My brother's keeper - community care saves lives

Rural communities in desperately poor western Kenya, tired of waiting for help that never comes, are bringing hope to families that would otherwise starve or die of health problems. "Many of our neighbours have seen their parents, children and other relatives perish from HIV/AIDS, so we have decided to step in and help where we can," said Steven Walele, a member of the Bungoma Orphans, HIV/AIDS and Poverty Organisation (BOHAPO), a community-based association in the village of Kabula. The pandemic has hit western Kenya particularly hard because of a combination of poverty, ignorance and cultural practices, such as wife inheritance and polygamy. Bungoma has an HIV prevalence of about seven percent, according to public health officials. Entire families have been wiped out, and much of the responsibility of caring for orphaned children has fallen on the weary shoulders of their grandparents, who are often too old to provide for them. Although they are surrounded by the lush greenery of maize and sugar plantations, most people own little or no land, and what they do have is used to cultivate just enough food for their own needs, leaving nothing to sell. BOHAPO, with no financial support other than donations from the local community and a youthful membership of just eight fulltime helpers and 14 part-timers, provides families with food, orphans with school uniforms, and HIV/AIDS education to residents. The organisation works through a network of similar youth and women's groups, giving the sick home-based care by performing simple chores like cooking and cleaning for those too old or infirm to do it themselves. Pamela Adhiambo (not her real name), with no income and little education, is one of BOHAPO's HIV-positive beneficiaries. When her husband and the 'co-wife' died from HIV-related complications in 2001, she was left alone to bring up their seven children. BOHAPO provides them with food once a week, but the children still only eat two meals a day, based on maizemeal and beans. "My two oldest children are not in school, and the young ones got school uniforms from BOHAPO - that is the only way they are still in school," she said. "They also sometimes give me the bus fare to go to Busia hospital [about 60km away on the Uganda border] to collect my antiretroviral medicine." Donations to BOHAPO are voluntary, so there is never a guarantee that Adhiambo and her family will receive food or other assistance. "When some members who can afford to grow food for sale have excess, they either give us food to distribute, or money to buy the children uniforms or medicine," said Jacqueline Amogola, another BOHAPO member. "When we have no donations, these families just suffer." The group also runs a mobile clinic in a neighbouring village for those who are too ill to walk the 10 kilometres to Bungoma town for help. They have to hire nurses for the mobile clinic, but occasionally medical personnel from the government-run Bungoma District Hospital donate their services. "Sometimes you go to homes where someone has a seeping wound for days but cannot afford the bus fare of 20 shillings [28 US cents] to go to hospital," Amogola added. "Many times they would get worse, or even die, if it were not for the mobile clinics." The group also provides peer education about HIV/AIDS, a vital tool in this area, where misconceptions about the disease abound. Many people still attribute the thousands of deaths in their region to witchcraft, refusing to acknowledge that wife-inheritance or polygamy, for so long a part of their cultural fabric, could be responsible for the epidemic. "When we go to local schools to educate them, we still hear young children ... [say] that having sex with a virgin will cure you or protect you from HIV," said BOHAPO member Edwin Walele. "Here, having many wives is still a sign of wealth - many men as young as 20 have more than one wife." Although they are taking the HIV message to schools, many children do not attend. The government began free primary school education in 2003, but children are required to bring a desk and buy their own uniforms, making schooling too expensive for poor families. "Many, many children remain at home doing nothing all day and ... that has its own problems - they resort to hanging around local bars and do not become productive members of the society," Walele added. "And of course, when they are in bars, they end up sleeping around, making the problem worse." In an effort to steer the village's youngsters away from such places, BOHAPO organises sports and other entertainment. "We sometimes have football tournaments that can last up to one month, during which time the young people are engrossed in the game and will not have much interest in the bars," Amogola said. Local businesses donate the prizes, as little as a thermos flask in some cases, to keep the children motivated. Without the community's help, one Kabula resident said, many of these children would have become "beggars or thugs". "Everybody gives what he or she can," she added. "What is important is that we are making a difference in our own society, helping our neighbours to survive."