A Time to Mourn

Malawi, Africa, June 2002

by Ellen Schell

Grief and loss have become commonplace in Malawi. The AIDS epidemic has hit hard: about 15 percent of the population is infected, and in 2001 in this tiny Central African country of 11 million people, 80,000 people died of the disease. In June 2002, Ellen Schell traveled there as part of her job at Global AIDS Interfaith Alliance (GAIA), an organization that works with religious and faith groups (which offer the only infrastructure in Malawi’s rural areas) to provide HIV prevention education and care. Also on the trip were Bill Rankin, Episcopal priest and the head of GAIA, and his wife Sally, a member of the faculty at the University of California San Francisco School of Nursing. The goal of the trip was to initiate and renew contacts with religious, health care, and government leaders, to plan for a local HIV prevention and education training conference, and to visit village-level projects providing HIV/AIDS prevention and care. Ellen shares the following excerpts from her journal with readers of God’s Friends.

June 13—Lilongwe

Our plane touched down in Malawi, and as it slowed we passed a tiny village at the edge of the runway—small round and square houses, no more than ten feet across, constructed of mud bricks and capped with thatched roofs, our first view of a typical Malawian village. I experienced childlike delight at finding my vision of an African village there before me.

We had dinner in the hotel with David Jones, an American working in a University of North Carolina HIV care and research project in Malawi. I admired a riotously colored painting of a village market; David told me he had once inquired if it were for sale. It had been, he was told, but the artist had died of AIDS, so now it was unclear if it could be sold.

June 14—Lilongwe

David took us to Lilongwe Central Hospital, a collection of buildings scattered on large grounds surrounded by a wall. On the road across from the entrance there were small stalls where people sold food cooked over open fires, plastic wash basins, and a random assortment of other items, including tiny bottles of cooking oil. Family members accompany patients to the hospital and camp on the hospital grounds, providing virtually all of the basic nursing care for their relatives. They purchase meager items from the vendors outside and bring food for the patients. Hospital rations consist of a cup of maize flour porridge each day.

A large building, four stories high, holds acute care wards. Patients sometimes move to the open-air balconies for the fresh air. Family members provide and wash linen for their relatives; it hung from every balcony ledge.

The buildings were dilapidated—rusting metal, peeling paint everywhere—but the hallways were swept immaculately clean. People shuffled through the crowded halls with blank, listless faces. I was not sure if they were patients or family members. I took a few pictures, and had planned to take more, but felt like I was being a voyeur on their suffering.

June 15—Lilongwe

On our way to a Roman Catholic mission, we drove through villages with simple brick churches and white mosques in their midst. Muslims and Christians exist together peaceably here.

All along the road we passed a constant stream of people. Foot is the major mode of transportation. Most all the time, women are carrying baskets, bundles of firewood, or steel or plastic pails of water on their heads. Often infants or toddlers are tied to their backs as well. I marveled at the huge loads they were able to carry with complete ease and grace, rarely using their hands to steady the load. They walk with a beautifully erect posture and swaying gait that undulates slightly as they adjust to the changing position of the load.

Occasionally we saw men (never women) on bicycles. David told us that gravely ill patients are often transported to the hospital by bicycle. The patient sits on the seat, and three or four people walk alongside, holding the patient up and pushing the bicycle, sometimes for miles.

We stopped to buy wood carvings from two young men who looked to be in late adolescence. One of them told us he cares for his three brothers because their parents had died of AIDS. The carvings they were selling were reliefs of lions, elephants, and rhinoceroses finely rendered on bowls and cups. I bought a wooden chalice for my church in San Francisco, St. Gregory’s. (Back home, we discovered a leak on the chalice’s first use. One of our parishioners took a great interest in the chalice, saying it helped him connect with the people of Malawi in their sufferings. He conditioned it with oil and sealed up the leak.) One of the carvers is a Muslim. I hope that he would see the use of their chalice for the Eucharist by Christians (also “people of the book,” as Muslims say) as an expression of the unity of God’s children.

At the mission, we heard the powerful sounds of a choir rehearsing in the rich harmonic African style. Peeking into the meeting hall, which was decorated with murals of village life and the Christian sacraments, we found to our astonishment that the choir producing this strong sound was a group of children and adolescents! Tears welled up in my eyes as we watched.

We shared dinner with a Malawian couple, both of whom are health care professionals. Bill asked if their two teenage girls were home alone that evening. "Oh, no," said the wife, "we have a full house." We learned that the couple care for four nieces who have been orphaned by AIDS. I asked how these girls were coping with their loss. They said the girls don't talk much about it. "They have so many friends who have also lost their parents."

Recently, watching a TV program that mentioned HIV, the girls laughed it off. The couple were troubled by their response; however, they worry more about protecting the girls from being raped. Rape is an increasing problem in Malawi, owing to the prevalence of the myth that sex with a virgin will cure AIDS.

June 17—Blantyre

We met with the man who will help us plan our training conference. Discussing the need to break down stigma and to communicate openly, he reiterated what we had heard from others: sex is a taboo subject, associated with sin and evil. Adding something new, he said that it is easier for Malawians to talk about sex in English than in their native language.

Speaking Chechewa, people are too embarrassed to use even the word “wife,” and instead say “my house’s mother.” But things may be changing. In addition to a widespread national billboard campaign for condoms, I also saw hand-painted signs in villages, each one unique, apparently the work of a concerned local citizen. One of these, for example, read, "AIDS is real. AIDS is not witchcraft. Use a condom, always!"

June 18—Chimwaye Village, near Blantyre

Our visit to a youth AIDS education project started with a football (soccer) game on the dry field behind the village church. The children played expertly despite bare feet. The real soccer ball—purchased by GAIA—is a great attraction; in most places the best that can serve is a homemade ball of newspaper.

After the soccer game, the players gathered for a series of dramas presented by actors in their teens and twenties. (The club’s leaders translated for us.) The actors were skilled; this is a culture with a strong storytelling tradition. For me the most poignant drama was one about a young man who had learned he was HIV positive. He confided to his friend that he was terrified to tell his parents about his status. When a relative died and the young man’s parents wanted him to marry the widow, as is customary, his friend finally convinced him to tell them about his status and say that he could not marry the woman because he didn’t want to infect her. A compassionate listener, the friend provided comfort and encouragement and told the young man to see a doctor to learn how he could keep healthy as long as possible. For Malawians, this means eating well, drinking pure water, getting enough rest—all basic health habits that support the immune system. The anti-retroviral drugs that have brought so much relief to people with HIV in the U.S. are only available to the few hundred Malawians who have the resources to purchase them.

Another drama began with a pastor entering his church with his fly unzipped. (This provoked gales of laughter from the audience—especially as the young man had a suggestively shaped piece of his shirttail sticking out from his fly.) When the pastor left the church, the congregation debated who should tell him about his unzipped fly. While they talked, a man sick with AIDS entered the church coughing. The congregation moved away from him and some shouted at him to leave the church. But then one got up and read from the Bible, then told the others how the gospel teaches us to love and care for one another. The hearts of the congregation were turned, and they welcomed the sick man. Then the pastor reentered the church. One of the congregation got up the courage to tell him his fly was open and he reacted with terrific embarrassment, producing more laughter from the audience. I chuckled at the adolescent humor of this skit, which was very effective in getting the attention of the young audience.

There is no way for a white American to be unobtrusive anywhere in this culture. In the cities, I felt a target for vendors, children begging, and, sometimes, people trying to take advantage of me. In the villages, though swamped by people, we were given a welcome that was filled with gratitude. It was humbling.

June 20—Blantyre

Sally and I met with a with a woman who told us that in 1989, several years into her marriage, her husband told her, "I have a woman's disease" (the colloquial term used for sexually transmitted diseases in Malawi). He told her to go to the doctor, which she did, and she was diagnosed with gonorrhea. "I must have gotten it from a dirty toilet seat," she said to the doctor. He replied gently, "No, this is sexually transmitted. You should talk to your husband." The woman said to us, "I was so naive!" She confronted her husband, who admitted his unfaithfulness.

By 1989, HIV was already widespread in Malawi. The woman was afraid that she might have caught HIV as well as gonorrhea. It took her two years to work up the courage to get an HIV test. The results were negative, but she found herself tormented by the thought that maybe the test had not been done correctly. Since that time, she has been tested twice more, and she now feels confident she is HIV negative. Her husband was also tested when he was hospitalized for cancer shortly before his death, and was found negative. That was a huge relief to her.

When she works with women in rural villages, she brings condoms to them. "They have to be able to protect themselves." Though a Christian herself, she has no patience with religious people who fear that distribution of condoms will promote promiscuity. She said that while knowledge about HIV is increasing, attitudes and practices are not yet changing. When she asks young women what they would do if they found that their husbands were HIV positive, most say they would not go for testing but would just plan to "die with their husbands." She gets very discouraged at times, and feels what she is doing is "just a drop in a bucket." But she tells herself, "Even a drop can cause a wave and bring change."

In the afternoon, we tried to do some sightseeing. But there was no escaping the epidemic. On the roadside, we saw joiners (furniture makers); among their beds and overstuffed chairs were coffins—a source of steady income. Farther on we passed a funeral. At an open grave near the roadside, the clergyman, surrounded by a group of women dressed in white, was preaching to the assembled crowd. It was one of several funerals we saw in our travels. Each time, I was struck by the numbers gathered, two or three hundred at a funeral, and by the solemnity of the mourners.

June 21—Lilongwe

We returned to Lilongwe to begin our journey home, and had dinner with David. He had been to a funeral that week for the wife of a friend, a well-educated, middle-class man. She had been ill for some time but delayed being tested for HIV. When she was tested, as expected, she was HIV positive; therapy was started, but it was too late.

At the funeral the woman’s body was brought from the mortuary to the house and laid out in the living room, which was packed with mourners. A group of church women, their leaders dressed in white and carrying a cross of red roses, sang hymns all day long. In the afternoon, the body was taken out to the front yard, and a minister came to say the service. At the end of the day, the coffin was loaded onto a white flatbed truck so the body could be taken for burial in the woman's home village, as is the custom. Mourners crowded onto the back of the truck, still singing hymns in beautiful harmony. David said that he knew they would continue to do so for all the hours of the long ride to her village. As the truck headed down the road, it paused at an intersection, waiting as another white flatbed truck, pulling another body and similarly filled with mourners, crossed ahead.

Ellen Schell, R.N., Ph.D., is project director for GAIA. She is a member of St. Gregory’s Church and is married to Donald Schell, one of St. Gregory’s rectors. For more information about GAIA, visit www.thegaia.org.

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