The past
Chikankata Hospital in Zambia was founded on the edge of the Gwembe valley in 1946 by The Salvation Army to provide a health service for some of the poorest people in the country.
The present
The AIDS pandemic in a situation of economic restructuring and declining net national and international aid has made the hospital in its present form unsustainable. At the same time the community's existence is threatened. Continuity between past, present and future is valued highly. AIDS is seen to kill individuals and their extended families slowly and this causes loss of hope for a better future and produces a fatalistic response which further destroys community structures.
A programme of home-based care that is clinical, pastoral and educational has been linked to family and neighbourhood-based counselling. This has enabled the neighbourhood groups in the areas covered by the programme to recognise and respond to the problem of HIV infection. The response is seen in the expression of care for each other, and in sustained commitment to change, where this is needed, in attitudes and behaviours. Thus a process of care is seen to have an emerging prevention impact.
This process has happened in both low and high prevalence areas. A team approach both in hospital and in home visits to those infected, to those affected, to those in danger of being infected, and to those connected in other ways, widens the circle of prevention.
The future
Led by its traditional headmen, the community around the hospital has begun to recognise that it has the capacity to care for its own health and to accept the responsibility to do so. It can discuss its own problems, recognise their causes, decide how to solve them, and determine the priorities in the light of the resources available. This process can extend to all aspects of its healthcare and not just to HIV/AIDS.
The hospital and home care staff, most of whom are Zambian and many of whom are locally employed, need increasingly to become identified with the community in this process. They can facilitate change by:
This process of using care to facilitate participation and change becomes community-owned rather than being the imposition of solutions from outside. The hospital and clinics become resource centres for the community. A community confidentiality develops. A degree of 'community informed consent' is found which may allow HIV testing without time-consuming pre-test counselling. The process of care resulting in change 'is as simple and yet as profound as the recognition that the love of Christ transforms'.
Maureen and Thadeo
Maureen and Thadeo are a married couple and both are HIV-positive, diagnosed in 1988. They have two children. Through home visits from a Chikankata team, and because of an increasingly supportive neighbourhood, influenced through some committed senior headmen, they worked through a difficult separation, reconciling after a year or so when they realised they could face the future better together than apart. They were visited regularly. The process of community counselling in the neighbourhood of their home helped their families to lose their fear and to include them in the wider family circle.
Reference
1.Campbell 1 and Radar D. Community Informed Consent for HIV Testing, Tropical Doctor, 1999; 29:194-195
Captain Dr lan Campbell is Medical Adviser to the Salvation Army International HQ
Chikankata Hospital in Zambia was founded on the edge of the Gwembe valley in 1946 by The Salvation Army to provide a health service for some of the poorest people in the country.
The present
The AIDS pandemic in a situation of economic restructuring and declining net national and international aid has made the hospital in its present form unsustainable. At the same time the community's existence is threatened. Continuity between past, present and future is valued highly. AIDS is seen to kill individuals and their extended families slowly and this causes loss of hope for a better future and produces a fatalistic response which further destroys community structures.
A programme of home-based care that is clinical, pastoral and educational has been linked to family and neighbourhood-based counselling. This has enabled the neighbourhood groups in the areas covered by the programme to recognise and respond to the problem of HIV infection. The response is seen in the expression of care for each other, and in sustained commitment to change, where this is needed, in attitudes and behaviours. Thus a process of care is seen to have an emerging prevention impact.
This process has happened in both low and high prevalence areas. A team approach both in hospital and in home visits to those infected, to those affected, to those in danger of being infected, and to those connected in other ways, widens the circle of prevention.
The future
Led by its traditional headmen, the community around the hospital has begun to recognise that it has the capacity to care for its own health and to accept the responsibility to do so. It can discuss its own problems, recognise their causes, decide how to solve them, and determine the priorities in the light of the resources available. This process can extend to all aspects of its healthcare and not just to HIV/AIDS.
The hospital and home care staff, most of whom are Zambian and many of whom are locally employed, need increasingly to become identified with the community in this process. They can facilitate change by:
- drawing attention to problems
- exploring concerns and hopes when people discuss what they see
- encouraging the living and giving hope to the dying by working for better relationships and a more secure future
- planning with the community a sustainable use of hospital resources
- seeking within the church a holistic spiritual response to sickness and poverty
- helping home care programmes in other areas and countries
This process of using care to facilitate participation and change becomes community-owned rather than being the imposition of solutions from outside. The hospital and clinics become resource centres for the community. A community confidentiality develops. A degree of 'community informed consent' is found which may allow HIV testing without time-consuming pre-test counselling. The process of care resulting in change 'is as simple and yet as profound as the recognition that the love of Christ transforms'.
Maureen and Thadeo
Maureen and Thadeo are a married couple and both are HIV-positive, diagnosed in 1988. They have two children. Through home visits from a Chikankata team, and because of an increasingly supportive neighbourhood, influenced through some committed senior headmen, they worked through a difficult separation, reconciling after a year or so when they realised they could face the future better together than apart. They were visited regularly. The process of community counselling in the neighbourhood of their home helped their families to lose their fear and to include them in the wider family circle.
Reference
1.Campbell 1 and Radar D. Community Informed Consent for HIV Testing, Tropical Doctor, 1999; 29:194-195
Captain Dr lan Campbell is Medical Adviser to the Salvation Army International HQ
