HIV Caregiver in Chad: Counselor, Healer, Hero
June 13, 2009, —
By Lane Hartill
See that woman there, the one in the red shirt with her back
to you? She just sold all of her plates and glasses and most of what she owns.
That girl in the background? That's her 10-year-old daughter. She does the
cooking now. And most everything else because her mom is sick: That's what she
tells her, anyway.
Monique Gamla is a home-based care worker who helps people living with HIV. CRS and partners support HIV-positive Chadians with food, medicine and psychosocial care. Photo by Lane Hartill/CRS
The woman watches the neighborhood kids stare at her. She
ignores them, looking off in the distance. They know what she has. Let them
stare; she has other things on her mind. Like how in the world she's going to
come up with $4. She could always sell her last big basin. Once that's gone,
she'll own nothing of value.
For the price of a large designer coffee or two cans of soup,
Mary could pay for her hospital tests. Once she gets those, she'll be eligible
for HIV medicine. Until then, the HIV will eat away at her. Sitting there, her
cracked feet tucked under her, she thinks about $4.
Now take your eyes off of her. Look at the woman next to
her. She just rode up on a bike, pedaling at a stately pace. She has a serious
face and warm brown eyes. See how calmly she looks at Mary? See how she leans
into her? She doesn't take her eyes off her. That's Monique, a 56-year-old
mother of nine, and a woman whose kindness hits you before she even opens her
mouth.
At this point, she's all Mary has left.
Caregiver's Hospitality
People like Monique. They open up to her. It's the way she
looks at them, the way she listens to them. Her voice is tender and soothing,
her reactions genuine.
Don't tell anyone, but she's breaking all the caregiver/patient
rules: She lets people with HIV stay with her when they come to Kélo, this town
in southern Chad. They sleep in her mud-brick house, which has become a hostel
for those in need.
Monique's hospitality is well-known among HIV-positive
Chadians. One woman wore out her welcome by staying more than two weeks. "She was in paradise," Monique says, laughing. She ate
meals with her every day, chatted with her, all while slowly draining Monique's
savings. Monique never said anything, of course. She couldn't bear to kick her
out. Food is hard enough to afford in the village where she lives. A hotel is
out of the question.
For the longest time, Mary wanted nothing to do with
Monique. She knew that Monique helped people with HIV. If her friends saw them
together, they'd suspect she had the virus. But when her friends started abandoning
her, when her husband died, she had nobody to turn to.
"When I was passing by on the street, she called me and
called me and called me," says Monique.
That's when Mary, which is not her real name, told Monique
her story through a cascade of tears.
She told her about her mother who lives in Nigeria, her trip
there, the man she married. He died and left her with five kids to take care
of. Her father, who remarried, has a wife who beat Mary; she didn't want her
around. Mary's life is a shifting mess.
" 'The sickness of my husband has attacked me,' she
told me through tears," Monique says. " 'I think about dying. I've
sold my things to pay for the tests. I've even run to my uncle to ask for money,
and he said, "Where am I going to get the money? All you have to do is go
see Monique." ' "
But Monique's tapped out. She has scores of patients she
helps. While she gives them what money she can spare, it's herself that she
doles out without hesitation. That may be the most important thing Monique
does: to be there for Kélo's HIV-positive residents. As a home-based care
worker with Catholic Relief Services' partner, the Diocese of Laï, Monique is
often the only person the sick can rely on.
Healing Friendships
Evidence is emerging that shows a link between
friendship—like that of Monique and Mary—and improved health. While no studies
have been done regarding friendship in HIV patients in southern Chad, the data from the United States is startling. A recent New York Times article quoted a
psychology professor, Bella DePaulo, who works at the University of California, Santa Barbara. Her research has found that friendship influences health more than
family members or spouses.
While Monique gives those in her care what money she can spare, it's a part of herself that she doles out without hesitation. Photo by Lane Hartill/CRS
"Home care is viewed by people living with HIV as the
only thing keeping them alive," says Sende Djangrang Epainete, CRS' HIV
and AIDS program manager in Chad. He says HIV-positive Chadians have said, "Although
we have been abandoned, the caregivers have become our fathers, wives, brothers
and sisters."
Those living with the virus say the caregivers help. But
food is essential.
"If you don't eat all day, you
are going to fall sick," says Etienne Abadoussou, who works
as an HIV counselor in Kélo.
Hunger is one of the biggest issues with HIV-positive
Africans. More calories and certain vitamins are needed in order for the HIV
drugs to be effective. That's why, twice a month, CRS is providing millet, beans,
sugar and vegetable oil. This also represents a huge savings for those who are
sick and can't work.
Without it, Etienne says, many would go hungry. And hunger,
when you have HIV, is torture.
"You get the shakes," he says. "You shiver
and have a headache." Etienne says trying to ignore the hunger pangs and
scrape together money for food isn't easy.
Stigma and Poverty
Etienne is somewhat of a celebrity around here. He's HIV-positive
and isn't afraid to show it. His work and public education about AIDS here
since the early 1980s have made a difference. Three HIV associations are active
in Kélo and the members enjoy strong support from one another. While the stigma
still exists here, it's not as strong as in other countries, say those who work
with the sick.
Poverty, however, isn't as easily overcome.
Poverty is the devil on the shoulder of those with HIV here.
Chad has some of the worst water and sanitation infrastructure in the region,
according to a 2004 demographic and health survey. Only 23 percent of young
women are literate and unemployment is high. This forces many women into
prostitution.
Kélo is a crossroads. Truckers from the north pass through
here on their way to Moundou, the largest town in the south. The increase in
oil workers in southern Chad, and the breakdown in traditional values during
the civil war (1979 to 1982) and the chaotic years that followed, have given
rise to a growing prostitution problem.
With no other work, young women lurk in Kélo's bars at night
offering their bodies to pay the bills. This contributes to the HIV prevalence
rate. Nobody is sure of the exact rate in Kélo. In a February 2000 study by
Chad's National Program to Fight AIDS, the prevalence rate, taken from specific
testing sites in Kélo, was 15.4 percent. In 2005, another national survey of
three zones, including Kélo, found an HIV prevalence rate of around 6.4
percent. The rate for the country is about 3.5 percent.
Home-Based Care
Back at Mary's compound, Monique is helping however she can.
She gets right to work stoking the fire and tidying up. She talks with three of
Mary's children. Sometimes she bathes the patients. She reminds them to take
their medicine, which CRS pays for. CRS also supports counselors like Monique,
who has been working as a home-based care worker for the last five years.
"When you see someone suffering, it's like you are
suffering," she says. "If I see someone like that who I help, I give
them something. They say it themselves: [Monique] did this for me, [Monique]
did that. That touches me."
Take Céline. "She couldn't even stand up," says
Monique, squatting next to Céline, a round-cheeked woman who is rolling tourto,
peanut paste that she shapes into long, elegant cigars. She sells each for a
few cents in the market. It's not much, but Céline has her life back on track
now, thanks to Monique's constant help and the HIV medicine. "You can't
even tell she was sick," Monique says.
She walks over to a mud shed with a tin roof. This is where Céline
was left to die, abandoned by everyone but Monique. Her life mirrored that of
Mary's. Monique knows that if all goes well, in a few months, Mary will be
smiling like Céline.
Lane Hartill is the West Africa regional information
officer for Catholic Relief Services. He is based in Dakar, Senegal.
