By Lydia Flier, 2010 PIH Summer Intern
Before Partners In Health’s project in Lesotho (PIH-L) implemented a community-based multidrug-resistant tuberculosis (MDR-TB) program in 2007, Teboho Khophoche, a young teenager, lived in a village near the capital city of Maseru with his grandmother, mother, and three uncles. All members of this extended family had been treated for TB several times over the years, but it was not until his mother died of that same disease that Teboho was diagnosed with MDR-TB.
Shortly after his mother’s death, Teboho became one of the early patients at the newly renovated Botsabelo MDR-TB hospital in Maseru. After five months of treatment in 2008, he was discharged to the care of his aunt, and PIH-L provided him with a monthly food package as part of his MDR-TB treatment. But after falling ill and being readmitted several times over the next few months, the PIH-L medical team met with the family to negotiate who would take responsibility for him during the home-based part of his treatment. His grandmother, who had moved to South Africa, agreed to stay with him until he was well. After he recovered, Teboho’s grandmother stayed on, and was joined by his aunt.
Teboho is one of 40 million orphans living throughout all of Africa. Though children can be orphaned by disease, famine, war and other causes, the HIV/AIDS epidemic, paired with high rates of tuberculosis (TB), has exacerbated sub-Saharan Africa’s existing crisis: over 12 million- children in sub-Saharan Africa have lost one or both parents to HIV/AIDS.
Yet these statistics do not capture the full impact of the crisis. UNAIDS and UNICEF jointly reported that millions of non-orphaned children are also vulnerable if they live with a parent or family member who is ill and cannot care for them. Moreover, unless access to medical care in Africa changes dramatically in the coming years, the number of orphans will continue to grow.
Once orphaned, young girls and boys are forced to find work; they frequently become heads of households, suddenly responsible for the care of younger siblings. These children are placed at greater risk for abuse, malnutrition, illness, and psychological distress. Orphans are also more likely to fall behind in or drop out of school than their non-orphaned peers, according to UNAIDS and UNICEF. Many orphaned children are sent to live with extended relatives – creating additional economic pressures on already strained family units.
In an effort to break the related cycles of disease and poverty, Partners in Health (PIH) has responded to the needs of these children at many of our sites, for example, by providing food packages and covering school fees so that they can finish their education. PIH runs programs for Orphans and Vulnerable Children (OVC) at our three African sites: Rwanda, Lesotho, and Malawi.
In 2007, UNICEF estimated that Rwanda was home to more than one million orphans. Inshuti Mu Buzima (IMB), PIH’s sister organization in Rwanda, assists more than 700 orphans and vulnerable children. Some of the orphans’ parents died of HIV or other illness at IMB facilities, while many others have been identified as needing assistance in concert with the Rwanda National HIV Associations Network and the local social affairs departments.
IMB supports these children by providing food packages, clothing, health insurance coverage, as well as emotional support. Long-term support includes paying for school fees and materials, and ensuring access to housing. Additionally, IMB holds a a three-day youth forum each year around World AIDS Day in December and invites most of these children to participate in HIV education workshops, as well as creative and cultural forums.
Additionally, IMB offers older children vocational training in sewing, carpentry, and welding – skills that give young people the possibility of supporting themselves and their families. Approximately 65 children graduated from IMB’s vocational programs in 2010.
One of these graduates is seventeen-year-old Claudine, who lives with her HIV+ mother and nine siblings. After losing her father to heart disease, she quit school to support her family. Her mother knew she needed a skill to find steady employment so she enrolled her daughter in IMB’s sewing school. Claudine is now looking for a job – a difficult task in rural Rwanda.
Today, she continues to receive support from IMB and is enrolled in a vocational cooperative where she is learning to sew.
UNICEF estimates that there are 1.1 million orphans in Malawi. Abwenzi Pa Za Umoyo (APZU), PIH’s sister organization in Malawi, currently supports 889 school-age children in the Southern region’s Neno District. The children are usually identified at an HIV clinic by filling out a referral form.
Children receive school fees, uniforms,shoes, writing materials, and if necessary, food packages and medical care. If the child and his or her extended family are homeless, APZU will work to find or build housing.
Beyond working with these children on a one-on-one basis, APZU funds the creation of community-based childcare centers, financially supporting income-generating activities through community-based organizations that train children in various job skills.
When he was seven-years-old, Lowesi George lost his parents to Malawi’s HIV/AIDS epidemic. Raised by his elderly grandmother, he left school in 8th grade when she was no longer able to afford his school fees. He was later identified by a PIH-affiliated organization, which taught him carpentry with financial support from APZU. Now 18, Lowesi plans to use the skills he has learned to support his grandmother and his younger sister, who is still in school.
In terms of the AIDS epidemic, Lesotho is the third-hardest hit country in Africa: an estimated 23.2 percent of its 1.8-million adult population is HIV positive. UNICEF reported 160,000 orphans in the country in 2007, with 110,000 of those children orphaned by HIV/AIDS.
Lesotho presents particular geographic challenges, as many patients live several hours away from the nearest PIHL clinic, and most must make mountainous hikes to reach any medical services. In addition to the seven mountain clinics, PIHL runs both the national MDR-TB treatment program and Botsabelo hospital, which was renovated to provide state-of-the-art MDR-TB care in the capital city of Maseru.
All PIHL orphans are children of patients who died from HIV or TB. Some of these children contracted HIV or TB from their parents, though many are healthy.
The first five orphans served by PIHL were three sisters who lost their mother to TB, and a brother and sister whose father died of advanced HIV/AIDS and TB. These children moved to a house in Maseru in 2008, and continue to live there with a PIHL-supported foster mother. They receive PIHL support for school fees and supplies, food, clothes, and medical care, including counseling.
In 2010, PIHL scaled up its OVC program to include more than 100 children, with each of the seven mountain clinics now supporting at least ten children who live with relatives. These families are provided with food packages and support for school fees and uniforms to defray the economic burden of caring for additional children.
Teboho, having completed his full MDR-TB regimen in November 2009, came up with his own method for reducing the burden on the grandmother and aunt who took him in. He is a budding entrepreneur, bringing in money for his family by raising pigeons to sell. PIHL has also provided Tebohao with knitting materials, and he has begun to make ladies’ shawls and jerseys for preschool children on his aunt’s knitting machine.
In January 2010, the PIHL OVC program helped Teboho re-enroll in school. After ensuring that his teachers and peers understood he was no longer contagious, he began to be welcomed back into the social sphere and just finished his second term with high marks.