THE EARLY YEARS (1985-1994)
3.2. The Roman Catholic Church’s Response to HIV and AIDS
3.2.3. The HIV and AIDS Commission is Launched
3.2.4.1. Initiation of Home-Based and Orphan Care Interventions
The AIDS-related home-based care activities carried out by the diocesan project became part of the phase in Zimbabwe in which there was a noticeable rise in HIV and AIDS advocacy, care and support of PLHIV between 1990 and 1991.580 Generally, the churches delayed to initiate AIDS-related care programmes because they were gripped not only by a sense of fear and confusion, but by stigma and discrimination that was fuelled by moralistic approaches. A retrospective analysis of messages about AIDS between 1986 and 1990 showed that the State and the church were equally at fault as noted:
Messages such as ‗AIDS kills. …Beware!‘ and pictures of skulls and crossbones were used on posters about HIV. The nature and character of the virus was sensationalised, primarily by service providers, while at the same time, churches moralised about HIV and linked it to promiscuity and sin.581
This situation was further propelled by the high rate of either ignorance or misinformed messages about AIDS. Caregivers were generally scared of providing assistance to PLHIV due to the fact that there was no clear information about the disease.582 Neither the government nor the church was an angel on this issue.583 Whereas the Roman Catholic Church could be blamed for taking an entirely moralistic approach, the government was equally responsible for adopting frightening approaches in the sensitisation of communities on HIV and AIDS.
The practice of volunteerism in providing home-based care to PLHIV was relatively new to members of the Roman Catholic Church as well as among other churches in Manicaland. The FACT organisation was the first institutions to initiate voluntary home-based care at St. Joseph‘s TB hospital, Mutare in 1990.584 In 1990, when the FACT home-based care project was initiated, volunteers were sceptical about possible contamination through contact with HIV positive people. This was the first time the general public was invited in recent times to volunteer in the context of responding to
580 See Irish Aid, Looking back, mapping forwards, 30.
581 See Irish Aid, Looking back, mapping forwards, 29.
582 HDN, Caring from within, 17.
583 V. Chitimbire, same interview.
584 Madava, The FACT story, 9.
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a pandemic such as HIV and AIDS. It is thus not surprising that the concept of volunteerism in the context of caring for PLHIV was met with mixed feelings.
Despite untoward feelings and notions about volunteerism, FACT laid a foundation that the diocesan AIDS-related project‘s voluntary caregivers‘ programme utilised in Manicaland. This was despite some challenges, including perceptions among the first voluntary caregivers that in return for rendering support services to PLHIV, ―rewards were seen as an entitlement for the ‗sacrifices‘ they made.‖585
A respondent, Christine Mombe, a member of the Roman Catholic Church in Mutare, explained that many of her friends who enrolled as voluntary caregivers at St.
Joseph‘s mission gave up this service. The reason being that ―people expected to be remunerated but unfortunately that was not forthcoming.‖586 The people, mainly women, who joined this programme in the early 1990s, expressed frustration at the little recognition of their efforts by the diocesan project. Thus the notion that community members were obliged to support fellow PLHIV voluntarily had limitations. One of the arguments advanced by voluntary caregivers was that home- based care for PLHIV, which was supported by donors including the diocesan project in Manicaland, failed to adequately recognise the ‗dirty‘ work done by ‗unpaid servants.‘ The argument given was that while fellow villagers engaged in productive work for the direct benefit of their families, voluntary caregivers spent time in community service.587 Voluntary caregivers perceived AIDS-related care as having created employment opportunities for villagers. Volunteerism opened up prospects of earning money and obtaining household supplies including food.
Before the establishment of FACT in 1987 and the launch of the Roman Catholic Church‘s diocesan project in 1992, as far as the present study was aware of, there were no other faith-based HIV and AIDS programmes in Manicaland. None of the Anglican and the United Methodist churches in Manicaland had established publicly known HIV and AIDS programmes including home-based care. In Manicaland, the Roman Catholic Church was the first church to initiate a well-structured HIV and AIDS care programme. The FACT is a Christian-oriented organisation but not related
585 C. Mombe, interview conducted by M. Mbona, DOMCCP office, Mutare, 19 August 2010.
586 C. Mombe, same interview.
587 E. Tichawangana, same interview. See also A. Dera, interview conducted by M. Mbona, Triashill mission, 9 September 2010.
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to a specific church denomination. Nationally, the initiatives of the Roman Catholic Church in home-based care were among the earliest. By 1994 the number of AIDS service organisations countrywide expanded, leading to the formation of the Zimbabwe AIDS Network. The involvement of the Roman Catholic Church‘s diocesan project in this forum created a new platform to lobby the State and donors for support.588 The participation of the diocesan project in HIV and AIDS issues at the national platform also put the church on the map of HIV and AIDS-related organisations in Manicaland and Zimbabwe.589
The philosophy behind the work of the diocesan project was that of providing services to all people regardless of religious or denominational affiliation. However, there was also a perception that the noble intentions of the project‘s care programmes were at times affected by denominational affiliation and favouritism.590 For example, a respondent from the Anglican Church mentioned that within the Roman Catholic Church‘s project, the process of identifying OVC for care purposes was riddled with nepotism that involved caregivers who ensured that the children closely related to them benefited ahead of others.591 Arguably, economic decline following the introduction of economic reforms by the State in Zimbabwe reached a point whereby in some families external support for PLHIV and OVC stirred hopes for money and food. Thus, in the 1990s AIDS-related funding under the diocesan project became a new source of hope for communities living in poverty amid an ailing public healthcare system. The HIV and AIDS home-based care interventions popularised the Catholic Diocese of Mutare through its involvement in donor funded community healthcare initiatives. The programmes supported by donor funds through the diocesan project included ―HIV and AIDS awareness, home-based care, orphan care, psychosocial support and income generating initiatives.‖592
588 Zimbabwe AIDS Network, <http://www.kubatana.net/html/sectors/zim001.asp?sector=HIVAID/>
[Accessed 27 June 2011].
589 Information supplied by J. Nyamande to M. Mbona, DOMCCP head office, St. Joseph‘s mission, Sakubva, Mutare, 10 June 2010. See also DOCCPM, ZAN review: Annual report of the Zimbabwe AIDS Network, (2010), 3.
590 A. Dera, same interview.
591 N. Mushawa, interview conducted by M. Mbona, St. Matthew‘s Vengere, Rusape, 12 September 2010.
592 See DOMCCPM, DOMCCP, Evaluation report, January 1993-June 1995.
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The strength of the diocesan project lay in the fact that it was community driven. This made it important to develop collegial relationships at local community level.
Theologically, the church‘s principle of collective participation of church members in seeking to serve one another strengthened the involvement of the community in the care of PLHIV and OVC. This meant that the work of caring for PLHIV and OVC was the responsibility of everyone and not just the few full-time professional church workers running institutions for the population in general.593 In other words, the hallmark of the home-based and OVC care interventions by the diocesan project was the adoption of a transformational approach. The church was the local Christian community living out their Christian vocation by working wholeheartedly for their own and their neighbours‘ social development.594 It therefore followed that as part of Christian community service, the Roman Catholics were obliged by the church‘s teaching to be involved in HIV and AIDS prevention, care and mitigation.
The Roman Catholic Church‘s hospitals in Manicaland assumed new status—from being providers of ordinary medical care to being sites used for carrying out the church‘s HIV and AIDS interventions. This became important for the success of the programme because the healthcare centres provided a point of contact between PLHIV and AIDS-related care and treatment services. The nuclei include Triashill, St.
Barbara (Mutasa), Avila, Mt. Mellery and Regina Coeli (Nyanga), St. Michael and St.
Therese (Makoni), St. Peter‘s (Chipinge), St. Joseph‘s Sakubva (Mutare), and St.
Andrew (Marange).595 In this light, the healthcare centres contributed to the provision of better services for PLHIV by recruiting and training voluntary caregivers, providing sanitary materials and some food as well as meeting other needs such as drugs. While stigmatisation and discrimination of PLHIV did not disappear immediately, the use of the church‘s healthcare centres enabled the diocese to also show that the HIV and AIDS pandemic is a biomedical reality and public health issue.
This approach to HIV and AIDS interventions by the diocese project in Manicaland became unique because it brought together medical personnel, church members, the community and clients.
593 Mutume, ―The priorities of the Zimbabwe Catholic Bishops Conference,‖ 470.
594 Mutume, ―The priorities of the Zimbabwe Catholic Bishops Conference,‖ 470.
595 Information supplied by J. Nyamande to M. Mbona, DOMCCP head office, St. Joseph‘s mission, Sakubva, Mutare, 10 June 2010. See also DOMCCPM, Evaluation report, January 1993-June 1995.
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From 1992 onwards the healthcare centres under the Roman Catholic Church in Manicaland gained more limelight than other healthcare centres in the province. The network of the church‘s healthcare institutions in Manicaland enhanced access to HIV and AIDS prevention, awareness, care and mitigation for the rural folk. Thus, the introduction of community AIDS-related care programmes at the Roman Catholic hospitals cast a positive image of the church in those communities. However, this had the effect of overloading the nurse-in-charge and doctors who assumed new responsibilities of supervision of community AIDS-related care programmes.596 Apart from the aforementioned setbacks, the programme scored some achievements in supporting a target of 600 HIV infected and affected individuals in its first two years, from 1992-1993.597 For example, in 1993 a total of 365 people received Z$
6,999576 for painkillers, food, protective wear and school fees.598 Some examples of OVC support showed that Avila received Z$3,100 for food and Z$1,363 school fees, Mt. Mellery received Z$2,000 for food and Z$372 for fees, St. Barbara received Z$1,700 for food and Z$1,376 for fees, and St. Therese received Z$2,100 for food only. Drugs for the amount of Z$11,915, protective clothing worth Z$12,861 and linen worth Z$953,122 were purchased.599 By the end of 1993 a few income generation projects were initiated at Mt. Mellery, St. Barbara, St. Peter and Avila for an amount of Z$1,1184,91.600 However, compared to the demand for support, the achievements were almost insignificant. On a positive note, the church showed solidarity by initiating care support for people infected and affected by HIV and AIDS.
Under the diocesan project, twenty-two workshops were held at nine institutions with 1 041 participants in 1992. The initiatives included HIV and AIDS awareness, skills empowerment, and care and prevention measures.601 Some of the topics and aspects covered include: (a) current trends and facts about AIDS, (b) communication, pastoral counselling skills, (c) moral and cultural issues, (d) sickness, death and dying, (e)
596 DOMCCPM, DOMCCP, Evaluation report, January 1993-June 1995, 13.
597 DOMCCPM, DOMCCP, First progress report of MCHC CRS project, January 1993- December 1993, 1.
598 DOMCCPM, DOMCCP, First progress report of MCHC CRS project.
599 DOMCCPM, DOMCCP, First progress report of MCHC CRS project, 2.
600 DOMCCPM, DOMCCP, First progress report of MCHC CRS project, 3.
601 DOMCCPM, DOMCCP, First progress report of MCHC CRS project.
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infection control measures, (f) care of the sick at home, and (g) responsible behaviour.602 In 1993, workshops were mounted at Avila (1) Mt. Mellery (2) Regina Coeli (2), St. Andrew (2) Triashill (1), St. Barbara (4), St. Michael (5), St. Peter (2) and St. Therese (3).603 At Triashill, the cordial relationship between the nurse-in- charge of the hospital and the priests enabled the smooth imparting of HIV and AIDS awareness messages.604 At St. Paul‘s Dangamvura,605 St. Simon Stock, Rusape606 and the Cathedral of the Holy Trinity, Mutare the experiences were negative.607 The creation of Mutare Community Home Care as an AIDS service organisation transformed the diocesan structures including the recruitment of new employees.
Apparently, some Catholics felt that the creation of the diocesan project could have been avoided and did not necessarily hold AIDS-related activities under the semi- autonomous organisation in a positive light.608
The diocesan project‘s AIDS-care interventions made a positive mark on a number of communities, whereby ―voluntary caregivers were held in high esteem by fellow community members.‖609 Within communities, the visibility of church‘s HIV and AIDS interventions was reinforced by the fact that the church‘s integrated care support programme was unique. The findings from a study of home-based care in Zimbabwe between 1991 and 1995 noted that church volunteer groups were formed and driven by Christian values. Care volunteers visited homes to provide spiritual support, ―end of life‖ counselling and welfare support.610 Even though some of them could have been Christians, volunteers were human beings with specific material needs. It is important to note that studies on voluntary caregivers carried out by external agencies were possibly not fully aware of some of the intricate dynamics within volunteering in a time of AIDS.
602 DOMCCPM, DOMCCP, First progress report of MCHC CRS project, 4.
603 DOMCCPM, DOMCCP, First progress report of MCHC CRS project.
604 E.Tichawangana, same interview. See also A. Dera, same interview.
605 C. Nyemba, interview conducted by M. Mbona, Fern Valley, Mutare, 2 September 2010.
606 R. Chiome, same interview.
607 G. Maedze, interview conducted by M. Mbona, Cathedral of the Holy Trinity, 25 August 2010.
608 Information supplied by A. Vinyu to M. Mbona, Mutare, 10 June 2010. See also J. Nyangadi, interview conducted by M. Mbona, Kriste Mambo, 29 September 2010.
609 A. Dera, same interview.
610 Irish Aid, Looking back, mapping forwards, 30.
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The fact that HIV either infected or affected everyone also motivated ordinary people to be involved in interventions. This realisation triggered calls for increased workshops, formation of health committees, and drama groups.611 Thus, the Mutare Community Home Care programmes were unique. The project staff fostered teamwork through collaboration among community-based AIDS action teams formed in villages, voluntary caregivers, and medical personnel at the church‘s hospitals.
While the diocesan project posted some scores of success, enough homework was not done on designing programmes and making them accessible in the local Shona or Manyika language. In using the English language only in its programmes, the project was naïve to the fact that language was an important tool in communicating mass- centred HIV and AIDS related messages. HIV and AIDS overwhelmed the project‘s capacity to meet the high demand for services. The operational environment for the project was not that supportive, given the fact that the State healthcare system was declining while cases of PLHIV and OVC were on the rise.612
HIV and AIDS interventions by the diocesan project were community based and thus the recruitment of voluntary home-based caregivers involved the input of traditional community structures. For example, in 1993 at Triashill, the selection of voluntary caregivers was done openly at the community meetings,613 and the same situation prevailed at Nyahukwe.614 This level of transparency enabled communities to select candidates as voluntary caregivers and enshrined a sense of collective ownership and responsibility for the project. However the diocesan project was also overwhelmed by a number of setbacks arising from inadequate planning, poor resource availability, lack of proper guidelines on volunteerism, lack of proper training for volunteers and lack of reference resources such as HIV and AIDS booklets.615 One of the actions taken by the project in order to deal with some of the challenges is that obtaining technical assistance from FACT whose strength lay in offering specialised and well- structured HIV and AIDS related training programmes.616 The propensity by the two
611 M. Mudzimiri, same interview. See also T. Nyawera, same interview.
612 DOMCCPM, DOMCCP, First progress report of MCHC CRS project, 4.
613 E. Tichawangana, same interview.
614 M. Mudzimiri, same interview.
615 DOMCCPM, DOMCCP, Evaluation report, January 1993-June 1995, 17-22.
616 DOMCCPM, DOMCCP, Evaluation report, January 1993-June 1995, 14. See also DOMCCPM, DOMCCP, First progress report of MCHC CRS project, 4. G. Foster, ―FACT- How it all began: A personal account,‖ in Madava, The FACT story, 6. See also Madava, The FACT story, 8-9.
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organisations not to view each other as competitors appeared to enhance teamwork.617 Therefore, to a large extent, early HIV and AIDS interventions by the Roman Catholic Church in Manicaland benefited from support gained from FACT.
The two FBOs shared a history of collaborative effort in carrying out HIV interventions. In 1990, FACT benefited from the facilities at St. Joseph‘s hospital, a Roman Catholic healthcare centre. This enabled training of volunteers in home-based care and counselling services.618 Some of the church‘s clergy and laity were also involved in the work of FACT prior to the formation of the diocesan AIDS care project. For example, Father Martin O‘Regan, stationed at St. Joseph‘s mission, Mutare, mentioned that he had been involved in the work of FACT in Mutare since the late 1980s. Accordingly, this opened opportunities for O‘Regan to gain first-hand experience of Christian led HIV and AIDS interventions.619 The FACT worked with urban and rural communities and also trained the first voluntary home-based caregivers in Manicaland.620 To suggest that the diocesan project positioned itself in competition against the State healthcare system in this period (1985-1994) is an inaccurate assertion. In fact there was a high degree of collaboration between the State and the church‘s healthcare systems. This is evident from networking between the project‘s staff and the State‘s provincial medical director for Manicaland.621 The Government of Zimbabwe held the diocesan project in high esteem, as noted in a statement in the report. The statement illustrates that the Roman Catholic Church‘s home-based care projects were of good repute.622