I decide to walk there as it's only a mile from the hospice, the road passes the Post Office where I have letters to post and I need the exercise. Also, arriving alone and on foot keeps the profile low and lessens the risk of exposing our patients to 'stigma', the prejudice against those who are HIV+. In the early days this resulted in people with the dread positive status being driven out of villages to die alone in the bush, family members refusing to share a bowl, toilet or indeed a house with an HIV+ person out of ignorance and fear. This stigma still exists to some extent, despite huge efforts at education and I don't want to make life any tougher than it is for these people.
Letters posted (this is possible only at a Post Office; no post boxes anywhere else- for security reasons?) I walk the last few hundred meters to 'Game' clinic where I squat in the only available bit of shade under a small pine tree, and wait for Geoffrey Kankala. It's now 14.25, still a bit early for a meeting planned for 14.15 but GK is used to my odd timing habits and, looking up the hill, I see him making his way down to the clinic, stopping frequently to greet friends and neighbours.
After a warm greeting, he conducts me to the home of Margaret Makukula or, in Zambian "Where Margaret stays"
When we arrive, Geoffrey leads me round the back of a small clump of buildings, each roughly the size and shape of a native Zambian hut but made of anodised steel sheets. As I pass one, I peep in and see a cosy little room with a bed and cupboards, all snugly fitted in the octagonal space. I wonder vaguely where the kitchen and bathroom are, then remember where I am. Tribal houses, traditionally round, grass-thatched buildings, any size upwards of 2 metres in diameter, are basically for sleeping and storage. A kitchen hut, similar but with open sides, will be in the centre of a large cleared and flattened sandy area which is where family life goes on: food preparation, cooking, eating, washing up, hair-dressing, playing, drumming, singing, dancing....
Behind the last building, in the deepest shade, two women are seated, one on a wooden dining chair and the other on the floor on a rush mat. The one on the chair jumps up, puts the chair in the shade for me as honoured guest, produces another for Geoffrey and, after shaking us both by the hand, sits down on the mat. After introductions are made, I find the chair-providing woman is Margaret and the larger one on the mat is her older sister Mirriam.
I explain, somewhat lamely, my purpose in visiting them which they both take up with great enthusiasm. I ask Margaret about her work as an Adherence Supporter. The role of these dedicated people is to support those living with HIV, encouraging them to adhere to the course of life-prolonging HAART (Highly Active Antiretroviral Therapy) without which they would progress rapidly to the AIDS phase with fatal consequences.
Margaret has six patients in her care and tells me proudly she visits each one twice a week. She explained to me that, HIV+ herself, she feels a strong heart connection with these people; "We are together, we care for each other and that keeps us going" She described to me how she got involved. Recently diagnosed HIV+ herself and in the initial stages of denial, anger and depression, a friend told her about seminars being run in Chilanga about HIV, Aids and the opportunistic TB which often is also involved. She attended these seminars, run by CHAZ (Churches Health Association of Zambia) and by learning about the 'enemy' was able to turn around her feelings of loss and despair and begin a positive way of life where she could reach out to others and be herself supported by a community of people like her, each area led by a 'Zone Leader' who is a good friend and mentor- Geoffrey in her case.
As the afternoon wore on, we were served glasses of water and the conversation became wider-ranging, covering the benefits of keeping chickens to use the manure in place of artificial fertiliser, the high price of tomatoes and Mirriam's ambition to organise a braai (BBQ) at the bar she runs to raise funds for the hospice "Well, most of the sexual behaviour which spreads HIV is after the beer drinking so they should support now what will later support them!" was her forthright view.
Margaret showed me the wooden stall by the road where she sets out tomatoes, sweet potatoes and bunches of spinach, her own little retail space.
Geoffrey escorted me back to the clinic where I caught a minibus bus home (enough exercise!) I found I had been very affected by the afternoon; as well as the enjoyable meeting and chat, I saw this as a snapshot of a sustainable model of HIV care in Zambia. Indeed, the crucial drugs are supplied to CHAZ by USAID and other international Aid Agencies but the rest is real good neighbours caring for each other.
Footnotes
Supervision is.... well, as you've gathered above, it's not the sort of supervision we in the UK would mean, either in medical or counselling mode, where the practitioner shares the challenges and management of and provides support and help for their client and themselves. This is done by a more experienced and specially trained counsellor of high wisdom and good interpretation skills, if you're lucky!
Here, the support aspect is more figurative; the people I'm supervising are volunteers (fits within the UK model of professionally trained but unpaid counsellors) whose generosity leads them to look after six clients each. These are patients of the hospice, are HIV+ and are enrolled on a life-long course of HAART (Highly Active Anti-Retroviral Therapy) which will greatly prolong their lives and make the concept of 'living positively' in the HIV sense a reality.
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Urban and suburban residential ares are known as 'compounds' which vary from open, rolling hill country with grand bungalows with double garages, their own borehole for water supply, gardens plus gardener to tiny, cramped houses,some housing several families in an enclosed area without proper sanitation, water supply or electricity.