My gift, according my father, is that while most people look at a 15-hour flight as torture, I look at is a time to get some rest. And he is right. My flight went by in a flash. I got some reading done, some work done, and slept the rest of the way curled up in my seat with my neck pillow and noise-cancelling earphones (best birthday gift ever).
My first hours in Zimbabwe were filled with contradiction. As I walked out of the airport in Harare I was greeted by clean, cool evening air. I was then welcomed by Oxfam's humanitarian program coordinator, Ransam, with a hug and a joke. But as we drove to my hotel the empty streets were shocking. It was only 10 pm, but there were almost no other cars on the road and very few people walking. We pulled into the hotel and as we walked up to reception the crickets were singing. I could tell, even in the dark, how beautiful the landscape was. But as a sign of the times in Zimbabwe, when I checked in I learned the hotel wanted me to pay cash—in advance—for my room and it preferred US dollars or Euros.
After checking in, I met up with Lyndsay, Oxfam's public figures liaison. She worked to put this trip together and I could tell she wanted it to go well. She has a lot of respect for Emile after their trip to the Congo last year. He gets it, she said, and really wants to learn. As for me, I couldn't wait to meet him and made her knock on his door at 10 p.m. to introduce us. He was tired but cheerful and very excited about the trip. We kept the meeting short: tomorrow would be the car ride to the rural area and we could get acquainted then.
I am always so tired at the end of the day in Mudzi, a region in the northeast part of the country where Oxfam has been working on the cholera outbreak. After a two-hour car ride from Harare we arrived at the Pumpkin Hotel—the only hotel in this region. We settled in (Emile got the suite with the waterbed, and I got the one next door) and had some lunch: Eggs and sadza—a finely ground cornmeal boiled in water.
After lunch, we headed out to look at a bore hole—a narrow well drilled deep into the ground. Mudzi has hundreds of them. They're the source of drinking water for many people in this rural region. This one was a half-hour-drive away on a bumpy, dry road—and when we arrived, we found hundreds of community members waiting for us.
Sitting in two large groups, they had prepared a speech and gifts: beautiful hand-crafted baskets and several large bags of fresh peanuts tied in large burlap bags with "product of USA" stamped on their sides. These bags had been recycled from earlier food distributions. The villagers wanted to show their gratitude for the work Oxfam and our local partner, Single Parents Widow(er)s Support Network, or SPWSN, had done together: teaching communities about hygiene , providing them with basic goods like soap, and repairing their bore holes.
Emile confessed to me that he thought the word was "boar" hole. And why not? if you were not a water engineer or public health person or someone dependent on these holes for water, how would you know what they were? It made me realize how little the developed world knows or understands about those who still fetch water by hand and don't have access to flushing toilets—or even pit latrines.
Back at the meeting, Emile addressed the village, thanking them for their hospitality and acknowledging their strength as a people and as a community. He was nervous and I could tell he had really thought through what he wanted to tell his hosts.
That is why this trip is so important: To get the word out. Yes, the number of cases of cholera might be less each week, but what about next year? How do we stop an outbreak from happening again? This year in this village this outbreak left 25 orphans. This is a staggering number of children who have lost their stability—all because they and their families could not access clean water.
As we drove back to the Pumpkin Hotel, I thought again, with amazement, about how so much devastation can happen in such a beautiful setting, and how the people can keep going with such optimism and positive attitudes. I realized it had been an important day for Emile, too: He was beginning to understand the context of people's lives, how they cope, and the importance of supporting them when their options run out.
We spent another long and dusty day in the field. Today we watched as nearly 2,000 people gathered to learn about cholera. They sang, laughed, and watched plays all about a deadly bacterial disease that can kill a person in a matter of days with diarrhea and vomiting. We listened to health promoters from Oxfam and SPWSN as they talked and sang about feces, and watched as they faked illness and dying—all to teach the audience about cholera.
Emile was amazed at the teams' drama and acting capabilities and at the community's ability to laugh about something so devastating. My favorite part was the singing—so lyrical and powerful. I found myself singing along (not nearly as well, of course) and envious that they could make such beautiful music with nothing but their voices.
We spent the second half of the afternoon driving to a cholera treatment center. The number of cases had finally started to wane but it was hard to know if it was just because the rains had stopped or if all our hard work was paying off. I am sure it was a combination of both—but we will know for sure next year when the rains come again. That is why we are going to continue our work after the outbreak is over: We'll introduce clean water at the level of the household using sand filters. We are going to try and break the cycle of yearly diarrheal outbreaks—lofty goal, but worth shooting for.
The day started out with a 9 a.m. meeting at the local hospital and a report on new cases. Yesterday, the cholera early warning surveillance system Oxfam put in place with SPWSN detected new cases. For the past several weeks there were only sporadic cases, but yesterday, following a funeral the day before , 19 cases were detected. It was amazing to be there and see our early warning system working—and to learn about the response. All 19 patients were brought to the health center and the response featured bore hole repairs, the delivery of supplies to the health center (including a salt and sugar solution for oral rehydration, disinfectant, tents, and beds) and the launch of a public health education campaign for the affected community. Amazing! By getting the patients to the health center so fast the hope was to avoid more deaths—and more funerals.
As we were listening to the report, I looked over at Emile, who was absorbing all the details and asking thoughtful questions. I was glad he was there so he could return home and share what he had learned about the seriousness of the situation in a way other people might be able to understand.
Oxfam had jumped in to supply ever-scarce fuel and supplies for the response. While everyone hopes this epidemic is winding down, no one was surprised that that there were still cases erupting. The infrastructure in Zimbabwe is so broken down it will take years to build a safe water system for all to use. Our biosand filters—a water treatment method that is used in the household—will provide more long-term protection for families and hopefully prevent diarrhea for them in the coming year.
The filters arrived the other day—thanks to UPS, who shipped them from the US for free—and we swung by the warehouse to look at them: large blue buckets with very little tubing. Their simplicity is amazing. I had drawn a picture for Emile the night before and explained how they worked. When he saw them in person, his eyes lit up: it all came together. I was happy to see someone who was just as excited as me about these blue plastic buckets and their potential to save lives.
We spent the night talking about the trip—all the things we saw and experienced. I pulled out my computer and we had a discussion, using a power point lecture, about the role of evidence in humanitarian response: How do you set up an early warning surveillance? Why is it so complicated? Why is it so important? I could see that Emile was synthesizing all the things he had learned over the past week, putting them together and grasping the complexities that make up Zimbabwe.
I am looking forward to reading what he writes. I am sure I will learn something from him and can't wait.
]]>Tacked to the outside wall of a government office building in Zimbabwe, the warning served notice to all who could read English that Mudzi district is in the throes of a major public health crisis.
Like wildfire, hot spots of cholera—a waterborne diarrheal disease that can kill quickly if not treated properly-- continued to erupt in late January in this rural northeast region on the border with Mozambique. I heard about the spikes—and the challenge of stopping their spread—at the morning meetings at Kotwa hospital, where aid groups and government health officials gather to coordinate each day’s attack on the disease. Oxfam and its local partner, Single Parents Widow(er)s Support Network, or SPWSnet, are among those responding to the crisis.
Fanning out from the hospital grounds, a small team of nurses, water engineers, and public health promoters hit the road each day, traveling up to two hours to reach the more remote areas where people need everything from clean water to basic information about cholera prevention. And they return each night—sometimes long after dark—to prepare their reports for the next morning.
The news they deliver, along with their statistics, is often unsettling: Reports of people drinking from a stream in which others are washing dirty clothes and dishes; shortages of oral rehydration salts and disinfectant; an ox cart toting a patient who died before reaching a clinic. All of it paints a picture of a country crippled by hyperinflation and failing water and sanitation systems. In Mudzi, less than a third of the households have access to proper latrines, according to one estimate.
Already cholera has sickened close to 85,000 people across Zimbabwe, killing more than 3,900 of them as of Feb. 6. The World Health Organization has called it one of the largest outbreaks ever recorded. And Mudzi, poor and far from central areas of commerce and government activity, has been one of the hardest-hit districts.
Here, in Mudzi, fear of the disease is palpable. Fist bumps have replaced handshakes as people worry that palm-to-palm contact could transmit cholera. Some people are even afraid to eat, though of course they must, one man tells me.
“We are not settled,” says the man, Wonderful Nyatsuto, as he helps a SPWSnet engineer repair a deep well, known as a bore hole, about a mile and a half from his home. About 15 people in his village have contracted the disease, he says, and a third of those have died. Cases of cholera started to erupt when people began fetching their water from a nearby river after the bore hole stopped functioning. Across Mudzi, many of the region’s 600-plus boreholes no longer work and communities are too poor to repair them. But without a supply of clean water, residents face a growing danger from the disease.
“We are trying to maintain the rules they tell us,” Nyatsuto adds. “Boil water. Clean hands before you eat. Clean the toilet.”
Still, in a region where many locals supplement their meager incomes by panning for gold in a network of streams and drink the contaminated water as they labor, people are continuing to get sick.
But getting to a clinic is no easy matter. Functioning ones are few and far between. Some have no medicines. Others have no medical equipment. And so sick people trudge great distances to get the care they need. Roads are rough, sometimes barely more than tracks through the bush, cars are scarce, and fuel is both dear and hard to find—even for aid workers who have access to outside resources to buy what they need. Sometimes, aid groups have to send vehicles all the way back to Harare, the capital, a two-and-a-half hour drive from the Kotwa hospital, to scrounge for a small supply of fuel that they can port back to keep their trucks in Mudzi running.
One day in late January, 49 patients packed a clinic in Makaha, a ward in Mudzi where cases of cholera were suddenly spiking. A series of tents and one dimly lit concrete room served as wards for people stretched out, limp and mostly silent, on cholera cots—beds with large holes cut in the middle beneath which buckets are placed.
Snaking between the tents and the out buildings was a narrow path of mud bricks powdered, here and there, with flecks of white—the remnants of the dried lime-chloride used to disinfect contaminated surfaces. Mixed with water, a jug of it sat at the exit of the clinic, a reminder to all visitors to give their hands a thorough dousing.
As she finished hosing down an empty cot with the chloride solution, a nurse, her face flat with exhaustion, described some of the misery she had witnessed in the last few days. A mother, six months pregnant and very sick with cholera had managed to get herself to the clinic only to lose her baby. The next day, her husband arrived with their five-year-old son whom he had carried more than 16 kilometers from their home in search of help. Weak with cholera, the boy had died en route. And now the husband was gravely ill, too. The nurse was uncertain whether he would survive.
Behind her, on a shelf, stood a plastic barrel—a mini storage tank for the mixture of oral rehydration salts that were helping to keep the clinic’s patients alive. But the barrel had barely two inches of liquid left in it—nowhere near enough to sustain all those who desperately needed the sugar-and-salt mixture. And there was no more solution anywhere else in the clinic. Fortunately, we had a small supply of rehydration packets in our Oxfam truck and immediately gave them to the nurse. But that’s not all she needed. The clinic had just two doses left of ciprofloxacin, an antibiotic used to treat a variety of bacterial infections including severe cases of diarrhea.
Beyond the tents, was the observation area—a patch of dirt in the shade of a large tree. Here, patients waiting to be admitted slumped on the ground and those who had improved continued to rest before making the journey home. Outside the gate to the clinic, family members huddled around small cooking fires, the smoke curling around them. They were preparing food for the patients inside—a kindness that was also a cause of concern to nurses who feared cholera could soon sweep through the family support network.
Compounding the challenge of treating cholera is the widespread hunger many people in Zimbabwe are now confronting in the months leading up to the next harvest. Hunger has left people weak and more vulnerable to the disease.
The World Food Program plans to feed more than five million people in February, the greatest number in a single month since 2002. But because more people need food, the program is reducing ration size so that it can stretch its stocks far enough to accommodate everyone.
For some families, even coming up with the basics to fight cholera—such as sugar for a rehydration solution—can be daunting. Dutchman Matika tells of having to borrow sugar from a neighbor to make his wife the solution when she came down with cholera. As he speaks, two of his young sons listen intently, their hair tinged with orange—a sign of malnutrition. With 11 children and three wives in his household, Matika says mealie meal—a local staple—is in short supply.
“When you walk around, you see it,” says an aid worker about the malnutrition that has followed on the heels of several poor harvests and that’s affecting people most acutely in the interior of the country. “Poppy tummies. That’s one of the very clear indications. It’s mainly in kids. And you get wasting away in adults.”
But this year, in Mudzi, there are signs the next harvest may be better. While there is never enough fertilizer to guarantee robust crops, the rains during the current wet season have been unusually plentiful. Where corn and sorghum, millet and ground nuts have been planted, green shoots abound—slivers of hope for the future.
]]>On this day, it seemed highly symbolic: a clean sweep. It was a day which many Zimbabweans were praying would bring them change, after months of political deadlock, an ever-worsening economy, and a humanitarian crisis as the country battled its worst-ever cholera epidemic and serious food shortages.
It was the day Morgan Tsvangirai, the country's main opposition leader, was to take office as the country's prime minister in a new unity government.
Tsvangirai won the first round of last year's presidential elections by a small margin. But he withdrew from the run-off, citing violence against his supporters. In September, though, he agreed to a power-sharing arrangement with Zimbabwe's president, Robert Mugabe. However the deal had been stalled for months amid political disagreements.
While there are skeptics who say the new political arrangement is a sell-out and unlikely to achieve much, many Zimbabweans beg to differ. They view the new political arrangement with optimistic caution. Many told me things couldn't get any worse, and that the formation of a new unity government gave them cause to hope again. They believed it could mark the start of change in their country, which has seen thousands killed from cholera—a curable and preventable disease—and where up to seven million people, more than half the population, are dependent on food aid.
Later in the day, after being officially sworn into office, Zimbabwe's new prime minister addressed thousands of supporters at a packed showground in Harare.
Some attending told me they'd sold household goods—a TV set; an iron; some clothing—to get enough petrol to come to Harare to listen to Tsvangirai address the crowd as the country's new prime minister.
He promised to end political violence and Zimbabwe's culture of impunity; to work for a society where people were no longer living in fear of reprisals or repression for their views. He said Zimbabwe would not be a pseudo democracy, but a functioning democracy, where the rule of law could be re-established.
A second top priority of the new government, he said, was to tackle the humanitarian crisis, to stem the cholera epidemic which has gripped the country, and to ensure that those who needed food got help—regardless of their political or tribal affiliations.
He also promised to appoint a senior cabinet member to coordinate humanitarian efforts; to remove tax duties for humanitarian food aid, and to organize a food summit to try to ensure that in the future, Zimbabweans would not go hungry again.
And he vowed to stabilize the country's economy—characterized by crippling hyperinflation; to get children back to school, hospitals to reopen, and civil servants to return to work.
All music to the ears of the crowd and—possibly good news for international governments that have said they will carefully monitor change in Zimbabwe before making serious commitments of financial help.
The crowds in the stadium cheered, danced and waved flags. Even a reporter from a government-controlled newspaper seemed happy.
"We used to be dead," he said. "Now we are alive. This is the start of change."
]]>"We hope the government of national unity can prioritize the humanitarian crisis and mobilize all the resources it can to make swift recovery possible while working to bring broader stability to the country," said Oxfam's country director in Zimbabwe, Peter Mutoredzanwa.
Oxfam also urges the new government to create the space for the active engagement of civil society in partnership to rebuild Zimbabwe. Civil society has a critical role to play in the current humanitarian crisis and the longer-term development of the country. Oxfam also asks the new government to ensure that beyond access to basic needs, people's rights to freedom of expression, movement and security are respected and protected.
"We're calling on the new government to remove all constraints and enable our staff and staff of other civil society organizations to be able to carry out their work on the ground freely and effectively" Mutoredzanwa said.
As a direct result of the deteriorating socio-economic conditions in the country, Zimbabwe is currently struggling to control the worst- ever outbreak of cholera in its history, fuelled by the collapse of the country's public health and water systems. The cholera epidemic has claimed more than 3,000 lives, and infected more than 69,000 people. In addition, nearly seven million people, more than half the population, are relying on food hand-outs because of serious food shortages. Seriously weakened, they are more vulnerable and therefore unable to fight cholera.
Hyperinflation and the dollarization of the economy has meant millions have been unable to access basic food staples, increasing the number of people needing food aid in both urban and rural areas.
This year's harvest is predicted to be even worse than last year's and food shortages could continue into 2010. As well as dealing with immediate needs, Oxfam believes the new unity government and donors must examine ways of providing longer-term help, including inputs for farmers to prevent future food emergencies and food insecurity; and ensuring communities have access to clean water.
Oxfam calls for specific attention to be paid to the impact of this tragedy on women and girls—who bear the brunt of the HIV epidemic—are most affected by the deterioration of basic services and the lack of farm inputs.
While several governments have said they will only restore substantial aid to Zimbabwe when there is concrete evidence of political and economic reform, Oxfam urges donors to explore innovative ways to channel emergency resources to people who urgently need help and for existing pledges of aid to be translated into funds on the ground.
Oxfam supports calls for the creation of transparent mechanisms with clear benchmarks, supported by regional bodies like the African Union (AU) and Southern African Development Community (SADC), to monitor the implementation of the power-sharing agreement and policies of the new government. One key benchmark will be an open environment where civil society organizations can freely engage in a wider dialogue with the government as part of longer-term efforts to seek a resolution of Zimbabwe's problems.
]]>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.
]]>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."
]]>— Maria Paulo, Chueza Temporary Camp resident
It is very hard to forget the trauma of the past but easy to rebuild hope for a better future. This is probably the most appropriate description of the emotions flowing in the hearts of thousands of people directly affected by the floods in January 2008 in Mozambique. The cyclical floods that have begun to occur are pushing people affected by them to look at climate change and their own vulnerability in a different way—and to change their approach for the future.
The government has announced the end of the emergency period, which means that efforts are now being focused on creating long-term sustainable services to help people living in the resettlement centers recover from the flooding.
It's time to build the future, say some in the temporary camps based in Marromeu, in Sofala Province, one of the most affected by the floods. It's time to reflect on the capacity local communities have to withstand the effects of drought and flood. In themselves, extreme weather events don't necessarily result in disasters. Disasters are often a consequence of human vulnerabilities—of people who have no choice but to live in dangerous locations, such as on flood plains or steep slopes prone to landslides.
According to official figures, the January flood displaced 115,000 people. In the provinces of Sofala, Zambezia, Tete, and Inhambane, many displaced people lost all their belongings, including houses, goods, and crops.
Oxfam is helping more than 48,000 people in the resettlement centers recover by providing things such as clean water, hygiene facilities, household utensils, plastic sheeting for shelter, and other materials for construction.
"We understand that the process of resettling people should be as flexible as possible, to provide motivation and the environment for the affected people not to return to their places of origins," said Michael Tizora, former head of Oxfam's humanitarian action program in Mozambique.
Oxfam has an operational base in Marromeu District, where a field team is assisting displaced people in the temporary camps of Chueza 1 and 2, Nhapirundo, Chapa 30, and Zona C, downstream of the Zambezi River and in the resettlement sites of Chupanga, Chiburiburi , and Amambos.
"Our need now is to get seeds to produce enough food in enough quantity to feed our families," said Paulino Chueza, the traditional head of Chueza center. "We promise the government not to go back to our houses, but we still need a lot of help and assistance to forget what happened and look forward."
In the district of Mutarara, Tete Province, where Oxfam has been operating, the program is helping farmers to recover their livelihoods in addition to providing a water and sanitation program that has targeted 30,000 people. In Tambara, in Manica Province, Oxfam has been working with Magariro, a local organization that is assisting 13,500 people with water and sanitation and supporting them in restarting their agricultural activities after the floods.
In almost all camps, people have basic necessities such as latrines, drinking water, health facilities, and schools for children. Oxfam recruited and trained local health promotion activists to assist beneficiaries in the proper use of these facilities and to promote good hygiene to avoid an outbreak of diseases like diarrhea. However, the future is still quite uncertain for most of the people. There are lessons to be learned from the floods of 2001, 2007, and 2008. The challenge now is to build local capacity to avoid the troubles caused by weather-related events and climate change.
Many people have lost everything, but not the sense of hope in changing the present and building the future. Positive change demands confidence, hope, and a lot of work.
]]>Once rich and fertile and capable of producing bountiful crops, the soil is now bone dry. Without water, the community's crops and gardens won't grow. Without these vital fruits, vegetables and grains, people aren't able to get the nutritious foods they need to stay healthy. And in a community affected by HIV and AIDS, this has devastating consequences.
"The ground used to be soft and easy to dig by hand; water was freely available just under the surface and food was plentiful; there was a lake nearby that provided fish for us to eat," Thandi says. "But now the land is dry and hard and there is no water under the surface; even the lake has dried up."
Thandi says rainfall has become more erratic over the last few decades, occurring less frequently and for shorter periods. Other members of the community concur. The seasons are not the same as they used to be; winter is not as cold now and summer rains are more erratic. People here have experienced droughts and floods for as long as they can remember, but since the mid-1990s they have noticed a gradual drying of the land. Even the rainwater tanks that were installed as a solution to the problem now stand dry.
Although Hluhluwe's people know the climate is changing, they have not heard about global warming, nor do they have any knowledge about the current global debates on these issues.
For the men and women of Hluhluwe, one thing is clear?they desperately want to learn how to adapt to the changes in climate in the longer term. At the moment they are simply trying deal with the prolonged drought conditions as best they can, by doing what they have always done but on a reduced scale. They make their gardens smaller, grow different types of crops and walk further to collect water?but these are short-term coping mechanisms, not long-term solutions.
If current trends continue, the Intergovernmental Panel on Climate Change says, sub-Saharan Africa will be 2-4 degrees warmer by 2050, and have 10 percent less rainfall. There will be more extreme events such as drought and floods and the length of the growing season will shorten even further.
"We need water pipes," Thandi says. "We need to learn how to look after the land and adapt to the drier conditions; we need to grow more drought-tolerant crops and vegetables. We need to learn more about climate change, and we need training in how we can speak up on these issues."
]]>Like many elderly and retired people, 70-year-old Mapatsi Tsuro spends his days in the garden tending to his crop of vegetables. But for Tsuro this is no leisurely pastime, rather it is a matter of survival. When he should be enjoying his golden years with the support of the family he raised, he now has to feed and care for eight grandchildren, following the untimely deaths of his three children.
Tsuro lives in Chicomba in eastern Zimbabwe, but his plight is common to millions of rural families in the region with the world's highest HIV infection rate and the greatest number of AIDS-related deaths. In Zimbabwe 1.7 million of the population of 13-million are infected with HIV/AIDS and Almost 900,000 of those infected are women.
Behind the alarming statistics lies human tragedy. The hardship for those infected and their families begins long before they die. Stigma, fear and despair often follow a HIV-positive diagnosis. The loss of income and support when a breadwinner or caregiver becomes ill, and the diversion of household resources to provide care increases the burden on family members, particularly children caring for terminally ill parents. Many only leave behind the trauma of bereavement and orphans.
Almost one in four children in Zimbabwe, 1.1 million, are now orphaned by AIDS. This number continues to grow as HIV and AIDS dramatically increases the vulnerability of children. The majority of the country's orphans are absorbed by the elderly in rural Zimbabwean households, a group which is barely coping with the extreme economic and social conditions in the country.
Oxfam America is supporting the Single Parents Widows Support Network (SPWSN) to improve the security of vulnerable groups by providing for their immediate nutritional needs, building sustainable livelihoods and enhancing the resilience of communities. Since 2002 Oxfam has been responding to the ongoing food security crisis in Zimbabwe through a livelihoods support program in the Seke, Mudzi, and Chikomba districts of Mashonaland East Province. The program provides seeds, fertilizers, primary health kits and on-going support to some 10,000 vulnerable households.
The supply of summer grain and legume seeds ensures that communities are able to sustain food production and build seed reserves. Over 60 community and individual nutritional gardens have also been established to grow vegetable during the winter months. The gardens ensure sufficient household food and the nutrition vital for maintaining health. Surplus crops provide some income for immediate needs such as health and education. The vulnerable groups receiving support include women-headed households, child-headed households, and households caring for orphans and the chronically ill, especially those affected by HIV/AIDS.
Neighboring South Africa is the site of the world's highest HIV infections, but also the country with the most people on ARV treatment. The National Strategic Plan aims to extend treatment to 80% of those with Aids by 2011. The plan also recognizes that Community Based Organizations (CBOs) and Non Governmental Organizations (NGOs) form an essential part of the integrated approach needed to address HIV/AIDS issues at community level.
Oxfam America's partner, The AIDS Consortium (AC) is one of the largest umbrella organizations in South Africa with a network of over 1000 affiliates. Members include CBOs and individuals motivated to meet the needs of the communities they live in. They offer a wide variety of services ranging from support groups for people living with aids (PLWA), job creation projects, home-based care (HBC), feeding schemes and orphan support, to national advocacy campaigns and large-scale treatment services.
"Community-based care workers are the unsung hero's of our country in the fight against AIDS and for community development," says AC executive director Denise Hunt, "with very limited resources they are forging ahead and making a huge contribution on the ground."
The AIDS Consortium represents the NGO sector on the South African National AIDS Council (SANAC). Here it is working with government and the private sector to formalize and increase the role of civil society. Hunt believes, "The only way we are going to meet the access to treatment targets are through dramatic shifts in how health care is delivered. Community care workers are in a position to play an expanded role and we are pressing SANAC to secure the finances, training and resources which will enable them enhance to their skills and contribution to service delivery."
Dr Liz Floyd, the head of Gauteng Multisectoral AIDS Unit, agrees that a more significant role for organizations is needed to meet the increasing demand for HBC and other support services.
"Government is developing a decentralized strategy for health care. It is very important to spread the resources to a network of mass-based care workers on the ground in communities in order to build community capacity to respond to and reach the people who need it," says Dr Floyd.
AC founder and Patron, Supreme Court Judge Edwin Cameron, is one of the few public figures to have openly declared his sexual orientation and positive HIV status. He points out that the epidemic is likely to be around for a long time and that community groups are vital to ensure an adequate response for PLWA. "We don't have a cure, but we do have manageable treatment," says Judge Cameron. "The public sector program is good but it is not reaching enough people. Community-based workers can bridge the gap between where we are now and where we need to be."
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