A third of our population and all of our future

KISIWANI, TANZANIA

The test, part 1

Carol is 12 years old and when we met her in the remote village of Kisiwani, Tanzania, she was just about to be tested for HIV for the first time. This test took place at the local community clinic and was part of monthly health checks for children supported in the area by Mildmay’s Boresha project. Carol is one of 50 children infected and affected by AIDS (CABA) in Kisiwani supported under the CABA element of European Union project. Carol was eligible for Boresha CABA support because her mother Fatuma is HIV-positive.

“I’m feeling fine,” says Carol before she enters the room to receive pre-test counselling and then take the HIV test.

“She knows she is going to test,” says Fatuma. “She knows what HIV is because in school they are told.”

Of the 34 children who tested on the day we visited only two were HIV-positive. Carol wasn’t one of them.

Some children are chosen and some miss out

Asha Rashid’s son Bakari is another beneficiary of the Boresha project in Kisiwani. Unfortunately, because Boresha funding is quite limited here, the number of children who receive support is far fewer than the number that need it. Which means even within the same family, some children are chosen and some miss out – Bakari’s sister Alima was not chosen.

Mildmay works with community-based organisations and community health workers to identify those in the greatest need and who fit the Boresha criteria. At the same time it tries to spread the support to as many families within a community as possible.

“I greatly appreciate the support Bakari receives through the Boresha project,” says Asha,  who is HIV-positive and has been receiving home-based care from Mildmay International trained volunteers since 2008. “It’s a great assurance, it’s a very good project.

“I only wish both my children were on the programme but chances are limited.”

Bakari was another of the children being tested on the day we visited.

“I will feel very happy if the result is negative,” said Asha.

Integration: of our programmes, and with the Ministry of Health

The 36-year-old is currently too sick to sell fish at the local market, which is how she makes her living. Despite the visits she receives from Mildmay trained volunteer Tatu Liputa, she finds it hard to stick to her antiretroviral drugs meaning her health can take dips. She was recently very ill with TB. “I can’t afford the bus fare to Same [the nearby town where ARVs are distributed] to get ARVs so I get sick. If ,I’m sick, I can’t work, so I can’t get money to pay for my bus fare. I am caught in a vicious circle.”

This is a familiar story of those living with HIV in remote areas like Kisiwani.

Asha and Bakari show how Mildmay has integrated its two programmes – the USAID funded Maisha Kamifilu project, and Boresha – continuing its support for families it has worked with in the past, by giving their children opportunities for a good start in life.

Mildmay also works closely with Ministry of Health and, at a local level, healthcare workers at village clinics.

What each Boresha child receives

Each child supported through the Boresha project in Tanzania receives regular visits from a Mildmay trained home-based care volunteer like Tatu. They receive regular health assessments (some receive Vitamin A, have their height checked, as well as more general health checks) at the local clinic and access to HIV testing. For school they are provided with uniforms, exercise books, play materials. Monthly meetings are held at the local community-based organisation; children’s clubs run once a month too for youngsters to come together discuss any problems they have and share experiences with their peers.

“Mildmay’s ongoing role is to follow up on the progress of these children through the CBO and the home-based care providers,” says field officer Evance Milisara. “We work out how each child can be supported and make sure that is happening, that they are healthy and doing well.”

The gatecrashers

Although Mildmay only officially helps 50 children in Kisiwani, its impact on the general health and HIV awareness within the community is far greater. When the CABAs make their way to the clinic for health assessments or testing, or attend their monthly children’s club, some of their friends inevitably tag along and access services by association. The clinic and the children’s club rarely turn them away meaning they too can reap some of the benefits. This group is affectionately known by the Mildmay team as ‘the gatecrashers’.

Stigma-busters

Aisha is just five. She is an AIDS orphan who lives in Kisiwani with her aunt Hadija. Aisha is HIV-positive too. She is on ARVs and she is living well.

“All her friends know that she is positive and they all love her – her friends and siblings.

“Before HIV was a death sentence and stigma sentence, but after Mildmay came to Kisiwani and sensitised the community to HIV, gave us the information we needed, that has changed.

“Aisha’s life is really no longer different to any of the others.”

The twins

Eric and Loveness are 6-year-old twins. Their mother ran away and left them when they were very young. Their father is dead. They are both HIV-positive.

They live with their grandmother Mariam, a widow who has received support from Mildmay International with a incoming generating project, basket weaving.

The children unfortunately are not part of the CABA programme but they are visited by Mildmay trained home-based care providers twice a month.

ROMBO, TANZANIA

Orphans and vulnerable children (OVCs) in Tanzania’s Rombo district are also being impacted by Mildmay International’s work.

Working with faith-based organisations

Mildmay works alongside the Catholic Sisters of our Lady of Kilimanjaro at the Tumaini Centre. This is just one example of Mildmay, a Christian organisation, working with faith-based community groups at grassroots level. The word ‘Tumaini’ means hope and the centre sets out “to give hope to those with great problems”. It was established in 1998 in response to many requests for help from orphans, street children and children living in vulnerable environments. The children used to visit the sisters looking for food, clothes and housing. As the numbers of needy children continued to increase the sisters found that most children came from families affected by HIV and AIDS and were either orphans living with their grandparents or street children who had run away from home.

Empowering young people

Sister Mary Lauda leads the four sisters and 32 volunteers who work at the centre.

Fifty children – of all ages – are supported by Mildmay in Rombo receiving psychosocial support and a head-to-toe health assessment (skin, oral thrush, ear, lymph, general probs and HIV). They attend monthly meetings at the centre which include sport and therapeutic play, health education, life skills sessions and spiritual activities. Nine of the Tumaini group are HIV-positive themselves, others have parents that have died from HIV or are living with HIV.

Once again, home-based care providers in neighbouring communities have selected the children for the programme who best fit the criteria.

“It has been seven months since Boresha launched at Tumaini, and we have really progressed in that time,” said Sr Mary Lauda. “These children and young people have been empowered in their community. They meet others and exchange ideas. They share their difficulties.”

“Mildmay International is supporting us as we take this project forward.”

The test, part 2 (Brigita #2)

Seventeen-year-old Brigita, one of the Tumaini CABAs whose mother and father had both died of AIDS, had just had an HIV test. The results were negative.

“I feel very happy. I wanted to find out my status,” she said. “I didn’t feel nervous.”

Brigita told how in the Rombo area many girls of her age are lured into prostitution.

“That’s something that is happening on the ground. When you are an orphan, some guardians they use you as a house servant and then ultimately some girls get put up as a prostitute. It’s important to plan for these situations and through coming to this centre – through learning life skills and roleplaying - you can know what to expect and how to deal with it.”

“They have a lot of activities here and I have made a lot of new friends. I feel as if I belong,” said Brigita, who now lives with sister in law and plans to be an accountant when she leaves school.

Therapeutic play and drawing

Drawing is part of therapeutic play and can teach carers how the children are feeling.

KOMBEWA, NEAR KISUMU, KENYA

Pamoja community based organisation (CBO) is one 1 of 35 CBOs Mildmay works with as part of the Boresha project in Kenya.

The organisation has 124 children aged up to 18 as members, and eventually aims to reach 180, who will come from surrounding villages including Kila and Kitmikai.

Pamoja has a CABA programme as part of Mildmay International’s Boresha project. It offers counselling for children who have lost their parents to HIV and deal with HIV issues affecting families, teaches life skills, gives advice on abstinence and condoms and provides support for young people involved in early sexual activity. Withinlder children help reach out to younger children.

Some of the issues which come up often at counselling sessions are: child labour, deprivation of school, child inheritance by uncles and family members. There are a lot of child-headed homes in these communities and girls selling sex for fish.

“We have a focus on health education, HIV awareness and training community health workers who go back and train in their communities,” said Julius Owuor, the coordinator of Pamoja, which also runs a children’s club and a group for caregivers.

View from Boresha project officer

Elizabeth Oluoch, Boresha project officer in Kenya, said: “Boresha is dynamic. At the start we had objectives but as time moves on we are realising new needs and new ways of doing things. We are really getting into advocacy with this project too.”

“This group gives them the confidence to go back and share issues of HIV together. They support them to disclose their status to other people.

“With these children, the first time they need opening up and when you talk to them at their own level they do open up. They don’t open up to their parents.

“We are realising there is a need to work with teachers too as there is more stigma among teachers. We need to create awareness among teachers so they allow children time away to get their drugs, understand when they are late, also understanding their condition.

“We also forgot about caregivers when we were designing the programme – but now some of the support groups are reaching out to caregivers through the CHWs.”

BONDO, KENYA

Bondo Stars AIDS Youth Development Group is another of Mildmay’s community partners delivering the Boresha programme in Kenya. Started by a group of widows in 2001, it runs a club for children affected or infected by AIDS (CABA), where they can come together, have something to eat, play with other children, interact and access care and therapy. More than 400 AIDS orphans and other vulnerable children have come through group since it began.

General activities of the CBO include care of CABA and PLHIV, HBC visits, nutritional support, counselling, group therapy, children’s club and IGA.

120 children are currently members of the Bondo Stars. They are supervised by 30 CHWs trained by Mildmay under a previous programme. Now its children receive support through Boresha.

Bondo Stars’ mission is: “To offer good immediate psychosocial support, to provide a sense of hope, to build a society that is safe, equitable and free from HIV and AIDS.”

Mildmay is our mother

Mary Adero Nyona, the formidable chair of the group, said: “Mildmay is our mother, our partner. We want to tell everyone about our work with Mildmay. Mildmay has given us a lot of things. So much so, that here is a lot of expectation now from clients, from the schools and from the community.

 “Now we no longer have bedridden people – they can walk, talk and do their things.”

Vocational training

Older Bondo Star’s members – previously of the CABA programme – are offered vocational training. The current CABAs supported by Boresha will hopefully also have these opportunities.

“We identify who needs to be trained, we spot young people who benefit from learning a trade – joinery, woodwork, electricians, mechanics,” said Mary. “These older ones can pass these experiences on to the younger children.”

RARIEDA, KENYA

Another CBO working with Mildmay is the Memba Health Unit, made up of 50 community health workers from 16 villages of the Rarieda district. We met 25 of the women at one of their regular meetings in a peaceful setting under a mango tree.

Community health worker Jennifer said the group had first become associated with Mildmay in 2009, when they as CHWs were trained in HBC, community strategy, adherence and opportunistic infections. We started another programme supporting children living with HIV as part of the Boresha project which has been funded since 2010. There are 350 children CABAs in their care

“We thank Mildmay for supporting us as we take care of children with HIV and AIDS,” Jennifer said. “We want to be able to empower the children to be self-reliant for the time when Mildmay is no longer there to support.”

Mama Wilfreda has been a CHW in Kiro village since 1981. “CHW is a job like the shoe of a chicken, you only remove it when you’re going to cook it.

“Mildmay has strengthened the capacity and skills of CHWs.”

Wilfreda has been HIV-positive and on ARVS for five years. “I’m standing strongly. I’m still strong even though the virus is inside. People say that the drugs have made me fatter, but that’s the only difference.

“A person who is negative walks like me, the way they go somewhere is the same way I go somewhere. In our support group – we all stand up proudly if we are HIV positive.

“Because we are trained it is easy for us to train the clients. Because of the education, stigma and transmission has gone down.”

Silvanos is one of the CABAs that Mildmay has helped – he is on ARVs, he is doing well. “I want to thank Mildmay for the support I have received – my uniform, for food, for cover and sleep at night.”