MISSIONARY POSITIONS
HIV positive volunteer Robert
Mensall found hope, despair and fortitude on Mission Malawi’s
second fundraising trek across the warm heart of Africa
Photos Denise Else
Loveliness
is a 32-year-old woman living in a small hamlet in northern Malawi. The walls
in her main room are streaked from where the rain seeps in. She hasn’t
been able to afford to fix the roof since her husband,
the main breadwinner, died a couple of years ago. Loveliness has HIV infection
complicated by TB.
She’s on treatment for TB, but local policy insists she can’t
take antiretrovirals until the TB treatment is completed. She has just returned
from a short spell in hospital while her four children had to fend for themselves,
as they live some distance from other relatives.
Despite all these problems, Loveliness invited four volunteers from Mission
Malawi 2 into her home.
We were received with the grace and kindness so typical of Malawi, ‘the
warm heart of Africa’. Malawi is a central African country with a population
of 11 million. About one in seven has HIV. It’s estimated that about
180,000 people need antiretrovirals, but so far, only a fifth of these have
received treatment.
A
second mission
In March 2006, 34 volunteers from the UK took part in Mission Malawi 2. At
the core of the project is a group of gay men from Manchester, but the entire
team consisted of men and women of all persuasions from the North West and
London. Between us, we raised over £110,000 sponsorship for a challenge
that involved ten days of cycling, rowing and trekking across this beautiful
country. The money is going to ActionAid to spend on HIV projects in Malawi
and Zimbabwe.
We visited several ActionAid projects during our trip including orphanages
and facilities for pre-school children, technical schools and projects to
help make communities autonomous in food production. These aim to hold communities
together and counter some of the damage done by HIV. ActionAid also supports
projects that directly help people living with HIV, including nutritional
support, volunteer and buddy schemes and self-help groups.
Testing
circumstances
After talking to a few people with HIV, it seemed that most only tested after
they had developed symptoms. Very few went for testing if they were well,
even if, for example, a partner had been ill or died. At the Kaggwa Community
Home Based Centre, about one in three visitors test positive. This centre
offers counselling and support for HIV positive people while a large team
of volunteers cooked large vats of a special nutritious porridge. Each person
living with HIV is entitled to a cupful per day.
HIV testing is carried out in the community, but newly diagnosed people are
referred to hospitals in the towns. We heard how people had to wait outside
the hospital for up to a week to get their initial assessments and have their
CD4 count measured.
These waits are partly because of a shortage of the technology needed to measure
CD4 counts, but mainly because of a shortage of medical staff. There are more
Malawian doctors in Manchester than in Malawi.
Viral load testing is unavailable and decisions about antiretroviral drugs
are made on the basis of CD4 counts alone. Even with Worldwide Health Organisation
funding for antiretrovirals, there aren’t enough resources for everyone
that needs drugs.
When the drugs don’t work
Of the people we spoke to, most were unable to take their pills consistently
because food was not always available and people don’t like taking the
drugs when they haven’t eaten. Others couldn’t afford the £6
a month for pills or even the 30p fare to the hospital to pick them up (we
spoke to people being paid £1 a day to pick tea on foreign-owned plantations).
Other people’s drugs had been damaged by the rain coming in through
holes in the roof. One guy we met proudly showed us his medication diary,
which showed that he’d only managed to take his meds three weeks out
of four in March.
Presumably, the fact that people can’t take their drugs every day will
mean that many of them will have developed viral resistance. But because viral
loads and follow-up CD4 counts aren’t done, this won’t be picked
up until people develop infections as their immune systems fail. In the developed
world, people with HIV have regular CD4 counts, but this just isn’t
possible in Africa. We hoped ActionAid might look into ways of delivering
antiretroviral drug prescribing to these communities and help patients take
their medications effectively.
A
special disclosure
How did it feel being an HIV positive person on Mission Malawi? The visits
to people, like Loveliness, receiving home care were particularly difficult;
it would be hard not to be moved from the terrible circumstances faced by
people with HIV here. It brought home how easy it was for me to access good
medical care and a consistent supply of drugs. I also know that even if I
did have to stop working, I would have food and
shelter; basic human rights Malawians with HIV cannot always claim.
There were a couple of occasions when I ‘outed’ myself as a positive
person to various groups. One set of women seemed shocked that this healthy
looking English bloke could be HIV positive. I explained that not only was
I able to cycle round Malawi but I was back at work at home and living a relatively
normal life.
The
women responded warmly to this with howling and chanting. That was a brilliant
moment; bringing hope from our village to their village. I hope I was able
to provide some hope and inspiration and maybe show that the drugs and holistic
care can work. The Kaggwa self-help group certainly inspired me. I’d
never met a group of positive people before who had their own football and
basketball teams and composed their own songs.
None of the problems we saw were insoluble. Almost all the suffering was preventable.
The Mission Malawi team was left with sadness that the global community had
ignored Africa’ problems for so long, mixed with hope for the future.
• To sponsor Mission Malawi 2 or find
out more about future projects, visit www.missionmalawi.fslife.co.uk
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