Daliso: sick man on ART
Melia: Daliso’s wife
Mbonyiwe and Siphiwe: caregivers
Signature tune (locally popular song about HIVand AIDS)
Presenter: At one time, HIV-positive people in Zambia enjoyed good health because they received free, monthly rations of high energy protein supplements, commonly called HEPS. Unfortunately, the partial withdrawal of donor support made the availability of HEPS both erratic and inadequate. As a result, many HIV-positive people now lack the good nutrition required for their bodies to withstand the onslaught of the virus.
In Chipata, the administrative headquarters of the Eastern Province, the HIV infection rate rose drastically, from 16% in 2000 to 26% in 2010. Hospitals and undertakers were overwhelmed. Clearly, something needed to be done quickly!
In response, some People Living with HIV and AIDS, called PLHAs, in the overcrowded compound of Mchini, came together and formed a group called the Zithandize Support Group. Zithandize means self-reliance. The aim of the group was to encourage PLHAs to rely on each other for home-based care and other kinds of support for dealing with HIV and AIDS.
In the following drama, Mbonyiwe and Siphiwe are caregivers with Zithandize. They are making one of their routine visits to homes afflicted by HIV and AIDS.
SFX: Fade in voices of many women and children at water kiosk
Mbonyiwe: Oh, sissie, this compound is really rundown. Look at the filth. No proper drainage or sewage management. How do people survive here? Maybe we’ve lost our way!
Siphiwe: I don’t think so. The visitation card says a blue shack near a water kiosk, and look, this looks like it!
Daliso: (Groaning off mic)
Mbonyiwe: (Sarcastically) Sounds like it, too – those groans. Someone’s very, very sick here. Let’s knock.
Siphiwe: (Traditional manner of verbal knocking) Hodi! Hodi!
Daliso: (Groaning off mic)
Mbonyiwe: (Louder) Hodi! Hodi here!
Melia: (From inside, off mic) Come in, please, whoever you are. With a sick person in the house, the door is always left open for visitors.
SFX: Sound of footsteps entering house
Melia: Ah – ah, you girls – that uniform – are you doctors from the hospital? No? Nurses? No again; nurses don’t wear white T-shirts and slacks, nor do they carry rucksacks.
Mbonyiwe: Indeed they don’t. Look at the emblem on our breast pockets.
Melia: It’s the red ribbon for HIV and AIDS.
Siphiwe: Correct. We’re caregivers, mama!
Melia: Caregivers? Where from?
Mbonyiwe: (To Siphiwe) Turn round, Siphiwe, so that she can see what’s written on the back.
SFX: Sound of footsteps as Siphiwe turns
Melia: (Reading) Zithandize Support Group.
Mbonyiwe: (Soft laugh) Yes, and we were informed that HIV and AIDS are taking a toll on this family.
Melia: Yes, indeed! Maybe the anti-retroviral medicines are no longer working for him. But come, sit on that reed mat. We’ve no chairs here.
SFX: Sound of pulling a mat and people sitting
Daliso: (Groaning and coughing)
Mbonyiwe: Your husband doesn’t look well. Yet you said he’s on ARVs. When did he start on them?
Melia: Five years ago.
Siphiwe: (Compassionately, after a brief pause) Please share your story with us.
Melia: (Sadly, after hesitation) It’s a long story.
Siphiwe: We’ll listen.
Melia: Alright. (Pause) Briefly, we have one child, Lozindaba, who now lives with her uncle since we are not able to give her good care. After Lozi, we had a boy, who died young due to poor health. After another child also died in infancy, and my husband, Daliso, got sickly, we knew we had HIV. So we went for voluntary counselling and testing. My immune system was still considered OK. As a result, I was advised to live positively and eat a balanced diet. But Daliso was a wreck. So he was put on ARVs right away.
Mbonyiwe: So have you been living positively and having a balanced diet?
Melia: (Sad laugh) If by positive living you mean the practice of abstaining from sex, being faithful to one’s spouse or using condoms whenever having sex, yes. However, it’s like locking the door after the burglars have entered the house. But as for a balanced diet (small laugh), my dear girl, you can see poverty here even with your eyes closed. How can doctors expect us to get a balanced diet, whatever that is, when we lack even salt?
Melia: So with Daliso needing more food and care than I, my immune system quickly nose-dived and I got on the ARV bandwagon two years after him.
Daliso: (Groaning more seriously)
Mbonyiwe: (Worried voice) What’s the matter with him?
Melia: You know us people carrying the virus – today it’s a running stomach, tomorrow flu, the following day fever or vomiting – always one thing or another!
Siphiwe: And the hospital?
Melia: We’ve been in and out so frequently I’ve lost count. The doctors say he just needs to eat a lot. But what can I feed him on, poor as we are?
Mbonyiwe: Yes, what do you feed him on?
Melia: Nothing, actually. I give him maize meal porridge, but he vomits. Sump, he vomits (Editor’s note: Sump is maize pounded and then cooked. It’s a common breakfast for the poor in Chipata). This or that, still out it comes. I’m at my wits’ end. It was better when we had HEPS.
Siphiwe: How better?
Melia: He never vomited HEPS. In fact, he couldn’t get enough of it. (Sadly) But it’s no longer available.
Siphiwe: It is available, mama, and we’ve brought you some!
Melia: (Chidingly) Don’t pull my leg, young lady. HEPS are no longer available. Now we can only groan and die.
Daliso: (Groaning and coughing)
Mbonyiwe: Mama, it’s true. We’ve brought some HEPS, enough for a whole month. See!
SFX: (Sound of rucksacks being opened)
Melia: (In wonder) My, my, my! You girls, what’s this?
Mbonyiwe: HEPS, mama, enough for a whole month. After they’re finished, we shall bring you some more when we come to monitor the patient’s progress. Do you think he’ll vomit again?
Melia: I told you, he never vomited HEPS. It was always his favourite and he grew so strong and healthy. (Heavy pause) But now I’m afraid you’ll come a few times, then disappear with your HEPS!
Siphiwe: No, mama. We’re local people within this community. So we won’t disappear. We shall always be here to bring you HEPS and care until your husband gets better. Then …
Melia: (Interrupting cynically) Then what? I knew there had to be a catch to this.
Mbonyiwe: (Conciliatory tone of voice) There’s no catch at all, mama. You see, it’s said that if you give a man a fish, he’ll eat for one day. But if you teach him how to catch fish, he’ll eat fish all his life.
Melia: I don’t understand.
Siphiwe: What Mbonyiwe means is that the HEPS program was like giving us PLHAs ready-caught fish. The best thing would have been to teach us how to make the HEPS ourselves. Then we wouldn’t be left high and dry like this.
Mbonyiwe: So at Zithandize Support Group, we have learned how to make our own HEPS. It’s so easy, after all. The main ingredient is soy flour, and most of us here are small-scale farmers.
Melia: Please come out in the open with what you mean.
Siphiwe: What we mean, mama, is that we need to find ways of getting more soybeans. Currently, we buy our soybeans from whoever around here grows them. We have a second-hand hammer mill and manufacture soy flour from pre-cooked soybeans and then add the other things needed to make our own HEPS.
Melia: (Mesmerized) Really!
Siphiwe: Yes indeed. But we can’t get enough soybeans from scrounging around. We need to get everyone involved.
Melia: In buying soybeans?
Siphiwe: No, in growing soybeans.
Melia: (Disdainfully) But I’ve never liked soybeans. They taste so bad and sell too cheaply at the market.
Siphiwe: That’s the problem! At Zithandize we teach people how to cultivate the crop. After harvest, we teach them how to pre-cook it so that it’s ready for milling. If this is not done properly, the flour usually has a bad taste, especially if the beans come in contact with cold water.
Melia: That’s all very interesting. But where do I come into this?
Mbonyiwe: You and your husband are small-scale farmers, just like the rest of us here. So you come in by growing soybeans and preparing them for the mill by pre-cooking. Zithandize will buy your soybeans at a fair price. Then we can make HEPS for all PLHAs in this compound, including you, your husband Daliso, my sister Siphiwe here, and me.
Melia: It all sounds so wonderful, but …
Mbonyiwe: But what, mama?
Melia: You’ve left us a whole month’s ration of HEPS and have promised to come again with some more next month. Yet you have to buy the soybeans and other ingredients for making HEPS. I wonder how you manage to keep such a program going.
Siphiwe: That’s a very good observation. You’re right; we’ll surely sink one day if we continue like a charity. So we’re recruiting members – out-grower farmers, if you like. So this is the other reason we’re here – to recruit you! If we get many people into this, this community will produce a lot of soybeans, which we shall buy after pre-cooking.
Mbonyiwe: So in addition to maize, everyone will have a new cash crop to focus on, and more cash to spend! With time, we shall add a small price to our HEPS to support production. It’ll be a full circle for you: you’ll grow, process, and sell soya beans, and then buy them back as HEPS for your good health. But it can only succeed if we have people like you on board. Are you willing to come on board, mama?
Melia: (Hesitantly) Er – er …
Daliso: (After groaning and coughing) Hey, mother of Lozi, surely there can be no er- er- about this. Can’t you see? This project is a noble effort that will ultimately assure good health to all of us PLHAs in this community. It’ll give us a new lease on life. So there’s no room for hesitation. Now, get the charcoal brazier afire and cook me my wonderful HEPS porridge.
Siphiwe: No, sir, we’re here as caregivers, first and foremost. So mama will be with you while we do everything. We shall clean the house, fetch good, clean water from the kiosk, and then fire the brazier to cook that precious HEPS porridge for you.
Daliso: (With admiration) You girls are angels. But start with the porridge because I’m famished! I promise not to throw up. By the time you return, I shall be as strong as Samson and ready to cultivate a whole hectare of soybeans!
Siphiwe and Mbonyiwe:(Clapping together) Gees!
Fade out sound of clapping
Presenter: You have just heard one successful assignment completed by the Zithandize Support Group. This group started with just a few sickly members. But through perseverance, its members are now mostly healthy and strong because they support each other to face the challenges of HIV and AIDS. The group has now extended its work to other less fortunate groups, especially in the surrounding rural areas, where it encourages HIV-positive people to grow soybeans and thereby improve their nutritional status.
Knowing how good nutrition can lead to better farm output and incomes, the response has been tremendous, especially among the rural poor.
This sort of initiative can be adopted anywhere by HIV-positive people who are facing nutritional challenges. It also has the potential to receive government support for soybean cultivation and processing, while donors might help with capital equipment like grain mills for processing the soybeans and making the HEPS.
HIV positive people anywhere should try it to achieve a healthy productive life for themselves!
Signature tune fade up full and out