Battle for life

Little Sandile here in the arms of his HBC volunteer Buyisiwe, was only eleven months old when he lost his struggle for life. He was HIV+, but the health system failed him. First they didn't have the special tests on hand to test infants under 18 months, then the results took 2 months instead of the stated 3 weeks to come back. When I accompanied his mother, ill herself, but getting stronger on ARVs, to the clinic to get the results, they were positive. The VCT counselors at the clinic who gave the results told his mother that he needed to come back on Monday, in five days, to give blood for the CD4 test that would check his immune system strength.

But we all could see his waning health. Just having finished six months of TB medication, little Sandile's oral thrush and sores got worse with time, despite trips to the clinic. That day I spent with him and his mom, poor Sandile spent the entire day crying, feverish and with oral sores all through his mouth and throat which were aggravated everytime he coughed.

Not wanting to accept the apathetic, bureaucratic response from the 'AIDS experts/advocates' at the clinic, I called the nurse I often work with at Estcourt Hospital's ARV clinic. I explained the baby's HIV results had just come back positive, that he had just gotten off TB treatment, and that he was ill. She said the doctor should see him right away, that he would judge the baby's immune strength by having a look at him, instead of waiting 3-4 weeks for the CD4 results to come back.

Sandile cried almost non-stop in the waiting room of the ARV clinic, and once the doctor saw him, wrote up a prescription for his ARVs on the spot. After a lot of experience in the hospital herself, his mom didn't want him admitted to the hospital, so after picking up a big bag full of medications, we left again for home.

Despite our best attempts to help little Sandile, four days later, he passed away.

Please pray for his mother's comfort, for her own fragile health, and for the health of his 6 year old brother Senzo. Please also pray for comfort for Buyisiwe, his HBC volunteer, and for his granny who has been his primary caregiver.

Lindiwe

I met Lindiwe late one morning in the Home-Based Caregiver’s home. She was sitting on a Zulu mat on the floor, covered in a blanket to keep the winter chill away. She was clearly sick, and had spoken with the home based caregiver for assistance. The symptoms of TB were evident and upon our advice, 34 year old Lindiwe, the mother of three, went to the clinic to get the sputum bottles to check for tuberculosis and to get an HIV test. As it became obvious that her finances were keeping her from fetching her TB results and doing the two day ARV adherence training to treat her HIV, we assisted her with the transport to get to the clinic. As predicted, her results came back positive for TB, and after time we found her CD4 count to be 142 – low enough for her to need quick ARV access, but this wasn’t to be.

The June public strikes interrupted Lindiwe’s access to treatment, starting just as she most needed the ARVs.

As the strikes dragged on into their final days, Lindiwe developed meningitis and was admitted into the hospital. At that point, the meningitis was too strong and her immune system to weak to start the ARVs. She never made it out of the hospital, leaving her two daughters, aged 14 and 20, without their mother, staying alone without any income. The last time I saw her, she asked me to look out for her girls. Fortunately, their father is working in Durban and thus can provide maintenance to care for the younger, schooling daughter. Accessing this support, however, has not been expedient: for three months, the girls got food vouchers from the social workers. Those three months have just come to an end, and their case is still no closer to being resolved. I’ll be bringing them food again to ensure they don’t go hungry, while urging the social workers to work through their case quickly.

In case after case with HBC patients, there is the bitter-sweet heartache and joy of assisting patients sick with HIV/AIDS. For some, like Lindiwe, our assistance has left a mark of love and care while not succeeding in lengthening their life, still leaving orphaned children behind to look after. Although increasing numbers of patients are accessing life-saving treatment, Home Based Care for the sick and orphans too often go hand in hand.

The beautiful thing about working with Thembalethu is being able to be with both situations in their greatest need – to share love, care, prayers, resources and health advocacy. On the behalf of all of those whose lives we have touched, THANK YOU for making this work possible!

Not a family untouched

During a recent home visit with home-based caregivers, we spent some time overlooking this small valley with houses and homesteads in every direction, almost as far as the eye can see. Over the past couple of months, it's become clearer to me that every homestead has a story, and almost every one of these stories is interwoven with HIV/AIDS tragedy. The more that I go on home visits, supporting the home-based caregivers, the more I come to understand the reality of AIDS - not a family remains untouched. They've all lost an uncle or an aunt, a mother or a father, a child, a cousin or even a grandparent to the disease.

As I stood on the ridge that day, overlooking the various clusters of homes, I asked about the stories of each family. "That single isolated mud hut over there, who lives there? And that one house left standing with all the other buildings in various stages of decay, who is living there?" Everywhere around, AIDS and poverty go hand in hand.

• The one house with a single mom and her three pre-teen kids without any income, the family extra vulnerable to the threat of infection and problems accessing treatment. I just met one such family, a lovely mother named Lindiwe who left two girls behind: a 20 year old and her 14 year old sister. Lindiwe fought a losing battle against HIV, tuberculosis and meningitis. The July public strikes caught her at a time when she was in desperate need of attention for the meningitis that eventually killed her before she could start the life-saving ARVs. With their mother's death, the girls were left without any income at all. We've been able to help Lindiwe's two girls access government child grant for the older one's small baby, and are working with the social workers to access child support for the younger daughter from her absent but employed father.
  
• The gogo whose adult children have all died, and is left caring for seven orphaned children on less than $100 a month, who is too frail to repair the crumbling buildings all around her. Working with the 19 year old who is prepared to take on the care of her younger siblings, we've linked them up to government crisis food provision while we push for their foster care grant to be processed. Their three months of food provision are about to run out, so we will be simultaneously providing them with additional food parcels while putting pressure on the social workers to process their case.
  
• A orphan-headed household run by an 19 year old girl with her 17 year old sister, and 7 and 4 year old nieces - left behind by two generations of parents and elder siblings. The recent rains are running through their second-hand tin roof, threatening to erode away two different walls of their house. They are already vulnerable in their situation, the 17 year old often running away with boys in a habit of finding a way to provide for herself, making her situation and her vulnerability to HIV all the more real. We are making the necessary repairs to the roof to keep the house up during this season. We have referred their case to the social worker's for the three month food assistance, and pushing the case through to get the orphan grant.
  

It's been a couple months of intense ups and downs. Realizations of the degree of need in the community, the discovery of numerous orphan-headed households who we have managed to link up to government assistance, to find out that the government's timeline for temporary assistance (three months of food parcels) isn't up to par to with the realities of their service delivery. Finding orphaned young people or widows staying alone and isolated without anyone to help them when HIV, TB, and side effects bind them to their sick bed. And yet seeing the amazing generosity and ubuntu of the community in bringing them food, fetching water from the community pump for them, bringing them firewood, washing them, and being their health advocate. Xoli and I were recently doing an inventory of all of the patients under the care of the Thembalethu Project. We have 70 patients being looked after by 30 home-based care volunteers, a huge testimony to their generosity, love and service to their neighbors in need. And yet, we have lost 26 patients over the past six months, most to a debilitating HIV related disease that could have been prevented if they had faced their HIV status earlier. And yet the number of people assisted with transport funds, immune-boosting porridge, moral support, and tender palliative care continues to increase, and those who access ARVs in time also is improving.

Last month we had a hugely successful VCT drive, bringing in HIV counselors from Estcourt Hospital to the tribal court to test and counsel willing members of the Amangwe public. Over the two days of VCT (voluntary counseling and testing), 83 people were tested for HIV including a large number of our Home-Based Caregivers. We are working with the hospital counselors to plan another HIV testing drive in the next couple of months, combating the 'small town' confidentiality breaches that suppress people's desire to get tested in the local clinic.

At our last monthly HBC support meeting last Monday, we also gave out veggie seeds (spinich, carrots, pumpkin, onions and beetroot) to all the home-based caregivers for their family veggie gardens and to share the excess with their patients and vulnerable children in their neighborhood. When on Thursday I was doing home visits with some of them, in their enthusiasm most had already planted their seeds. With the hugely positive reception, I've bought some more seeds to give to orphan headed households, and very vulnerable patients.

I feel so honored to have your support and prayers to be involved in all of these people's lives, to bring support to the HBC ladies in caring for the vulnerable in their communities. May God bless you for making this work possible!

Also check out the new prayer requests in the right column.

The Fires

Massive veld (bush) fires combined with fierce wind that take out massive numbers of homes, an amazing and encouraging church and community response, funerals, orphan advocacy, working with government hectic… It’s been a very busy couple of weeks. In a recent conversation with my Dad, he quoted me a Chinese curse – that your life may always be interesting. Perhaps these Chinese had never been to Africa, where there’s rarely a dull moment!

A week and a half ago Friday, here in the Winterton area, in the middle of a dry winter, we had record winds. These are called the “August Winds” and typically bring in “September Rains.” The dry winter is also a time of burning – the farmers burning fire breaks to protect their farms, houses, and assets from uncontrolled fires. The Zulus burning their grazing land to increase and speed the green pastures for their cattle. The wandering skevenga (loosely defined ‘troublemaker’) walking around lighting the long, dry winter grass on fire to stay warm or watch the neighbors run around to put it out. On 27 July, however, just days before the nationwide annual August burn-ban, a stray spark from a farmer’s fire break was carried by the wind and did a HUGE amount of damage. (I was trying to send pictures, but it isn’t working currently. I’ll paste them on my blogsite soon.)

According to a local paper, over 80 families lost their homes (or huts, mostly thatched, within their homesteads), and over 400 people were affected as an out of gale-force winds blew a large fire across the Winterton area. The fire was indiscriminate, wiping out the houses of white, black and Indian alike. The fire took out the newly thatched house of two amazing doctors as the local public hospital (Emmaus) – they lost everything they owned. Three other families of farmers also lost their homes, as well as some of the hospitality industry (Villamora is now gutted, for those of you who’ve been here and know where it is) were wiped to the ground. People were lucky to escape unharmed, though a seven-month-old baby was killed and her mother still suffering in critical condition from massive burns to her face and the much of the rest of her body. Yet the bulk of the destruction was caused when the fire raged through the densely populated Khethani township just outside Winterton’s city center. Long before the fire, this was an area with massive social problems and little community spirit: filled with a random collection of people from all over, illegal immigrants from neighboring Lesotho and significant lack of community cohesion.

And yet, the church and community response was amazing encouraging – a positive step toward bridging the gap between black and white, rich and poor. As soon as the fire hit and swept through, leaving behind it a trail of smoldering destruction, the community responded with amazing generosity. While foreign volunteers (my friends Sofi, Cameron, and Andy at the fore) rushed in to pull people out of the path of the fire, the local church rallied together to gather donations, provide emergency housing, a soup kitchen, and do inventories of all the people lost in the hectic, as well as all those who lost all they owned. The generosity of the Winterton and neighboring communities was amazing. The doctor friends mentioned above have an 18 month old adopted baby girl who has never had so many clothes in her life; and all who lost their homes (mostly kitchens as they typically are thatched) have just received a full kitchen set, as well as school uniforms to get them back on their feet and their kids back in school. I’m living in my friend Sofi’s volunteer accommodation, and babysat for her two year old daughter almost non-stop through the first 48 hours of the fire as she was, and continues to be on the front lines of getting people assisted. She’s been amazing, but could use your prayers for rest and recovery now!

Otherwise, the Thembalethu project continues to grow and expand. We’ve been meeting up to three times a month with all the home-based-care volunteers; monthly meetings to check in with them and collect data about their patients, trainings and other referral-orientation type meetings with them to help them link up with resources in their community and beyond. Just today we had a Winterton pastor come in with a chaplain friend of his to do a training in trauma counseling. It ended up being a trauma/grief counseling session instead, as the carers haven’t ever had many chances to be debriefed about the many deaths of their patients that they experience in the course of their volunteer work. We hope to continue with this process, and planning spaces for them to debrief with each other about the burdens they carry seeing so many people they’ve tried to help die every month. But slowly, we’re making a difference. Sometimes it’s so few people that are surviving amidst all the calls I get to tell me about a patient who has just died. People are dying in such high numbers here, it’s hard to imagine the HIV/AIDS situation could get much worse as it’s expected to. The training was to me a very good reminder of how important it is to allow myself to grieve, to share with others the sadness, anger, frustration, guilt, and pain that I feel. This is hard, and I’d appreciate your continued prayers for me, for Xoli (with whom I’m working), and for the HBC volunteers.

But there are still beacons of hope in this sea of HIV/AIDS. I got a phone call this afternoon from Sibusisu, a HBC patient that we helped back in June to get on ARV treatment. At the time he was so sick he couldn’t walk, and had the symptoms (runny stomach and vomiting) that are the final stages for many patients. But he called me to tell me that he is very well, and has a three week contract to work on a farm about two hours from here. He told me his two young daughters are staying with his mother while he’s away (his wife passed away in February), and he promised to get them tested as well for HIV. It brings me to tears full of gratitude to know that he’s alive today because of your support. His name means blessing in Zulu, and he is a blessing to me, and blessed himself to have this new lease on life. Thank God that he’s doing well. Please pray that he’ll continue to get stronger as the ARVs continue to suppress the virus in his body, giving his immune system a chance to pick back up to normal levels.

Otherwise, we’ve been busy meeting with the Nkosi (the tribal chief), the local mayor, the social workers, the Department of Health (whose lack of planning pressurizes us to all but frantically fulfill their requests), and other NGOs. We are planning our first stab at an Amangwe-wide HIV testing and counseling drive for two days at the start of September with counselors from the Estcourt Hospital. The idea is that people are afraid to get tested by the staff at the local clinic for their lack of confidentiality, and counselors from outside the area help increase the confidentiality in an area where stigma remains rampant. We’ve also started to give out some food parcels to orphans in extremely vulnerable situations – living entirely alone, or going weeks without any food, while trying to link them to Microfinance for Youth for business opportunities and to government orphan assistance. There’s a local NGO that is starting a PMTCT (Prevention of Mother to Child Transmission of HIV/AIDS) program through the Department of Health that will employ five community volunteers to try to decrease the transmission rates to children, and try to keep the mothers alive. Although we may lose some of our best HBC volunteers to this partnering program, I will be happy to see them employed, and hopeful that many other lives will be saved through their work. I know of more than five mothers of young babies that have died in the past three months – all without an advocate and fellow HIV+ person to help them through the process. We’re checking to see if the babies have gotten the virus from their mothers – these infant tests take a long time to return. Please pray for these children.

Also please pray for the children and families affected by the uncertainty and perhaps pending closing of the local orphanage. Pray that the social workers will have wisdom to know how to do best for these kids and that their families (it appears most of them have a loving extended family) would welcome the children back with open arms. Pray that they would be expedited through the system to get the foster care assistance they need.

Home-Based Care Volunteer Profile

Ntombi Mayaba

Ntombi lives in Kwa Vala village has been caring for her sick and dying neighbors since 2005. She saw the assistance that her friend Elsie in neighboring eMandabeni was providing to the sick and orphaned, and decided to motivate her neighbors to do the same. Ntombi is now the leader of the KwaVala home-based care group, which consists of herself and two other active HBC volunteers.

Ntombi attends a Presbyterian church, and shows tremendous love for the patients that she cares for. When she was a child, she lost both of her parents at a young age, and well understands the impact that the love of neighbors and family made in caring for her after her loss. Her current HBC patients include women and men suffering from full-blown AIDS; a mother (32) on ARVs, but yet paralyzed for life from spinal tuberculosis, and orphaned children struggling after the death of a parent.

Challenges and Prayer Requests

Hello Friends!

Things are getting very frustrating here as the public sector strike has been on for over 2 weeks now. This means that the schools, as well as clinics and hospitals and all other government offices have been closed for this time. It’s really impacting the HBC volunteers and their patients – many are suffering without being able to get medical assistance, and they can’t afford to pay to see a private doctor. People who are supposed to collect chronic medicines (for blood pressure, epilepsy, and ARVs for AIDS) are having great difficulty doing so. This could have dreadfully vast implications in the community if this strike doesn’t come to an end soon.

The Injesuthi Clinic, which normally has a queue at least 100 people long every morning, has been limited to seeing only emergency cases – and many are afraid to go in for even those cases. People are suffering greatly, and there seems to be no end in sight. AIDS-related opportunistic infections left untreated can quickly progress to fatal illnesses.

The frustration is that the public workers are being intimidated by the unions, who in term are jostling around for political power and influence. This is the biggest strike since the New South Africa came in after Apartheid in 1994. Below you’ll see links to articles on this, if you’re interested.
Public service strike disrupting HIV care in South Africa – AIDSMap News
Civil Servants' Strike Intensifies in S. Africa – Washington Post
Public worker strike disrupts South Africa – Chicago Tribune

*Please pray that both the unions and the government will come to their senses so that the country can get back to normal.

*Please pray for healing and protection for the sick suffering without any access to treatment.

Please also pray for assistance and hope for the many orphans in South Africa. I’ve heard the most disturbing stories about orphan situations throughout Amangwe in the last couple of weeks: staying alone without food or clothes to keep warm in this winter weather; staying 12 kids together with a sick granny; a 10 year old boy staying entirely alone, etc. Pray we’ll be able to find sustainable, empowering ways to support, encourage and love on these kids.

Thank God for the exciting developments within the Winterton church community to bring together and advance the work of multiple ministries, Thembalethu being just one of them. Simunye, the name of the interdenominational committee, well-represents God’s work: In Zulu it means “We are one”.

I’m very grateful for your support and prayers!

With love,
Betsy

Two Busy Months

Thembalethu Update
2 June 2007

A Saturday breather, and a chance to get some word back to you all finally. Thank you all so much for making it possible for me to get back here, to support this work. Your generosity has been amazing! God is good and I’m so grateful for your partnering in this work!

I can’t believe it’s already been two months since I arrived back here. After some initial settling back in, it’s seemed almost like I never left. Except of course for all the memories of lovely times that I spent with you all during a brief respite at home. Being back, my focus has definitely changed primarily to support the Home-Based-Care volunteers in caring for the sick and orphaned in their community. So, of course, the ways that I spend my time have shifted a lot. And, the team of people that help to oversee the project are a bunch of predominantly white South Africans, instead of Americans in partnership with Zulu teachers and field workers. Oh, and I suppose that I’ve been seeing a lot more HIV positive people on the brink of (or already into) full-blown AIDS. Oh, and I’ve joined the Winterton white bakkie brigade (bakkie means pick-up truck, and for some reason the majority of my farmers neighbors have white ones). And I’ve already attended too many funerals or mourned with far too many families of patients. But, despite all these changes, my favorite part continues to be working with the lovely Zulu people, and especially the ma’s and gogos who remember the age-old Zulu custom of ubuntu – caring for each other.

When I first got back to South Africa, I was a bit uncertain about how relations with the Winterton Methodist church would work. Afterall, I had just barely given them a project proposal, and didn’t have time for an in-person explanation before I left the country. So we communicated by email for the few months that I was in the US, and they remained absolutely solid in their commitment to the Home-Based-Care work, and certain of God’s leading in it. Yet, coming back and having a chance to explain the whole concept and, allay their concerns in person made a big difference.

After being here for a little more than a week, a meeting was set up to meet with the Church leadership committee. I sent out a prayer request for wisdom and discernment, for God’s unity in meeting together with the church. And God answered our prayers beyond my best imaginings.

At that meeting presented to the church leadership the same pictures, information, and explanation that I used in the United States. I wasn’t sure if I should cut some information out since it is their own neighbors that I was speaking about. I decided not to change a thing, and am glad of it. Multiple members said how convicted they were of their own apathy, their lack of understanding of the full gravity of their Zulu neighbors situation, and their renewed commitment to making the home-based-care project not just work, but thrive and continue – under the name Thembalethu “Our Hope”.

It was decided that the following Sunday, I should share the same presentation with the entire congregation. I think God must have been preparing me for this, as I had a couple practice opportunities in the US before I left. So I did the same presentation over again, this time integrating a challenge from the story of the Good Samaritan. I can’t say that things changed overnight, but I think people came away challenged, unable to walk away unaffected after being confronted by the situation in their neighboring village and an opportunity to help out.

Much like the blacks that I’ve come to know and love over the past few years, the whites also have their share of baggage from Apartheid. Until the end of the Apartheid system in 1994, the government, schools and even some churches spread an indoctrination of inferiority of the blacks in every aspect of their being, as well as spreading ‘swartgefaar’, the idea that blacks are by nature more violent, brutal, and criminal in nature. This indoctrination over generations to the whites continues to hold many in bondage, and fear reigns. But God is moving in their midst, and I’ll be taking some of them out with me in the next couple weeks and months to see for themselves the Zulu individuals and families that live so close to them, but are emotionally and socially and economically still so very far apart. Many citizens of the new South Africa have a lot of baggage from the past 200 years, and their own life stories that they need to unpack, and it is very exciting to see so much movement in the Winterton area to tear down the barriers in a big way.

From an HIV infected person to a pandemic

A crazy day with patients at the local Estcourt Hospital the other day opened my eyes to the reality of the health situation here.

I was bringing in a very sick HIV+ client to get her CD4 count redone. Sister Buthelezi (the nurse in charge of the Estcourt Hospital ARV rollout) came out to the pick-up to see the patient, to take her blood. She said she should be admitted to the hospital, so we waited for the doctor to come and check her, to write the admission letter. In the meanwhile, I saw another friend who was also coming into the ARV clinic to get her CD4 count retaken. I watched incredulously as box after box after box after box were being shuffled and placed under the clinic’s verandah. A stream of skeletal patients were struggling to move the 14kg (30.8 lbs) boxes, one at a time, from the back storage room, to the entrance. Three trips per patient – three big and awkward boxes of food to assist them: rice, beans, maize meal, immune booster porridge, salt, sugar, powdered milk are some of the contents. Some were lucky and had brought helpers with them to transport the boxes, those who didn’t were left out from assistance, unless they had money to pay for private transport. Once they made the three trips with their three boxes out to the ARV clinic entrance, they still had to find a way to get these three boxes to the hospital entrance, and, then to the taxi-bus stop, and then through the taxi-bus transfer area, then on the new taxi-bus, then on their taxi to their home areas. If they were able to make it that far, they could call additional family or friends, or the random child to come and help them carry the boxes up the dirt roads to their homes.

What lunatic thought this would be a good way to help the sick? Skeletal patients everywhere carried boxes from one side to the other. Three in all, because the shipment from the Department of Health had been delayed, and so three months worth of ARV nutritional support boxes arrived at once, and were distributed at once because of the lack of storage at the clinic. I felt many eyes on me, trying to figure out where I had come from, whether I might be able to help them cart their boxes home. Unfortunately for them, it was a very long day at the hospital, and I left too late for them to get my help.

I returned a couple of months later to hear that all the boxes had run out, and those who have become dependent on the food assistance are now left without any food to take home with them.

While I was still mulling over this crazy system, I was rushing all over the hospital looking for a gurney to get my very sick patient admitted to the ward. There was none in sight, and I discovered that the nurse in training I had sought assistance from at first, had run off instead. I cruised throughout the out-patient department, the emergency area, and through various wards searching for a gurney. Skeletal patients were everywhere.

While I know that it is a mass generalization, I have learned take keen notice in people’s appearance. Most every patient that I’ve taken to have tested for HIV so far has the same gaunt, sunken-eye look that I see all over the streets and pathways, and corridors of the hospital. And, without any real evidence for my assumptions, I saw them everywhere. Laying on benches, struggling to sit on wooden pews, sitting in wheelchairs, and gathering up the strength to walk the vast distances of the hospital. Likely AIDS cases were everywhere. In fact, I started to understand just what the AIDS epidemic here is doing to the health sector.

I normally end up feeling a strong sense of frustration and anger toward the public health system at the incompetence, inefficiency, and apathy I have noticed, and hear repeatedly from patients and caregivers. For once, I was able to see the huge impact that AIDS was having on the health sector. The hospitals and clinics are being flooded by countless emaciated HIV+ patients in every clinic, with every possible queue with every possible ailment. They go in with secondary infections and diseases (TB, pneumonia, terrible body rashes, meningitis, oral thrush, weight loss and STDs) and get treatment for these. This pandemic of AIDS together with a global brain drain and compounded nursing shortage that heavily pulls away doctors and nurses to wealthier countries where the pay is many times higher. For these ailments, sometimes it’s only calamine lotion and an asprin that the patients walk away with. More careful, passionate nurses and doctors refer them to get an HIV test, recognizing the possibility that all of these things have a primary cause.

And yet, anti-fungal cream on the blistered, boiled hands of an HIV+ boy is like putting a bandage on a broken arm, and not looking at the deeper problem. Many patients fear to get tested, and have difficulty accepting the possibility, then the reality that they have HIV. The AIDS epidemic is far from limited to the patients of the clinics and hospitals. The very same nurses and doctors are suffering a common fate. Memorial Services are held regularly to honour the life of a staff member who’s passed away.

A wave of sorrow and understanding flooded over me as I realized the gravity of the problem, that it truly leaves no sector, no life untouched. The sea of HIV continues to rise in this part of the world, seemingly with no end in sight…

Revival in Winterton

And yet, exciting things are happening in Winterton. Just last year a number of people gathered together multiple times to pray for revival in the Champagne Valley and Central Drakensberg region that include the small farming town. It is exciting to see how it looks like God is answering these prayers, though in unexpected ways.

A network of Christian people and organizations that are community-minded and Christ-centered are gathering momentum and coming together: My good friend Sofi, who is doing much the same home-based care support work that I am but in a smaller village called AmaSwazi, recently and quite vibrantly became a Christian. The local Matthew 25 orphan feeding project looks as if it is in the process of being revamped and becoming more community-minded. A new holistic and community-minded Christian organization has taken over the helm of a local orphan foster home. A lovely English couple has moved into town to integrate judeo-Christian morals and character-building (learning from the Jesus film and other materials) into local public schools. The Microfinance for Youth project continues under the Jeskes, a lovely American couple, to bring opportunity and entrepreneurship training to orphaned youth and caregivers. Economic opportunities are developing for Zulu artisans to develop their skills and market their high-quality woven and beaded creations. And Youth With A Mission (YWAM) making Winterton a discipleship training and outreach base for Christian youth from all over the world. And even better than all of these individual initiatives is what looks to be their coming together under the common umbrella of Winterton churches called Simunye. And a Friday morning Bible study in which many of us meet together to share our experiences and learn together about God’s word. We are all very eager to see how God continues to work in this community and bring hope, love and opportunity to this area that for so long has had so little.

So, this is a novel in itself. Thank you so much for your support!

God bless! Unkulunkhulu akubusisu!

Betsy

Thembalethu "Our Hope" Overview

Thembalethu, a project supported by the Winterton Methodist Church, is a response to expand local initiatives, caring for the sick and orphaned in the Amangwe Tribal Area (Loskop). Its vision is:

To share God’s love and hope to the communities struck by HIV/AIDS through training, empowerment and linkages to resources, assisting those infected and affected by HIV/AIDS and poverty.

The Situation:

* 40% of adults (officially, likely much higher) in KwaZulu-Natal, South Africa are HIV positive – making it one of the top global hotspots for the AIDS epidemic

*1.2 Million South African children have been orphaned by AIDS (UNICEF, 2005)

*25% of all South African children suffer from stunting due to malnutrition (UNICEF, 2005)

*The Amangwe Tribal Area has active volunteer home based caregivers (HBC), well-poised to advocate and care for the sick and orphaned in their communities, many have been caring for their sick and orphaned neighbours for over five years with very limited outside support or assistance.

The Project:

A group of well-trained HBC volunteers, working at the most grassroots level offer tremendous hope to alleviate the depth of suffering the Amangwe community is currently experiencing. As health promoters for the healthy, advocates for the sick and community caregivers for orphaned children these amazing volunteers can do a lot to bring God’s love and hope to this community.

Training home-based care givers: Training ranges from HIV/AIDS education, motivating people to get tested for HIV, Christian spiritual care, home hospice care, accessing and supporting patients on Anti-Retroviral medicines (ARVs), opportunistic infections, & community support of orphans.

Empowering community advocates: Informing and educating local volunteers in specified processes necessary to access government resources (birth certificates, ID’s, social grants) and assertiveness training to ensure that the needy receive assistance.

Linking communities to resources: Thembalethu works together with government community development staff, local hospital and clinics to better service the sick and orphaned in the Amangwe community. Interested HBC volunteers receive training and micro-loans to support home businesses (sewing, food reselling, etc).

Bringing assistance and hope to the sick and orphaned: HBC Volunteers help the sick access the medical assistance they need, help orphans obtain birth certificates and social grants, and sustain income-generating projects to provide an income source for orphans and vulnerable children.

7 May: New Wheels and Getting Started

7 May 2007

I feel I’ve really gotten started into the Emangweni community over the last week. The most exciting development is of course getting a new bakkie (pick-up truck)! I borrowed Sofi’s a couple of times over the past few weeks, but it’s been SUCH a blessing to not have to worry about the roads I drive on to get to meetings, to visit patients. And of course, having the capacity to transport patients regularly is exciting! The Home-Based Caregivers have been thrilled to see the snazzy new car, and know that it’s dedicated to helping them assist the sick and orphans in their community. It has a door-type canopy that is ideal for getting people in, and transporting lots of people in the back.

I have continued to meet with the various groups of home-based caregivers throughout Amangwe, and they continue to bring up difficult cases that seem to be stuck. In Tatane I went with the HBC to visit a 46 year old HIV+ man who had virtually been abandoned as a child by his mother, and thus has never had a birth certificate or an ID. He was not allowed to do a CD4 test to check his immune system strength because of this, thus ARV treatment (Anti-retroviral drug cocktail is the life-saving life-long treatment for AIDS) remains out of his reach. (This is actually against the law, as it has recently been changed to allow access to free treatment to all needing it, regardless of their documentation status.) I’ll be working with the ARV clinic at Estcourt Hospital on this one, as this is certainly the first case like this of many. Today, in fact, while sitting at the Injisuthi Clinic waiting for a patient to give blood for the CD4 test, I saw how all the HIV+ maternity cases were not allowed to get their CD4 count taken if they didn’t have their ID on them, much less if they didn’t even have one. I know that Sofi has worked out a system through Emmaus Hospital to get these sick patients without ID documents on ARVs anyhow, so I’m confident there’s a way forward.

Later in the week at HBC meetings in Mandabeni, they had called a sick patient, and the grandmother of orphans in to receive assistance. The sick mother lives entirely alone with her teenaged children and has no family to support her and no income. She is suffering from what appears to be a repeat case of TB, as well as being HIV+. I organized to take her in to get a CD4 count taken (again – the blood sample was wasted the first time), and take the TB sputum test. I took her in together with another patient from Mqedandaba needing to start TB treatment, and do the CD4 count. After one false-start at the clinic, and nearly being turned away the second time (because of lack of transport of blood samples to the hospital the first day and, because the VCT counselor was away, and then the blood sample bottles ran out), both patients gave blood for their CD4 counts today. Additionally, Xoli and I did home visits in KwaVala and Ngunjini to a 47 year old bed-ridden stroke-patient, a patient on ARVs (who was having very bad urinary blockages – we called the ambulance and he died the next day in the hospital), and a patient who was unwilling to reveal any health information to the HBC volunteers, but who committed to get tested.

Today I met with the social workers whose office is adjacent to the Injasuthi clinic, and who work under an NGO called (Amangwe) Child Welfare South Africa. I have been aware over the past three years of the tremendous turnover of social workers in Amangwe, and the tremendous backlog that has been created as a result. I spoke with them about these challenges of the past, and current mismanagement that has 60 cases of orphaned families waiting for over five months for the superior to sign off on before they go to court. As a result, these 60 families who are caring for from 1-4 orphans continue to be withheld foster care income to care for the orphaned children. At the social workers’ request, I committed to contact their superiors to follow-up on the gross negligence. Additionally, we made a plan to utilise the HBC and community health workers to assist them in contacting the applicants (from 2003 to the present) in areas that the HBC are working to check that their situation remains the same. The HBC will help contact the applicants in their areas, and I will help transport them to the Social Workers to save time in the process of checking up on their details and status to reopen the untended cases. I’m happy to see there is a potential way out of this big social welfare mess in Amangwe – a way to really help orphans in the area. And maybe a way to encourage the social workers into sticking around longer if their working conditions (ie. Less of a backlog) improve. Time will tell.

Hope for AIDS

“I just went to another funeral on Saturday in eMoyeni. A lot of people are dying out there. A lot of people are dying everywhere here. Come back and let’s fight for them.”
–Xoli Msimanga, Health Advocate and Friend, Amangwe Tribal Area

Hope for AIDS

March 2007

Above is a picture of my friend Ncamsile's grave. She was 21 years old, HIV+, and the mother of Nomvelo (in the blue dress with silly glasses). Her sister Smangele is in the black t-shirt. This family has two generations of orphans with a family plot of nine recent graves. The entire middle generation wiped out by AIDS. Families like this are increasingly common in South Africa.The tragedy and crisis of AIDS in sub-Saharan Africa is nothing new to the most of you. Many of you have been faithfully partnering with me over the past couple of years as I’ve gone in neck-deep in its epicenter, Amangwe Tribal Area, South Africa. Death’s shadow looms ever-present over the Amangwe community, and with it come ever-increasing numbers of victims to the plague – the mothers and fathers, and their orphaned children left in its wake. A Friday doesn’t go by without seeing funeral tents go up in numerous homesteads around the village. At last survey of the South African province of KwaZulu, Natal, 40% of pregnant women (the only ones to get tested in numbers) tested HIV positive.
Yet, the tremendous fighting spirit of the Zulu people isn’t letting AIDS get the best of them.

• A mother who miraculously survived death’s grasp with a non-existent immune system, and after months on AIDS treatment is now not only caring for her own children, but joyfully taking in orphaned neighbors. She also has her own garden from which she delivers fresh homegrown veggies to those in need around her. After her employer helped her access life-saving AIDS treatment, she now plays the same advocate role in the lives of numerous friends and neighbors around her.
  
• Community volunteers who rally their neighbors together to care to the sick and the orphans in the community by bringing them food, helping them access government resources, praying with the sick and holding their hand as they breathe their last.


• Home-based care volunteers who have taken up the cause of neighbors in need: helping a 30 year-old mother, paralyzed for life by tuberculosis in her spine, access a wheelchair and transport to the hospital for life-saving AIDS treatment as well as home physical therapy and spiritual support.

Yet, for each one of these victory stories, I’m confronted by the reality of hundreds and thousands of others that haven’t received help. I just called Xoli, my Zulu friend and co-coordinator with home-based care. “I just went to another funeral on Saturday in eMoyeni. A lot of people are dying out there. A lot of people are dying everywhere here. Come back and let’s fight for them.”

What is needed are volunteers trained to identify HIV before it is too late, to motivate people to get tested and to fight for access to life-saving treatment. This combined with spiritual support is the formula I see to prevent additional children from being orphaned by the disease. A mother or father that survives AIDS means one less family of orphans.

I am excited about this new project because it provides the opportunity to:

Be a Catalyst - The project is first of its kind for a small, rural church filled with white farmers hoping to use their resources to bring hope and healing to their black Zulu neighbors. The dynamics of a very separate South Africa (the old system of apartheid is the Afrikaans word for separateness, after all) means that approximately 90% of whites have never been to a black home, much less spent any time in a black community. After over two and a half years of working in the community, I can help to link them up to the network of volunteers.

Save Lives and Care for Orphans - During my last couple of months in South Africa, I was impressed by the huge community clout held by some of the prominent HBC volunteers. With very few resources, they are already looking out for orphans and the sick. With additional knowledge, skills and resources, they can more effectively help to correct the myths of AIDS, help with prevention efforts, care for the sick, and get sick mothers and fathers onto life-saving treatment. Also, find income-generating ways of supporting orphaned children.

Build on Momentum - This is a great chance to continue the momentum that developed amongst the Amangwe home-based care volunteers after the 10-day HBC course we organized back in November. These amazing women now have a good grasp of their role as advocates for the sick, trainers of family caregivers, HIV/AIDS and its treatment, tuberculosis and other HIV related opportunistic infections, as well as linkages to resources for orphans and vulnerable children. When I left, they were asking for training and resources to counsel and motivate the sick to get tested for HIV; stigma and denial being the paramount obstacles encountered in identifying the real cause of sickness.

Support the Local Church - Sensing God's call to "Defend the cause of the weak and fatherless; maintain the rights of the poor and oppressed" (Psalm 82:3, NKJV), I will be helping the Winterton church find a way to sustainably demonstrate God's love and care to their neighbors. Additionally, I will continue my involvement in a new bilingual (English-Zulu) church plant, hopefully starting a Bible study with my Zulu neighbors who I transported to church every Sunday evening over my last two months in South Africa.

How can you partner in this work?

Xoli and I will continue to train and support the HBC volunteers caring for the sick and orphans.While the project funds will be covered through the Winterton, South Africa church, I still have about $340 per month to raise to cover my salary. Many thanks to all of you who make this work possible!

Donate Online: online giving is the quickest and most direct way to donate. Go to University Presbyterian Church website and click on the online giving after you create an account, make sure that you specify “Missions-Global” and “Elfers-South Africa” in the fund and sub-fund choices.

Prayer Support: If you are interested in being a regular prayer supporter, please let me know so I can add you my list for specific prayer updates. I have seen the amazing power of prayer in my life over the past two years and am so grateful for the covering God provides through your faithfulness.

Bless you,

Betsy