Trouble in Paradise: A grassroots battle against AIDS in Zululand

Many compounds are hard to access in this deeply rural area

The road came to an abrupt end. We hiked the rest of the way on foot. It wasn't long before I stood outside what was nothing more than a dilapidated mud box clinging to the side of the rock-strewn hill. Black smoke gushed out through a gaping opening where a rusted metal door hung crooked from its side. The house is so small that a single bed couldn't have fit inside. The skeleton of an earlier structure, suggesting a more prosperous era, rests nearby covered in trash.

The entire scene reeks of desperation. It could have easily been a war zone. This wouldn't have been far off the mark. We are instead on trek with Joan Dutton, Director of the Umvoti AIDS Center. Joan and her staff are visiting a selected group of their patients. Nearly all are living in absolute poverty and have AIDS. Many are children.

The woman we are visiting is 42 years old. I would never have guessed. She looks much older. In the twilight of her battle against AIDS, she can no longer even leave her bed. "There’s not a lot we can do for the lady on top of the hill," says Joan later. "We can give her food parcels, but she is already too sick to take the ARVs [antiretroviral medications]. One of these days we will come and she will be dead."

Joan Dutton leads the team to an isolated patient

Deep in Zulu country, this ailing woman had been sent away by her family and is living with a young man in his late teens, who is caring for her. "The only time an African man is caring is when he does not have accommodation or food," says Mumsie Mkhize, Coordinator of Home Based Carers. "I have much respect for him," responds Joan. In this region of Africa, life is cheap and many people are bitter. Yet people still manage to find hope in the courage displayed by the many makeshift families that bravely struggle against all odds.

Joan started the Umvoti AIDS Center in 2001, when "it became clear that the people in the rural areas had been largely forgotten in the AIDS clamor and debate that was current at the time" (Umvoti AIDS Charter). Over 80 percent of the center's clients come from rural areas in Kwazulu Natal. The average household income is 126 rand ($21) per month. "In all of South Africa, Kwazulu Natal is the worst hit," says Joan. "About 70 percent of people here are infected."

During their first year, the Umvoti AIDS Center started small, training 15 home-based nurses and working in three sub-areas. Joan brought food from her farm to feed the children. There was no project vehicle. They used their old farm buckie [truck] for all essential transport. Gradually they expanded the organization and trained staff. Currently, the organization ministers to some 60 people in an area of 2,500 square kilometers, yet despite this they are still driving the same buckie.

The farm buckie overheats

Members from the Umvoti AIDS Center travel to new areas on a monthly basis and hold awareness meetings. One of their main goals during these visits is to teach people how to deal with the ramifications of AIDS once they find out they have tested positive. "Our job is to make sure everything goes right in the community," says Justice, who specializes in offering psychological help to children. "We have nothing to hand out, unless somebody donates it. We go to make sure people are taking their medicines, eating healthy, and have ID cards."

The Umvoti AIDS Center is facing an uphill battle. Stigma continues to be a major problem in preventing the spread of the disease. This is a country where the Deputy Director of the South African government recommends a shower as a method of avoiding AIDS. When people die here, even the hospitals list the primary cause of death as tuberculosis or some other opportunistic infection.

The outreach program tries to reach as many patients as possible

Testing also takes time. A CB4 count can take up to three weeks to process. Government-issued antiretrovirals are free only for people with a CB4 count under 200. "However, a lot of people die here before they even get onto treatment," reveals Joan. "People cry about a tsunami; we have one of these every couple of months. But we have to get on and deal with it."

We head back into the valley. Large groups of men sit patiently by the main road, wearing suits of blue. This indicates their lot as manual laborers. Yet they are not working. They are waiting for trucks from the farms to pick them up and offer them work. Most will wait all day. Jobs are scarce. Unemployment is rife; very few people are looking for unskilled laborers.

Joan turns the farm buckie up a dirt road, expertly guiding us through a maze of unmarked village paths. Mamzie points out partially constructed houses that will never be completed. AIDS has ensured this. We arrive at a spotless compound. There are only three small structures, but it is obvious enormous care was spent constructing them. One is built in the classic Zulu style that is becoming increasingly rare in the area.

A young rape victim takes shelter in this traditional Zulu house

Mamzie explains that we are visiting a woman who has been disabled since birth. Two months prior, she was kidnapped by a man from the village. He dragged her into the bush and raped her for two days before she was found. The man was caught and the case is now in the courts. However, things are moving slowly and the family of the accused rapist has started harassing the family, demanding that they drop the charges.

As I enter the hut, a man working near the entrance crafting small traditional dresses greets me. He is the brother of the woman we have come to visit. I look around the hut. It is practically empty. I suddenly realize that there is a woman sitting silently on her knees almost directly in front of me. I didn't notice her at all when I walked in. She seems to be taking up almost no space.

She either can't talk or refuses to. Joan puts down a parcel of food and clothing. Winter is rapidly approaching and many people do not even have the means to protect themselves from the harsh elements. Mamzie asks her brother how she is. He updates her on the court case. Joan promises to send a social worker out as soon as possible; she also assures the brother that they will try and speed up the case. There is little more that can be accomplished today. We move on.

Justice looks over donated clothing with another Umvoti staff member

The Umvoti AIDS Center recognizes job creation as an urgent need. "We want to be teaching skills, getting people self-employed, because there are no jobs in Greytown," says Joan. She explains that unemployment is one of the primary causes of the high crime rates in the area. The Center is offerings programs on activities such as gardening, sewing, pottery, and weaving. These trainings are open to everyone, regardless of their status.

While this is a start, "there are still many men around that don't have skills and don't have jobs," says Joan. Many projects focus primarily on income raising projects that target females to the detriment of men. This can be dangerous. The Umvoti AIDS Center is planning on addressing this issue as they look to expand their own facilities. They intend to train local men with skills including welding, bricklaying, and electioneering. These men would then be hired to work on expanding the infrastructure of the center. "We need to develop our people," says Joan. "They can't rely on food parcels the rest of their lives."

Water can be difficult to obtain in Kwazulu Natal

The Umvoti AIDS Center, according to their charter, is making a concerted effort to "build the image of the volunteer and to spend a greater proportion of [their] funds on the people that do rather than on things." This effort has led to an unusual program targeting students at local schools. Midway through a trial three-year program, they are currently offering psychological support to vulnerable children across the municipality.

Ninety schools have arranged to be a part of the project. Three schools are targeted at a time, with one session per school each week. The groups generally average around eight children per group. Teachers, counselors, and staff of the Umvoti AIDS Center identify kids that are socially challenged. These students are then assisted through "play learning" and confidence building exercises. After three months, the program relocates and new schools are selected. To date, 40 schools have participated in the project.

We park the buckie in front of a lonely compound. A tired-looking dog barks feebly at me. An old woman, sitting near a tree, waves weakly at the dog. The dog disappears. Weeds grow from the once manicured rocks near the communal meeting area. A few small houses sit empty; ornate iron grating now rusting peers through broken windows. The garden is overgrown with weeds. Expensive barbed wire fencing on the perimeter has not been maintained. Goats climb through large gaps, searching vainly for food.

Joan Dutton, Director of Umvoti AIDS Center

Mamsie approaches the old woman. They speak briefly and she totters off to a hut near the back of the compound. A young girl in her teens emerges. She bravely limps painfully across the yard. No one helps here. We patiently wait. Joan explains that last time they visited, the girl couldn't even walk. Now she can. Her husband left her when she first became ill. Now he is living in Johannesburg with a new wife and family. She remained, cared for now by her aging grandmother.

"It's our custom that a man can take 15 or 20 wives," says Mamsie. "We can't run away from it. We don't like it, but we can't run away from it." She approaches, smiles at us, and then shuffles into the house in front of us. Joan enters the house with the old woman. We wait outside. Mamsie talks about some of the other families that Umvoti administers to. Some are headed by children who have had to assume the responsibilities of their sick or deceased parents. There are no government solutions for situations like this. Private groups like Umvoti can do little more than provide limited help.

"At one point, we had a mother so sick that her four-year-old daughter was caring for her and her other children," murmurs Mamsie. "It was unbelievable. She was cooking all the food, doing everything. It was very humbling." Unprecedented circumstances are leading to startling responses from people of all ages, races, and economic backgrounds. Organizations reaching out to empower and assist rural populations are finding unexpected success stories in the most horrendous of circumstances. Statistics only show a catastrophic situation with no apparent solutions. As Joan exits the house with a smile on her face, it is clear that progress is occurring. You just have to look on the individual level.

For more information, contact Joan Dutton, Director of the Umvoti AIDS Center in Greytown, South Africa, at mwtonyd@mweb.co.za.


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