The Village Voice - November 17-23, 1999
INSIZA DISTRICT, ZIMBABWE -- Wilson was the hardest. He had
been such a charmer, a flirt even, but then AIDS dulled his
sparkle and confined him to his bed. That's when Sibongile
Ndlovu increased her visits to every day, bringing him food and
caring for his bedsores, which had bloomed into an affliction
worthy of Job. 'The whole skin on his side was coming off,' she
says, and it filled his hut with the smell of sickness. She
convinced the clinic to give her medicine, and she rubbed the
ointment on his raw bedsores every day for the two months until
Four years have passed, but despite that ordeal Ndlovu is still
caring for patients. How many has she assisted? "Forty-two,"
she says, checking a tattered ledger with neat, handscripted
notes. How many have died? "Sixteen."
Ndlovu is not a nurse or health-care professional of any kind.
She is a peasant farmer who volunteers with the Insiza Godlwayo
AIDS Council (IGAC). Her family income is about 300 Zimbabwe
dollars a month, not even 10 U.S. dollars. Three days a
week�more if one of her patients is severely ill�she stops by
the homes of the sick, washing their bedclothes, fetching
water, tilling the little plots of land on which these
villagers all survive, even parting with some of her meager
income to purchase things her patients need. Wilson had a
craving for oranges, which are luxury items here. But she
Africa's response to AIDS is often depicted to be as
dysfunctional as its economy, just another example of what some
AIDS workers call "Afro-pessimism"�only bad news coming out of
Africa. It is true that just a handful of African governments
have mobilized a response remotely commensurate with the
magnitude of the epidemic, which has already slashed life
expectancy by as much as 20 years in some countries. AIDS
stigma has also made many ordinary people shy away from dealing
with the epidemic. "I have found the most unacceptable denial
and apathy in Africa," says Elhadj Sy, who heads the southern
and eastern Africa team for UNAIDS. "But on the other hand, the
most incredible responses to HIV have been developed here. We
live in this contradiction of extremes."
Nowhere are these extremes more pronounced than in Zimbabwe,
the former Rhodesia, which whites ruled until 1980. When it
finally gained independence, Zimbabwe was the South Africa of
its day�relatively prosperous, with no foreign debt, and a
currency stronger than the U.S. dollar. Now, the economy is in
free-fall, and a quarter of adults in the prime of life, aged
15 to 49, are infected with HIV. The virus is killing more than
65,000 people a year.
Yet the director of Zimbabwe's National AIDS Coordination
Programme, Everisto Marowa, says that government spending on
AIDS prevention has, in real terms, "certainly not increased
and probably declined" over the last five years. Last month,
the government announced a special AIDS tax, but even AIDS
workers criticized the idea because the government provided no
plans on how it would spend the money. Corruption and
mismanagement are rife in Zimbabwe, and previous special levies
have disappeared with no accounting.
Meanwhile, the government admits it is spending more than 70
times the budget of the AIDS Programme on its unpopular
military intervention in the Democratic Republic of the Congo,
though independent observers estimate the war costs many times
more than that. Few citizens understand why a third of the army
has been deployed in the civil war of a country that does not
even border their own, especially when inflation and
unemployment in Zimbabwe both exceed 50 percent. But many
suspect a few may be profiteering: The head of Zimbabwe's army
is a director of one company that has mining rights to the
mineral-rich Congo and of another that has trucking rights.
Yet below the radar of government, in individual communities
there are astonishingly vigorous responses to AIDS. "In every
province we have member organizations," says Thembeni Mahlangu,
director of the Zimbabwe AIDS Network. "They were often started
by a church or NGO [nongovernmental organization] and sometimes
just by individuals." For example, Auxilia Chimusoro founded
Zimbabwe's first AIDS support group, and then tirelessly
traveled the country launching more. By the time she died in
1998, Chimusoro had started more than 50 support groups, most
in poor rural communities. In the capital, Harare, the Musasa
Project works with battered women, helping them break free of
partners who often force them to have sex, almost always
without a condom.
IGAC, the group that helped Wilson, specializes in home-based
care and orphan support, and it has recently launched a youth
prevention campaign. The leadership of most AIDS programs "is
composed of professionals," says Lucia Malemane, a nurse with
Zimbabwe's Matabeleland AIDS Council, who taught Insiza about
AIDS. "But with IGAC, it's just ordinary peasant farmers."
Heroic as these efforts may be, they are tinged with
poignancy�and not just because the government, which could knit
these isolated efforts into a powerful national response, has
shirked its duty. Most community programs lack any but the most
basic medicines. Certainly they cannot afford the expensive
regimens that have reduced the AIDS death rate in wealthy
countries. Without effective drugs, home-based care can seem
like little more than home-based death. With the disease mowing
down so many people, and with poverty making volunteering so
burdensome, it remains to be seen whether such homespun efforts
can endure for the decades that may well pass before an AIDS
vaccine is developed.
But for the moment, thousands of ordinary Africans are defying
all odds to care for their sick, raise their orphans, and try
to slow the virus's spread. If governments finally mobilize
against this disease, they will find some of the best and most
energetic AIDS strategies right under their noses.
And they might find something else. Traditionally, Africans
relied on extended families and tight communities to weather
adversity, but even before AIDS, colonialism, urbanization, and
social atomization had weakened the sinews of African society.
The epidemic threatens to snap them�but it could also have the
opposite effect. "AIDS is horrible, but in times of great
stress societies can either fall apart or come together," says
Alan Whiteside, who studies the demographic impact of AIDS at
South Africa's University of Natal. Noting how the American gay
community built powerful institutions and a stronger culture,
he says that "IGAC, with a little help, could be an example of
building civil society in Africa."
There are few places where the difficulties of responding to
AIDS are more daunting than here in Insiza, a flat, dry
district of southern Zimbabwe punctuated by dramatic rock
formations and dotted with imizi, rural homesteads composed of
neatly ordered round huts. Villagers here are so poor that most
don't bury their dead in coffins, but merely wrap them in
blankets. At one funeral, near the start of Zimbabwe's winter,
the grieving family was so destitute that, after lowering the
body into the grave, they started removing the blanket from the
corpse so their children wouldn't go cold. Stricken with pity
and horror, IGAC's coordinator Japhet Gwebu gave the family a
Only about half of Insiza's population can read and write, and
what schools there are often lack even furniture, forcing
students to work on the floor. The district hospital is
supposed to have five doctors, but on a recent visit, it had
only one, and the operating theater was closed because the
hospital had run out of anesthetics. Nurses are also in short
supply�but not patients, who have poured in over and above
Frequent droughts cause starvation. The 1992 drought killed
most of the cattle, which means that even though the rains were
good this year many prime fields lay untilled because there are
no beasts of burden to pull the plows. Nobody, of course, has
tractors or automobiles. How many residents have electricity or
running water? Fidres Manombe, chief executive officer of the
district council, laughs at the question. "Oh, it's
negligible," he says.
Back in the late 1980s, when a new disease began causing people
to waste into skin-shrouded skeletons, most people in Insiza
believed the affliction was caused by witchcraft. Only in 1994
did they learn the medical facts, and immediately a group of
elders decided they needed to do something to care for the
droves of sick people and the swelling number of orphans. But
how to organize the villagers?
Homesteads are scattered far apart, yet throughout the
district's 7500 square kilometers�an area larger than
Delaware�there is only one paved road. Nobody has telephones.
Isaiah Ndlovu, one of IGAC's founders and most active leaders,
has never even heard of e-mail, but he sometimes sends messages
by relay, villagers passing on his communiqu� so that by the
end of the day it has traveled across the vast farmland to its
intended recipient�if someone hasn't misunderstood the message
or forgotten it completely. So to mobilize his community,
Ndlovu must visit homesteads one by one, and that's how he
keeps the program going, checking in on the volunteers and the
dying people they're caring for.
To any destination closer than 10 miles, Ndlovu just walks.
When he has to catch the one and only bus that serves his
village, the 56-year-old rises at 3:45 a.m. and trudges 45
minutes in the dark to the bus stop, an unmarked patch of grass
by the unpaved main road. Delays of eight hours are not
uncommon. "But," Ndlovu says, standing in a winter drizzle one
morning when the bus was already long past due, "it's better
for the bus to be late than you to be late for the bus."
Today, five years after its founding, IGAC has 500 active
volunteers and at least another 500 who help out as needed. To
put this in perspective, New York's largest AIDS organization,
Gay Men's Health Crisis (GMHC), had 500 home-care volunteers in
1994, just before new drugs lowered the death rate. With a
budget exceeding $24 million, GMHC rewards its volunteers with
parties and other perks. IGAC has an annual budget of less than
$17,000, and volunteers, though they are dirt poor, are asked
to pay dues. The volunteers also give directly to their
patients, bringing tomatoes or soap, candles or ground maize,
which Zimbabweans eat at virtually every meal. "It's not every
time that we can bring something," explains Kelina Ncube, one
of the volunteers. "We just give them some of whatever we have
to eat that day."
All this giving takes its toll. "When we started it was easy
going," says Ndlovu. "But as we go along, some are starting to
say, 'We have contributed too much."' Indeed, at a meeting, one
woman asks if she and the other volunteers can be compensated.
Some of this may be bellyaching�"we have different characters,"
says Ndlovu, dryly�but most of the complaints stem from brute
poverty. "We have to nurse sick people and handle food for
them, so we need to wash with soap," he explains. "But soap is
very, very expensive." In Zimbabwe, a bar costs the equivalent
of 20 cents.
"In the U.S. you have all these volunteers, but they're never
worrying about putting food on the table," says Noerine
Kaleeba, who launched Africa's first support group for
HIV-positive people, The AIDS Support Organisation of Uganda.
To keep volunteers going, Kaleeba says, some African
communities have planted a special garden from which only
volunteers can harvest, or created a fund that pays the school
fees of their children. (Zimbabwe, like most African nations,
does not provide free education.)
It is often said that Africans are passive in the face of death
and suffering, that life is cheap here. The truth is that life
is hard. People are so poor that even when they give a large
proportion of their income, as most IGAC volunteers do, the
total amounts to only a small sum�so small that even bare-bones
efforts are hard to launch and maintain. Groups like IGAC are
"isolated and scattered blossoms," as Kaleeba puts it, adding,
"I wish this blossom could be turned into a flower garden."
It was Sikhangele Ndiweni's mother who launched IGAC's first
attempt to raise money: a communal garden for cultivating and
selling vegetables. But the plot was small, so the earnings
were, too. Ndiweni's mother never saw IGAC's subsequent
ventures; AIDS killed her in March of 1997, and her husband
died three months later. As their oldest child, Ndiweni dropped
out of school to nurse them�"I had to wash my mother and greet
the people who visited her," she says�and now, at 20 years old,
she is raising her sister and four brothers. She depends on
IGAC for food and school fees, but she is not merely taking.
Like her mother, she is helping IGAC raise money.
In addition to her household chores, Ndiweni tends a herd of
goats, part of a donation IGAC received from HelpAge, an
organization that assists the elderly. The goats, split into
small herds and looked after mainly by orphans, are one of
IGAC's two main income-generating projects. The other is a
grinding mill for maize. The profits get divided up and given
to committees throughout the district, who then perform triage,
deciding which families in their villages most need blankets,
school fees, or emergency rations of food.
Margaret Nkomo, a member of one of IGAC's local committees,
says that in her corner of Insiza there are 46 children who
have lost at least one parent. About a third of those orphans
have no means of support besides IGAC, yet the goats and
grinding mill paid for only some of the children's primary
school fees. Nkomo and other volunteers covered the rest by
dipping into their own shallow pockets. But secondary school
costs more, so some older orphans couldn't afford to go.
Ndiweni would love to finish secondary school�she liked it and
was a good student. But there is no money, and she has been
catapulted into adulthood. Now she has begun making home-care
visits, helping others even as she is herself helped. "I can't
bring any food," she says, "but I can cook and wash and help in
Eliot Magunje, an activist in Harare, is not impressed. "It's
not home-based care, it's home-based neglect," he charges.
Magunje is HIV-positive, and much of his anger springs from the
harsh fact that drugs which could prolong his life are too
expensive here. But he exposes the central weakness of
virtually every home-based care program in Africa: They offer
little or no medical treatment. The ointment for Wilson's
bedsores was an exception. Usually, says Isaiah Ndlovu, "Our
medicine is to pray."
The emotional toll keeps accumulating. Volunteer Moddie Nkomo
cared for her sister's son until he died, cleaning him after
his frequent diarrhea. Then there was the "very difficult day"
last November when Nkomo "was looking in on three people, and
they had all died. Even today we buried another," a 35-year-old
man. His wife had died last year, and Nkomo had cared for her,
Many AIDS workers believe that programs like IGAC cannot last,
especially given the lack of government support. AIDS, after
all, has slammed into a continent already battered by a
terrible history. Driven off the most fertile land, which
remains in the hands of mostly white farmers, rural Africans
constantly face food shortages. Many men are forced to migrate
between the cities where the jobs are, and the homesteads where
their extended families live. This oscillation is psychological
as well as geographical, because many Africans exist in a limbo
between traditional cultures that cannot be resurrected and a
Western materialism that can seem empty. A catastrophe on the
scale of AIDS could disintegrate these fragile communities.
Yet in Insiza, the opposite is happening. AIDS is definitely
straining the community�but that is precisely why many
villagers are volunteering. Especially in rural areas, many
AIDS volunteers "are not committed to fighting the disease so
much as nurturing their community," explains Sy of UNAIDS.
"Success or failure shouldn't necessarily be seen in the number
of people dying but helping the community stay together."
That's why foreign aid is so fraught. While poverty can be
incapacitating, donors often impose their own priorities or
undermine the spirit of self-reliance. IGAC is successful
because the villagers have mobilized themselves.
Tall, upright Ezekiel Sibanda is the sobuku, or headman, of one
of Insiza's villages, and he says IGAC has set a precedent.
Women have banded together to weave grass mats and sell them,
sharing the profit and giving a little to the needy. Another
group is doing the same thing raising chickens, still another
has started a garden, and a youth group is making bricks. Such
communal endeavors didn't exist before IGAC, Sibanda says.
"People were not as giving. IGAC has brought us together."
And it has done so in a manner that harks back to "what our
traditional communities used to be," says Marowa of the
national AIDS program. Precolonial African civilizations were
often organized in smaller, more communitarian units than
European nation-states. "Indeed, the most distinctively African
contribution to human history," writes John Reader in his
highly acclaimed book, Africa: A Biography of the Continent,
"has been precisely the civilized art of living fairly
peaceably together not in states." As Kaleeba explains, "While
the state exists, the primary responsibility lies within my
family, neighbors, and community. No one has written that law,
but it is passed on and understood."
Traditional African societies tended to be flexible networks
where individual gain at the expense of the community was
taboo�virtually the opposite of capitalism. This was no utopia,
but rather an adaptation to Africa's harsh realities. The
continent has always been underpopulated, so communities needed
every able body, and needed them to give to the larger society.
Africa's communal civilizations, Reader maintains, evolved to
ensure "survival in a hostile environment of impoverished
soils, fickle climate, hordes of pests, and a more numerous
variety of disease-bearing parasites than anywhere else on
IGAC's response to AIDS, then, is a reclamation of the age-old
ways that enabled African communities to withstand previous
scourges. The selflessness of the volunteers springs from
deeply ingrained roles that were weakened but not broken by
colonialism. The money-making projects are adaptations of those
traditions to the present crisis, as is the frank talk about
sex in IGAC's new youth program, which hands out condoms and
warns girls away from "sugar daddies."
Still, poverty shadows these people too closely to consider
IGAC's future secure. Many of the organization's goats, for
example, died in an epidemic of their own; IGAC, of course,
couldn't afford medicine to treat them. Another drought could
finish off the herd, wither the communal gardens, and sap the
community's spirit. And, of course, there is the relentless
tide of AIDS.
Isaiah Ndlovu is walking with his volunteers on their way to
visit another stricken family. Do the endless deaths make him
frustrated or angry? "No," he says, "not at all. We have
accepted it and when you accept it, it becomes ordinary life.
Okay, death is here. But let's care for the sick and the
orphans. To me it's just that simple."
Huddled in blankets in her hut, Tabeth Nkomo knows she and her
husband are both dying, knows her aged mother is already too
feeble to till the fields, and knows that her four children
will soon be orphans. "I'm afraid for my last-born," she says.
"He's too small to fetch water and firewood." So the biggest
comfort that IGAC gives her is not bringing food or washing her
frail body but the way they look after her children, cooking
for them and disciplining them when they go astray. "They help
when I'm alive," she says, "so I trust they will still help
them when I go."
Research intern: Jason Schwartzberg