AIDS is now a leading cause of death and morbidity in Sub-Saharan Africa, and the devastating impact that this is having on local communities and national economies is hard to overestimate. The Christian response to this crisis has been variable, but overall there have been many positive examples of innovative, compassionate and incarnational care and prevention work.
Care
With the advent of the HIV/AIDS epidemic in southern Zambia, the initial response of Chikankata Hospital The Salvation Army was to develop designated AIDS wards and services. However, it soon became apparent that there were too many people for the inpatient services to handle, and that many of the needs could be met by care services based in the community. Therefore, as long ago as 1987 a Home Based Care (HBC) programme linked to hospital diagnosis, counselling, education and treatment was established.
This programme allowed people to be cared for in their own homes, and created opportunities to train families in the care of people living with HIV/AIDS and discuss HIV/AIDS education and prevention with families and the wider community. The HBC teams are multi-disciplinary and include community nurses, nutritionists, and counsellors.
The HBC programme at Chikankata soon developed into a comprehensive HIV/AIDS programme including:
Chikankata has developed a diverse but integrated approach to supporting the local community in combating HIV/AIDS. The programmes that are developed are tailored to meet the needs of different sections of the community.
These community-based programmes belong to the community that benefits from the services, not to the aspirations of an NGO (Non-Governmental Organisation) or healthcare institution. The community is not restricted to a geographical area, but rather the term ‘community-based’ denotes that the local community owns the programme. The result of the link between home care, prevention and general community development has been an investment in the community that is not so readily achieved through inpatient care. Furthermore, home care has proved to be 50% cheaper than inpatient care.
Holistic care, whereby the physical, social, spiritual, economic and psychological needs of both the individual and the community are met, is of paramount importance to the team at Chikankata. Such diverse needs can only be met by working with all those that contribute to a community, i.e. individuals, families, communities, government institutions and NGOs.
However, the communities in the Chikankata area were increasingly expecting that the hospital would meet more and more of their needs, rather than meeting their own needs themselves. These were not only those needs related to HIV/AIDS, but also those related to other aspects of their lives, such as income generation, food production and schools.
The management of the hospital recognised that the use of paid hospital-based community care teams was expensive and that they were increasingly unable to meet the growing workload as HIV prevalence increased. One manager said the community healthcare structure was being used as a ‘Neighbourhood Watch Scheme’, which the community used to ask for help on a wide range of issues. The response of the hospital management was to meet with the local leaders and communities and share their concerns that they could not continue to meet all the demands being made upon them. The response was the development of Care and Prevention Teams (CPTs) which are run by the community and not the hospital. Care and Prevention Teams have the following components:
During recent research it became apparent that many NGOs involved in AIDS programmes had diversified their approaches to combating AIDS. A number involved in care have developed a more diversified approach to care by caring for any who are chronically sick in their communities, not only those who are HIV positive. For example, FACT in Mutare, Zimbabwe, saw this was necessary for it was felt to be wrong to visit only those who were ill due to HIV while not caring for their neighbours who were equally ill but not necessarily HIV positive.
Care in the community by God’s community
In the face of a high level of need and limited formal health resources, FACT saw the pressing need to mobilise the local community to provide care. Churches that were approached were offering a resource of concerned individuals willing to be trained to provide care to their families and neighbours in their communities. The FACT home care programmes are co-ordinated by experienced health workers who are responsible for local teams. Each team is headed by a volunteer, managing other local church volunteers who provide the actual care to those in need in their areas.
The training of volunteers consists of basic counselling and care skills such as bathing and personal hygiene, washing clothes and bed linen, house cleaning, provision of appropriate food and the treatment and dressing of minor wounds. While the main aim of the volunteers is to attend to those infected with HIV, they are trained to care for all who are chronically ill or dying, e.g., people with TB, diabetes or simply dying from old age. Above all, the volunteers recognise that the needs of those they visit are not purely physical, but also emotional and spiritual. Volunteers are drawn from the local community and it is often their neighbours for whom they are caring. The formation of positive, serving relationships is the basis for good practical care and supportive counselling.
The majority of those visited are living with family members who are the traditional carers. The volunteers also offer support to them. They can offer advice on how to care for the different infections common to HIV and on the other informal and formal services available and how to access them. The volunteers can also offer emotional and spiritual support to the family carers.
By utilising the traditional family and community caring mechanisms a larger number of people are able to receive help at relatively low cost. The church, through its volunteers, is given the opportunity to reach into its community to serve and support those affected by HIV/AIDS and other chronic illnesses.
The relational-based care offered by the volunteers naturally opens up opportunities to raise awareness and understanding about HIV/AIDS and especially how it is transmitted and prevented. HIV/AIDS prevention that develops out of the context of care enables many social and moral issues (which can hinder openness) to be laid aside. People whose friends or family are infected and are facing the reality of the disease tend to listen and subsequently pass on sound information to others. For an AIDS organisation working in prevention, one of the best entry points is care, which most often also brings credibility to their work.
The Christian response to AIDS needs compassion and a practical expression of the love of Christ, not only responding to the real needs of the communities affected by this epidemic, but a willingness to incarnate that love by being a Christ-like, physical, relational and active presence within those communities. These two examples from Zambia are only a snapshot of the radical, compassionate response that Christians are making to the AIDS crisis worldwide.
Care
With the advent of the HIV/AIDS epidemic in southern Zambia, the initial response of Chikankata Hospital The Salvation Army was to develop designated AIDS wards and services. However, it soon became apparent that there were too many people for the inpatient services to handle, and that many of the needs could be met by care services based in the community. Therefore, as long ago as 1987 a Home Based Care (HBC) programme linked to hospital diagnosis, counselling, education and treatment was established.
| Key Themes This article considers two different Christian responses to the AIDS crisis in Southern Africa, illustrating the need for locally appropriate and initiated strategies rather than just large donor run projects. The Biblical principles of incarnation, relationship and servanthood run at the heart of a Christian response to AIDS. Chikankata Hospital in Zambia initially set up an inpatient programme that soon became swamped. A home based care programme was soon developed, but as the community turned to it for more and more help, it was soon realised that the hospital could not meet the demands put upon it through existing means alone. As a consequence, Chikankata involved local stakeholders and leaders to develop community based care that was initiated and run by the local community, with the local church and hospital acting as servants and support to the community rather than as initiators or primary care providers. In Mutare, Zimbabwe meanwhile, FACT has mobilised local churches to provide care and counselling for individuals living with HIV and AIDS, their families, and others chronically or terminally ill in the community. Practical care is the first principle, earning the volunteers and trained health workers the right to tackle prevention and counselling issues. |
The HBC programme at Chikankata soon developed into a comprehensive HIV/AIDS programme including:
- in-hospital counselling
- AIDS education in schools
- child support programmes
- technical assistance programmes for other organisations
Chikankata has developed a diverse but integrated approach to supporting the local community in combating HIV/AIDS. The programmes that are developed are tailored to meet the needs of different sections of the community.
These community-based programmes belong to the community that benefits from the services, not to the aspirations of an NGO (Non-Governmental Organisation) or healthcare institution. The community is not restricted to a geographical area, but rather the term ‘community-based’ denotes that the local community owns the programme. The result of the link between home care, prevention and general community development has been an investment in the community that is not so readily achieved through inpatient care. Furthermore, home care has proved to be 50% cheaper than inpatient care.
Holistic care, whereby the physical, social, spiritual, economic and psychological needs of both the individual and the community are met, is of paramount importance to the team at Chikankata. Such diverse needs can only be met by working with all those that contribute to a community, i.e. individuals, families, communities, government institutions and NGOs.
However, the communities in the Chikankata area were increasingly expecting that the hospital would meet more and more of their needs, rather than meeting their own needs themselves. These were not only those needs related to HIV/AIDS, but also those related to other aspects of their lives, such as income generation, food production and schools.
The management of the hospital recognised that the use of paid hospital-based community care teams was expensive and that they were increasingly unable to meet the growing workload as HIV prevalence increased. One manager said the community healthcare structure was being used as a ‘Neighbourhood Watch Scheme’, which the community used to ask for help on a wide range of issues. The response of the hospital management was to meet with the local leaders and communities and share their concerns that they could not continue to meet all the demands being made upon them. The response was the development of Care and Prevention Teams (CPTs) which are run by the community and not the hospital. Care and Prevention Teams have the following components:
- The CPT address not only health issues but general development matters.
- The community elects the CPT committee members.
- Local key stakeholders are invited to join the committee e.g. volunteer health workers, businessmen and women, etc.
- The local church is encouraged to take on a servant role, rather than a leadership role based on prescriptive authority. To be a servant is to be lower than the one we serve, and to show the sacrificial love of Christ.
- Hospital-based staff also work as team members.
- The CPT and community agree on a management structure and plan of action to provide most of the resources and activities required to respond to the community's needs..
- An influential individual from the local community, or someone particularly committed, is selected by the community to act as the main motivator and link person..
- The CPT then negotiates with the hospital staff to agree the assistance that can be offered by the hospital to support the community’s efforts. This could include regular monitoring and evaluation..
- Above all, the CPT strategy encourages the community to take on responsibility for the provision of caring for fellow members of the community who are chronically ill (not only those ill due to HIV/AIDS). Furthermore, care is not restricted to those who are ill, but also those affected by the illness, i.e. dependants, most often children and elderly parents..
During recent research it became apparent that many NGOs involved in AIDS programmes had diversified their approaches to combating AIDS. A number involved in care have developed a more diversified approach to care by caring for any who are chronically sick in their communities, not only those who are HIV positive. For example, FACT in Mutare, Zimbabwe, saw this was necessary for it was felt to be wrong to visit only those who were ill due to HIV while not caring for their neighbours who were equally ill but not necessarily HIV positive.
Care in the community by God’s community
In the face of a high level of need and limited formal health resources, FACT saw the pressing need to mobilise the local community to provide care. Churches that were approached were offering a resource of concerned individuals willing to be trained to provide care to their families and neighbours in their communities. The FACT home care programmes are co-ordinated by experienced health workers who are responsible for local teams. Each team is headed by a volunteer, managing other local church volunteers who provide the actual care to those in need in their areas.
The training of volunteers consists of basic counselling and care skills such as bathing and personal hygiene, washing clothes and bed linen, house cleaning, provision of appropriate food and the treatment and dressing of minor wounds. While the main aim of the volunteers is to attend to those infected with HIV, they are trained to care for all who are chronically ill or dying, e.g., people with TB, diabetes or simply dying from old age. Above all, the volunteers recognise that the needs of those they visit are not purely physical, but also emotional and spiritual. Volunteers are drawn from the local community and it is often their neighbours for whom they are caring. The formation of positive, serving relationships is the basis for good practical care and supportive counselling.
The majority of those visited are living with family members who are the traditional carers. The volunteers also offer support to them. They can offer advice on how to care for the different infections common to HIV and on the other informal and formal services available and how to access them. The volunteers can also offer emotional and spiritual support to the family carers.
By utilising the traditional family and community caring mechanisms a larger number of people are able to receive help at relatively low cost. The church, through its volunteers, is given the opportunity to reach into its community to serve and support those affected by HIV/AIDS and other chronic illnesses.
The relational-based care offered by the volunteers naturally opens up opportunities to raise awareness and understanding about HIV/AIDS and especially how it is transmitted and prevented. HIV/AIDS prevention that develops out of the context of care enables many social and moral issues (which can hinder openness) to be laid aside. People whose friends or family are infected and are facing the reality of the disease tend to listen and subsequently pass on sound information to others. For an AIDS organisation working in prevention, one of the best entry points is care, which most often also brings credibility to their work.
The Christian response to AIDS needs compassion and a practical expression of the love of Christ, not only responding to the real needs of the communities affected by this epidemic, but a willingness to incarnate that love by being a Christ-like, physical, relational and active presence within those communities. These two examples from Zambia are only a snapshot of the radical, compassionate response that Christians are making to the AIDS crisis worldwide.
