FIELD REPORTS
ZIMBABWE: LIGHT FROM DARKNESS By Edward Tick, PhD The front lines of health and healing today are everywhere around our country and the world where individuals, societies, and ecosystems are at risk. On these lines and often unheralded, courageous healers
and communities utilize traditional, scientific, humanistic, communal, holistic, and spiritual resources to address our most pressing global health issues. FIELD REPORTS offers reports from these front
lines about significant health crises, concerns, and healing approaches that occur beyond our usual horizon of vision. Our concern is for world health. We seek to hoist flags of hope.
imbabwe, a country of about 13 million people in sub-Saharan Africa, is landlocked and plateaued. It contains Victoria Falls, originally known as “the Smoke that Thunders,” the largest waterfall on the planet and considered one of the natural wonders of the world. It boasts the impressive stone ruins of Great Zimbabwe, the largest ruins south of the Sahara and the remains of an indigenous empire that thrived more than seven centuries ago. Zimbabwe has herds of elephants and other animals roaming its wide wilderness. In the past, it was a major producer of tobacco. It also produces cotton, corn, wheat, and sugarcane. It was once considered the breadbasket of Africa, a bountiful land that could not only feed itself but also help its poorer neighbors. It was a country of great promise and resources. Today Zimbabwe is in health and economic crises that should concern the entire world. It is suffering a severe, years-old drought. Its agriculture-based economy has collapsed. Inflation is extreme. Resources are scarce. AIDS/HIV and other diseases and life-threatening health conditions are rampant. This third article in our series on AIDS, Poverty, and Violence in Africa focuses on Zimbabwe, a country of great suffering yet enduring hope, where much needs to be done and much is being done on both small and large scales to alleviate its health crises and sustain its people’s spirits.
any on the planet: 34 years for women and 37 years for men. Even worse is its poverty and disease burden, now worsened by the economic crisis of hyperinflation. It suffers from a huge burden of HIV/AIDS and other diseases, with over 3,400 individuals dying each week. The country as a whole has over 160,000 young children suffering from HIV/AIDS and over one million AIDS orphans. Zimbabwe’s rural areas are particularly hard hit because there are few healthcare services available and very few HIV/AIDS services. AIDS is a terribly painful disease when there is no pain medication. The desperation among stricken people is palpable. Volunteers delivering medical supplies in rural areas must drive trucks slowly in the middle of the road to avoid hitting sick and suffering AIDS patients, who sometimes throw themselves in harm’s way from the bush. Zimbabwe does have existing homebased medical and hospice care teams with adequate numbers of trained caregivers but little capacity to procure or deliver medicines, supplies, orphan care, or caregiver support. There is an urgent humanitarian and strategic need to provide palliative care and to support the development of sustainable healthcare. Training on end-of-life care, including pain and symptom management, is essential. The Foundation for Hospices in SubSaharan Africa is a nongovernmental organization fostering the development of hospices throughout sub-Saharan Africa. We are partnering with the United Methodist Church, which operates 14 homecare programs in remote rural areas, where the need for relief is huge. We will provide nursing supervision for trained village vol-
unteers and funding for palliative care medicines. We also just began a partnership with Direct Relief International, whereby they will ship medicines and supplies to our partners there. Although this constitutes a major project, it only brings limited relief to the overall problem. Our partnerships constitute a real success story. Partnerships involve American hospices enrolling as sister hospices with African hospices. Partners provide medical supplies and funds from afar. They send professional teams to deliver needed supplies. These teams work, train, support, visit, and encourage African hospice staff. They also bring African hospice workers to the United States for training, fund-raising, and respite. Our foundation now has four American hospices partnering with sisters in Zimbabwe. To further and more effectively address the AIDS crisis in Zimbabwe, we have begun a rural palliative care initiative. This program proposes, over three years, to scale up palliative care in rural Zimbabwe in four focused geographical areas: Nydire, Old Mutare, Mutambara, and Seke. Scaling-up means adding a full palliative care component to existing home-based care teams. These teams are currently operated by the United Methodist Church in Nydire, Old Mutare, and Mutambare and by Seke Rural Hospice in Seke. Part of the scaling-up includes addressing the longterm need for healthcare professionals trained in palliative care. An educational component of professional training for nurses and physicians is an essential component of this program. Domestic and international collaboration is essential for programs such as this to succeed. Our initiative is a collaborative
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RURAL PALLIATIVE CARE INITIATIVES IN ZIMBABVE Zimbabwe is the epicenter of the sub-Saharan African AIDS epidemic. This country now has the lowest life expectancy of
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effort of several agencies, operationally led by the Foundation for Hospices in SubSaharan Africa and guided by the African Palliative Care Association. The lead incountry agency is Island Hospice Service in Harare, Zimbabwe. Home-based service providers will be The United Methodist Church and Seke Rural Hospice. Academic providers will be one medical school and one institution offering a diploma course in palliative care nursing. The Hospice and Palliative Care Association of Zimbabwe will also partner in the program, assisting with assessment, monitoring, and evaluation. Each participating organization is independent and responsible for its own budget and employees. Participants in the program are under a contractual arrangement, with the Foundation for Hospices in Sub-Saharan Africa as the lead contracting agency. Other agencies involved include independent American hospice organizations and American Methodist Churches, who will establish twinning partnerships with the Zimbabwean hospices and palliative care teams. Funding for this program begins in 2008 and will come from several public and private donors internationally, as well as from American hospice partners. By strengthening and capacity building with existing programs and teams, this program is not setting up any new programs, thus increasing sustainability. Long-term labor needs will be supported by the academic training programs being set up, which will include scholarships. Future funding beyond the three years will come from American hospice partners that have been established especially for this purpose, including hospice programs and Methodist churches. We anticipate that this rural initiative program in Zimbabwe will bring significant resources and relief from suffering, both immediately and in the future. It also demonstrates the types of international and nongovernmental collaborative efforts and partnerships that can be effective in addressing dire healthcare needs in some of the planet’s most stricken regions. –Philip G. Di Sorbo, MA Director, the Foundation for Hospices in Sub-Saharan Africa Washington, DC
NEED AND HOPE IN ZIMBABWE I have traveled with the Community Hospice South African Partnership to South Africa four times since 2003. My last visit in October 2006 was to Island Hospice, our hospice’s partnership in Harare, Zimbabwe. I traveled with a computer expert and another social worker. Both are enthusiastic hospice and African partnership supporters. We left the United States carrying lots of supplies—vitamins, some medicines, and lots of bandages. We had no delays in customs, and our wonderful hosts met us at the gate. Although it proved true that food, fuel, power, and water are in short supply and are a significant concern, we were well cared for during our stay. In Zimbabwe, families often save food for months to get ready for company. The grocery stores were full of food, but not necessarily what was wanted or needed. We waited in line for fuel and experienced the loss of power and water on an almost daily basis. Word would go out that there was fuel available at a particular place and people would line up and wait patiently for hours. We spent days with the Island Hospice employees. They made us a lovely lunch each date and took us on home visits. They were delightful and happy to have visitors. I was amazed at how cheerful everyone was, even though they were coping with daily shortages that are beyond American comprehension. We wondered how they managed to get to work with major fuel shortages. Most employees skipped lunch because food is in short supply. They all spoke of concerns regarding the shortages but expressed hope for the future. Many patients, especially children, had deforming tumors. If these children were in the United States, such tumors would be relieved—if not eliminated— by radiation therapy. However, there is no radiation therapy in all of Zimbabwe. We spoke with employees at the hospital who used to provide such therapy. Today they wait day after day, hoping for new equipment to provide the radiation therapy that is so badly needed. Home visits were disheartening, because there was so little we could give the patients. Pain medication is almost nonexistent. We provided vitamins and some over-the-counter pain medications. Yet, it
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did not matter what we did or did not provide; the families of the patients were thrilled to have visitors and to know that someone cares. We were invited into their homes with open arms. They offered us food and refreshment, even though they had very little. Zimbabwe is a beautiful country. At one time, it was the breadbasket of Africa. Now it must import wheat and people go hungry. Reports indicate that the poor are doing their best to grow their own food. There seems little left of the middle class. They are hurting because each day there is less in the stores, yet they are dependent on stores to supply their food. We witnessed the extremes: well-maintained roads in some areas and roads that have not been repaired in years in other areas; beautiful homes next to tin shacks. Island Hospice in Zimbabwe was a training center for us as visitors. This hospice supports itself by providing all kinds of training to the community. They seek grants and do an admirable job of working with very little. Staff people were warm, genuine, and friendly. This worker left Zimbabwe knowing that we have to keep supporting these hard workers, if for no other reason than to help them keep their spirits up. I also left with both concern and respect for their future well-being— how can so many people manage so well with so little? –Karen Hamm, LCSW Community Bereavement Counselor Albany County Hospice, Albany, NY
FROM DARKNESS TO LIGHT “We were people living in the dark and now there is light and there is hope. . .”— Hwange District School Teacher As you read this I will be on my eighth trip to Zimbabwe. My excitement at seeing the many people who have become dear friends and colleagues is clouded over by anxiety. Even before leaving, I knew that I would be witnessing more suffering and hardships than I’ve ever witnessed in my life. Since my first trip in 2003, I have observed the steady decline of the economy, and in turn, the quality of life for the people of this country. But this visit is different. I’ve heard that many of the men and women I am accustomed to working side-by-side with have passed on. As if fighting the battle against AIDS wasn’t
Field Reports
enough—now there is starvation and malnutrition. The statistics are astonishing. The average life expectancy for women in Zimbabwe is the lowest anywhere in the world. Zimbabwe has the highest population of orphans—more than any other country on the planet. The official inflation rate is now over 4,500%, making it impossible for people to buy the essentials such as food, soap, medicine, and clothing—if it is even available. Currently, the country is facing critical shortages of almost every basic commodity. Store shelves are empty. These shortages, combined with a severe drought, have created the worst food crisis the country has ever seen. Yet, amid these colossal hardships, significant accomplishments have been made by many domestic and international organizations, including World’s Window, Inc, a nonprofit organization I started two years ago. When I first went to Zimbabwe I was the typical tourist, traveling from one safari site to another, in constant amazement at the beauty of the wildlife and the terrain. The excitement of being in Africa, the continent that holds its own mysterious aura, was exhilarating. I was living a dream and an adventure I never imagined I would experience. Little did I know that only on the final days of my vacation would my true adventure begin. It started in a small village called Chikandakubi and has no end in sight. My first steps out of the typical tourist trek led me into the rural areas of Zimbabwe, away from the hotels and exotic food and drinks. I was taken there by a man I had met in the town of Victoria Falls. It was a meeting that I know now was meant to be. Today, that man is not only a dear friend but the person who oversees the projects that World’s Window, Inc has established in Zimbabwe. In 2003, Chikandakubi was a poor village where women laid on grass mats, too
Field Reports
sick and weak from malaria to partake in daily life activities. It was a village with no running water, no electricity, and a school with few supplies. It was a place where the people were warm, friendly, and proud of their homesteads, their churches, and the school, despite what little they had. What I saw that first day made me realize how blessed I am to have the food, clothes, medical care, and money to live a comfortable life in America. Further, it made me realize that despite the odds and daily struggles, these people had hope for a better future. Their hope was instilled within my heart and motivated me to take a new direction in my life—to create projects and programs to help these people become self-sustaining and improve their quality of life. World’s Window, Inc, a grassroots nonprofit organization, has been developing projects in Zimbabwe for over two years, with the assistance of village elders, the village chief, teachers, and other community leaders. The organization also works closely with local Zimbabwean ministries to compliment initiatives already started in the country. World’s Window, Inc believes that in order to create a thriving community, everyone—men, women, and children—must be given equal opportunities and resources. We have provided a men’s workshop— complete with tools, equipment, and an on-the-job training program, conducted by a teacher from a New York State correctional facility, that began in August 2007. We have given women the resources to knit, crochet, basket weave, and sew to earn an income and provide for their children. We will personally deliver 13 brand new sewing machines into the hands of the sewing club during this trip. We have provided books for the library we built, as well as a solar panel that operates lights and the school’s first computer. We have provided medicines and medical supplies
and established a first aid center that helps people survive and thrive. We have provided donkeys, carts, and medical supplies for home healthcare workers who devote their time to care for the critically ill. We have provided seeds, plants, and seedlings for a community garden, and animals for a breeding project. We have supported the education of over 500 children and given them basic necessities such as shoes, hats, and school supplies. We are installing the first solar-powered well this fall, and our plans also include the building of an HIV/ AIDS clinic, where the first step will be to provide antiretroviral therapy to pregnant women. World’s Window, Inc is dedicated to building goodwill and great working relationships in Zimbabwe and in the United States. We have much to be proud of— our projects, our loyalty to the people we serve, our integrity within the nonprofit world— but most of all, we are proud of the people of Zimbabwe who refuse to give up hope. This is merely an introduction to one small impoverished area in Zimbabwe and how one small organization can make a difference in the lives of the people who call it home. As Nelson Mandela said, “overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists there is no true freedom. Do not look the other way. Do not hesitate. Recognize that the world is hungry for action not words. Act with courage and vision. Of course the task will not be easy”. –Cindy Schmehl Executive Director, World’s Window, Inc., Ballston Lake, NY, www.worldswindow.com.
Edward Tick, PhD, is the executive and clinical director of Sanctuary/Soldier’s Heart and the author of War and the Soul.
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