With Aids rampant and no cash for Western drugs, Africa is condemned to hopelessness and resentment Maggie O’Kane Malita Maxwell has Aids. But so does just about everybody else in the women’s ward of Chiradzulu hospital, with its broken air conditioner, smell of old, sweet urine and greasy mattresses covered in bright green plastic. In the administrator’s office, Margaret Kalanda is discussing her staffing difficulties. Two nurses have died of Aids and haven’t been replaced. She has also lost a laboratory technician, an electrician and two hospital attendants in the past year. Kalanda is a graduate of Chancellor College at the University of Malawi. Of her class of 20, three are dead and two are ill with Aids. James Morris, the mortuary attendant, knows what is happening in this town in south Malawi. But it could be any town in Southern Africa, where an entire generation of people are going to their deaths. After the first sickness from Aids the average Malawian is dead within five years. The women are dying in their 20s, weakened to the virus by childbirth. The men are lasting until their 30s. They all die without any chance of treatment with costly drugs that could give them another 10 years of life. Morris keeps his mortuary well, washing it out every morning with a green garden hose that he leaves hanging on the whitewashed wall smelling of bleach. The bodies are stacked up until they have two ambulance loads – one going north and one south. “I had two teachers last month. Seems to be more ladies these days. Six ladies to every four men, I’d say. They have a baby and then they seem to die,” Morris says. Surrounded by the silent, swollen and festering faces of the dying, 25-year-old Maxwell walks stiff as a puppet through the ward, trying to keep the running infection in her legs and groin from rubbing against each other. She was recovering from the death of her son, who lived for a year before her virus killed him. Then her immune system, crushed by Aids, fell to a wild angry thrush that invaded her body. Nurses say they cannot treat her raw, infected sores until she has washed herself with salt water. She has no money to buy salt. “I sent a message home that I was in hospital so they could come and see me, but no one has come.” Here patients don’t survive without relatives to feed them – the hospital cannot. The government is broke. On the radio at lunchtime the news in English says a Japanese delegation is donating a printing press to the National Bank and a message of congratulations to the Malawian government for its excellent record in paying off its debts to the World Bank and the International Monetary Fund. Maxwell stands in the middle of the ward with two Panadol tablets in her hand, the only treatment there is. “Someone has taken the bed,” she says. When she dies – and it will be soon – she will leave behind three orphaned children. By the end of this year Africa will have 12,1-million orphans. In Durban this week 9 000 delegates are meeting for a United Nations Aids conference. The primary call for change was expected to be an appeal to drug companies, such as Glaxo Wellcome, which have sold more than R20-billion of anti-Aids drugs in the past two years to the developed world. “The thing about the big pharmaceutical companies is that there are no competitors to encourage them to reduce the price. They know that the people are dying here, but they don’t care. They can charge what they want, so they can charge R1 000 a month for treatment in the [United Kingdom] and just forget about countries like these,” says Elisabeth Poulet of M’d’cins Sans FrontiSres, the aid agency leading the campaign in Durban for pharmaceutical companies to bring down prices. Masida Davila, a 40-year-old accountant, is also dying of Aids. His wife died five years ago and he has sent his only child, an 11-year-old girl, to boarding school. It is a Catholic convent and he hopes they will protect her when he dies. “She is on my mind all the time. How do I look after my daughter?” Davila earns R600 a month and cannot pay for the Aids drugs that could give him another 10 years. He is in a race against Aids for time to provide for his daughter. “I’m buying shares for her. This month I bought a thousand shares.” Davila, in his smart linen suit, buys shares, while Maxwell cannot afford salt, but both are excluded from the world of treatment. By 2010 the average person in Malawi will live only to the age of 30, according to the latest report from the UN. “The emphasis is on saving the children, the next generation, but saving them from what? Unless we keep the parents alive there will be nobody to bring them up,” says Dr Poulet. At 6.30am, as the town bell rings for the healthy to rise, the women are already drying the tobacco leaves under rusting corrugated iron roofs. The smell of bougainvillea, which produces flowers all year round and supplies the wreaths, is in the air. Reverend Hesbesa is attending two to three funerals a day. He is in a good mood today: “Not a single funeral.” But late in the evening he gets a call. Gracie Awafie died this month on a mat laid out under a tree. She slowly choked to death, a combination of tuberculosis and laryngitis – two of the diseases that infect Aids patients. In the last hours her face puffed up like an adder in a last battle against the infections. Cheap drugs were available to treat the infections, but her grandmother, an old woman who cannot walk, could not get her to hospital. “The whole support structure has collapsed,” she says. “I’m glad to have visitors,” she said a couple of hours before Gracie died. “It’s hard being with her all day on my own – in and out. One minute she wants to be inside, one minute she wants to be out.” Hard words, but then Arume Awafie had already nursed her daughter to death from Aids and buried her great- granddaughter.
With powerful anti-Aids drugs out of reach in Africa, the country must rely on the condom. But sex and reproduction are part of a culture that encourages promiscuity. Africa is about survival; breeding to ensure your own survival. It is a culture where marriage parties, harvest festivals and graduations come with sex. And the introduction of the condom hasn’t been easy. There has been little help from the churches. The Catholics, Pentecostalists, Presbyterians and Seventh Day Adventists are all saving souls, building churches and water systems and running literacy classes, but they refuse to endorse condoms. God’s flock on Earth has so far been reduced by about 31-million by Aids. Reverend Howard Mbeza, of the Presbyterian church next door to where Maxwell is dying, says: “We don’t discourage them. Let’s just say we keep silent. But we tell the people they must abstain from sex before marriage and they shouldn’t commit adultery.” In Malawi 10 years ago, when the Aids virus was rampant and ignored by a stern Presbyterian president, young girls were taken out into the bush and prepared for married life. The ritual involved sex with a single man elected by the village elders, a man of experience who could prepare them for marriage and infect the next generation of women. The practice still goes on in some areas. The name of the elected man, the Faesis, means hyena. The tradition that allowed an entire village of 14- year-old girls to be initiated by one man also dictated that a widow should be cleansed by sex by an outsider to clear her home of spirits; in the last months of a pregnancy and for the first six of a newborn’s life a woman should allow her husband to seek other partners; and a young woman who was still a virgin could not sprinkle salt on a salad. In such a culture of sexual diktats, multiple partners and women without power, Aids has triumphed. The Aids counsellors’ door is painted sky blue, but is smeared with the dust of years of African summer and there is no money for new paint. Outside Room 13, Maxwell waits for her counsellor, Angela Makata – a luxury provided by M’d’cins Sans FrontiSres, which also keeps the hospital running. “She accepted that she was positive; she just wanted to know what I could do to help her with her pain, her weeping raw sores. I couldn’t get anything stronger than Panadol for her. The doctor has gone to America and hasn’t been replaced, and the clinical officer is on a course,” she says. Maxwell, her mattress still missing, has wandered outside to lie on the concrete, wrapping herself in a thin cotton cloth of buttercup yellow. Her counsellor says: “I really feel angry. The Western world is making a mockery of us. They do have the drugs, but they sell them to Africa for exorbitant prices so nobody can afford them. People are infected and they are waiting to die. They are living in a world of hopelessness.”
For some, the only hope lies in denial. In a private room off the women’s ward is Mary. She is a computer programmer who designed CD covers as a hobby. Her boyfriend was a presidential bodyguard. “He was small like me, but handsome,” she says. Now he has disappeared. All the signs are that she is HIV positive – but she doesn’t want a test. “My blood sugar level is low. I think it is TB. They want me to stay here for two months, but I’ll give it a month. I want to go on to do advanced computer studies.” The covers she designs are for country and western CDs. Her favourite song is by Dolly Parton. “It’s called Making Plans to Live,” she says.
@EA day in the life … Cheryl Uys-Allie The community of 4 000 people at Schmidtsdrift, which has been living in 900 tents since 1990, is hoping its long wait for housing is over. Since its relocation to the area near Kimberley in the Northern Cape in 1990 by the South African Defence Force, the members of the !X- and Khwe community have heard many promises. But now tenders are out to develop a site for their houses and the wait is over. For a decade 900 tents, a supply store, a bottle store, a prefabricated school building and a community hall have been their community. They have survived blisteringly hot summers and bitterly cold winters. Most of their children know no life other than the confines of the tent town. Snapshot realities of life at Schmidtsdrift can be seen this weekend as part of an exhibition by the Market Photography Workshop outreach programme. The exhibition, funded by the European Community, includes photographs taken by displaced and marginalised communities throughout South Africa. Disposable cameras were given to men, women and children of all ages and they were at liberty to photograph anything in their surroundings that they felt depicts a part of their day and their reality. The idea was to record a day – for the children it was a school day, for some of the women it was a day tilling in the fields of neighbouring farms. The Schmidtsdrift photographs can be seen from July 15 at the Sandton Gallery in Johannesburg and from September 28 to October 2 at the Open Window Gallery in Pretoria