population of close to 30,000 people. But back then, it was just beginning to grow, a chaotic sprawl of families, ragged and tired, desperate for food, water, and shelter.
"It was a very difficult situation. Every morning we would come and we would find at least 100 people, towards the wadi, just squatting around," recalls Asewe. "Some would come with small plastic sheets. Some would have traditional mats, but some would have literally nothing. It would be raining the whole night. The children would have literally nothing on top of their heads."
Many of them didn't survive.
"They put in their own graveyard. Every morning organizations like Doctors Without Borders had outreach people just to count how many graves. Yes. So it was very very painful when they first came."
For nine months, Asewe worked with Oxfam, and alongside other organizations, to bring some order to the camp.
"I left happy, though," she says, "because I had seen the beginning and I saw all the changes—everybody putting in a lot of effort." Besides getting water and sanitation services in place, aid groups had even managed to set up activities for children. And the overcrowding was relieved a bit when some of the refugees moved to a new camp—one that was planned for them in advance, so water systems and latrines were already in place.
For the first few weeks of her posting to Kerfi, about 45 kilometers south of Goz Beida, Asewe couldn't even get there. The heavy seasonal rain had swollen the seasonal river, or wadi, swamping parts of the village, and making it impossible for trucks to cross. The short drive from Goz Beida to Kerfi took six or seven hours through the rain, as drivers struggled to negotiate the mud and gushing streams.
Doctors Without Borders was the only aid organization working in Kerfi at the time, said Asewe and it had managed to get there before the rains began to fall. It had parked two of its trucks on the far side of the wadi rushing by the village.
Eventually, workers built a small raft from old drums. An Oxfam driver would deliver Asew to the wadi's edge, and she would float across, her feet dangling in the water, to catch a ride on the other side in a Doctors Without Borders truck.
"We did that until September," Asewe said. "We were not able to get a driver across until October so that delayed all the possibilities."
But once she was able to set foot in Kerfi, Asewe wasted no time in laying the groundwork for her program.
In crowded situations, where there is little room for people and their animals to live as they are accustomed, the spread of waterborne diseases poses a major threat. In December Kerfi was home home to more than 3,000 displaced people—on top of the 4,200 who were already living there.
"The major issue was there was a lot of wadi water, but no clean water," said Asewe, noting that Doctors Without Borders was treating numerous cases of diarrhea. "It was pathetic. The host community, having been completely surrounded, also lost the area they would use for extra space. Their main complaint was they hardly had any place to get their animals to graze." Nor did they have any place left to use as a bathroom.
"Hence the demand for latrines and water," says Asewe.
In convincing people to adopt new ways of doing things, it's important to make them part of the process—so they own it, too. But first, Asewe has to find out what they know, and in this case, it quickly became clear that people were not making the link between the dirty wadi water they were relying on the diarrhea they were suffering from.
"That gives you a key basis where to start," says Asewe.
She organized a development committee of nine women and eight men from Kerfi who would eventually help her with the big task of public education. After some training, together they settled on three main messages they needed to convey to the community.
The messages may sound simple to western ears, but for the residents and displaced people of Kerfi, they could mean the difference between life and death.
Here is what the health promotion committee and Asewe want the people of Kerfi to do:
Part of Asewe's public education program also includes granting families ownership of community latrines—along with cleaning and maintenance duties. About 20 people share each latrine. When a cluster of three or four have been built for people who are under the care of one chief, Asewe arranges for a handover ceremony, with plans made for who's going to keep the latrines clean and how they'll close them down when they're full. And with each latrine, Oxfam provides a latrine kit—a brush and bucket for cleaning.
Some people get the messages very quickly; others are slower to change.
"The best people to target are the children," says Asewe. They learn quickly and adapt readily. "For adults, they may be able to understand, but changing habits may not be so easy."
But whatever the frustrations may be—wadis overflowing with water, insecurity that keeps her tied to Goz Beida, the slow pace of people's adaptation—Asewe says none of that is enough to snuff out the enthusiasm she has for this work.
"I'm still so happy to be the public health promoter who goes to that little house and finds the child and plays around with them and see how you could improve their little lives," says Asewe. "That makes me more happy. It's quite an opportunity and a blessing."
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