By Dana Raviv
When Catherine tells her life story, she begins in the year 2009. "Life changed with the clinics," she says. It was in 2009, at the age of 31, that she began the anti-retroviral treatment that would reduce the toll HIV was taking on her life. But she soon learned that access to drugs is not a cure-all for a diseases rooted in poverty, and comprehensive health care means more than just treating illness.
Not long after starting anti-retroviral treatment, Catherine was admitted to the hospital with tuberculosis. For two weeks, she remained glued to her hospital bed, a foreshadowing of the six-month convalescence that would follow. Her father cared for her during this time, while her seven children— four of her own, and three adopted from her deceased brother— were forced to learn how to care for themselves.
With no money to pay for school fees, and no provider to supply food, Catherine's children went to the fields. They asked neighbors for ganyu, piecemeal work that would earn them a little money. Each day, they hoed others' land and gathered wood for others' fires — children as young as eight and ten laboring to support their family. Meanwhile, Catherine mustered what strength she had to grind discarded maize husks into a powder fit to cook. Doctors could prescribe medication for her HIV and TB, but no pill could cure her family's hunger.
Catherine is only one of many patients facing this problem in her community. PIH's sister organization in Malawi, Abwenzi Pa Za Umoyo (APZU), implemented the Program on Social and Economic Rights (POSER) to address the poverty — including lack of housing, clean water, food, and education — that so often causes and exacerbates poor health for its patients. In 2010, APZU and its POSER team piloted the Model Permaculture Farmer program as a way to tackle poverty and hunger. As Catherine recovered from her debilitating TB, she became a Model Permaculture Farmer.
Permaculture is a style of farming that eliminates the need for harmful and expensive fertilizers while improving the quality of the soil for future seasons. The Model Permaculture Farmer program aims to help patients provide for their families in the long-term, and to prevent the malnutrition that could make someone like Catherine more susceptible to TB and other opportunistic infections. As part of the project, participants received vegetable seeds along with weekly lessons on how to use sustainable agriculture techniques to improve crop yields. They learned how to stretch scarce water resources, increase the diversity of their crops, and grow vegetables without the use of foreign chemicals that deplete the soil over time. Catherine quickly became an expert in permaculture practices.
Leaning over her vegetable stand in the market, Catherine now smiles proudly. She points to the piles of tomatoes, okra, and eggplants, colorful symbols of surplus after such a dark tale. The seeds and training she received have allowed her to grow more food than her family can eat. She sells what's leftover in the outdoor market, earning money for maize and bread. In addition, her children are now able to go to school, as there's enough income to purchase uniforms and shoes, and pay the fees necessary for them to attend class. Through her training, Catherine has learned how to save seeds from her best crops so that she can continue to feed her family in future seasons.
As Catherine tells it, her story starts in the health clinic. But it doesn't end there. It continues in the community: in the home where she raises her children and the farm where she grows her food. Providing comprehensive healthcare means more than having the hospitals, doctors, and medications necessary for treating illness. It means going out into villages to tackle root causes of disease, like Catherine's hunger, and the cycle of sickness that would otherwise keep her from supporting her family.
Dana Raviv served as the Volunteer Training Coordinator for APZU in Malawi.