Interview

Working together for women and health

Doris Nalishuwa and Josephine Mulumu are health activists in Zambia, where one in five of the population is HIV positive. They spoke to Judith Emanuel about the daily challenges they face

What is the situation of women in Kalabo?

Doris Until recently women had no information on women’s activities and remained with a very traditional role. Many now realise they have a role to play in the community, that they have responsibility for running a home and supporting their children. Women have developed knowledge through women’s groups and that is how they are coming to stand on their own two feet.

Josephine I enjoy being a single parent although at times it has been hard. I kept the children with me even though my brothers wanted to keep them. I wanted to bring them up my way. I got them all through school and they did well.

Doris, how did you get involved in the Women’s lobby?

In 1999 I was invited to the national women’s lobby training of trainers. We do not get any funding. We educate women on their rights. We invite the Victim Support Unit who support women and children who are abused. Traditionally women kept quiet about such things. They didn’t know they could say no, that they had rights, that women are able to talk. Women’s groups are popular here; they kill the boredom of staying at home. Women can develop skills.

What other community activities are you involved with?

Doris Since September 2002 I have been chairperson of World Vision, the only non-governmental organisation in Kalabo. World Vision organises and funds a wide range of activities including HIV education, anti-AIDS clubs, recreational activities, anti-malaria campaigns, orphan support, providing schools with desks and books, infrastructure such as clinics, schools and water wells, drug donations to the hospital and food relief.

I see my role along with other community members to be a bridge between the local communities and the managers. We ask the communities what they want and find out the priorities of different areas. We make sure that what has been brought in reaches out to the communities, we ensure accountability and that projects are implemented as planned.

We are also involved in Kalabo Boma Women’s club. There are 15 of us. It is an income generating project which started in 2001. We got some HIPIC (poverty reduction) funding. A woman had moved to Kalabo who knew how to tie and dye, so we employed her to teach us. With the money we got we bought some material. It is going on well. We would like to make finished products but we don’t have a sewing machine that can do embroidery yet.

How did you get involved in HIV/AIDS work?

Josephine In 1993, the Kalabo Women and AIDS group was set up. The aim of the group was to disseminate information about HIV/AIDS to girls and women in Kalabo. At that time there was lots of false information about the disease. Women were the people who were always nursing those with AIDS. They needed to know how to care for sick relatives.

When girls start to menstruate here, we hold initiation ceremonies. We discussed what was good about the initiation ceremonies and what could be taught at a later stage, for example marriage issues. We believed that children are ignorant of such issues. The girls used to be taught at the initiation ceremonies that they were now old enough for sex and they should not say no. With HIV/AIDS this was dangerous. We thought that if you tell them about sex it would encourage them to experiment. We got a lot of support for these changes in initiation rights.

Doris We also needed to educate parents. They did not mind their children experimenting. More children were being born outside marriage than before. I think parents are getting better at talking about sex and HIV/AIDS. They promote use of condoms and discourage sexual activity. To some extent people are getting the message. Maybe they stick more to one partner.

Josephine We also held workshops for mixed groups, which the women wanted. We needed to bring men and women together. We asked women if they would be free enough to discuss issues with men and there were good discussions. In 1997 funding finished and the programme phased out.

We also started home-based care in 1994 for people with AIDS. We were supported by the hospital. Then the hospital support fizzled out in 1997. One problem we continually have is that we get funded for something and then the funding stops and the work stops.

At the end of 1999 some nuns started a new home-based care scheme but left Kalabo soon afterwards. I was asked to take over as co-ordinator even though I hadn’t been involved with it before but some months later there were some difficulties between the priest and myself and he took this role away from me and from caregivers who were friends and relatives of mine. It was a very hard time for me. We decided to set up a broader based HIV/AIDS group and that is how Sepo was born. We wanted to be involved in prevention work and extend our work beyond the township.

Doris This is when I got involved. I like to be involved in women’s activities and want to save peoples lives. We have managed to get some funding and provide a fortnightly clinic with a nurse, provided by the hospital, and food, from our own homes for about 35 people.

What challenges does Sepo face?

Doris We have a committed group of volunteers and nurses and it is all voluntary work. We have a very good public profile which helps people know we are there and open up to us. But we need to develop some income generating projects, as we cannot always rely on World Vision.

How would you like to develop?

Josephine We are currently running from peoples home. We would like to set up a drop-in centre for users/patients. We would want a store room, a private room for the nurse to ensure privacy. Ideally people could come throughout the week. We could provide lots of education and have literature and videos. There would be counselling. A few of us have done counselling courses. We could also develop income generating opportunities for guardians, help for them to develop skills. We could keep things they make at the centre and sell them from there. It would be really good to have somewhere to bring people with AIDS together so that they can support each other, share their fears and encourage each other. We might be able to open a restaurant to generate income for the centre.

Doris It’s very rewarding work. Some people are bedridden when they are referred to us. It’s fantastic when you see people getting up. But it is awful when we are unable to provide food and you see them go downhill again. People know they need food and will plead for it. We were given a lot of multi-vitamins but people won’t use them because they make them feel hungry. Hunger and AIDS go together. Those that live better, live longer; the poor die fast.

Josephine We are also supporting 51 orphans with their school requirements, fees, uniforms, books, exam fees. We want the orphans and patients to be involved and make a contribution, not just handouts.

Josephine, you are district HIV/AIDS focal point person. What does that involve?

I am responsible for co-ordinating HIV/AIDS activities in the whole district with the provincial office. There are 103 schools. Each school has an HIV/AIDS focal point person and I should ensure they are doing the work. I also network with other HIV/AIDS stakeholders in the district, for example, non-governmental organisations, Ministry of Health and Social Welfare. I should be full-time but can’t be because of the shortage of teachers. It is tough going but I enjoy it. There is no postal system to the villages so communication is a big problem, I have to rely on people going out from the District Education Office, but letters often don’t get to the individual schools. It would be much easier if I had some transport.

What would you like to change in relation to health services here?

Doris People don’t go to the hospital because they have to pay user fees. Community health workers are very important but there aren’t any in town. People come to SEPO for panadol, who they refer to the hospital, but community health workers would be much better for things like that. Traditional birth attendants are not being trained in the township either. Some women go to ante-natal care but don’t deliver in the hospital. The hospital people say they want women to deliver there but then they speak harshly to them. For example, they will tell them off for previously delivering at home. This kind of treatment makes people stay away from services.

And do you have any opportunities to talk to women’s HIV/AIDS organisations outside of Kalabo to exchange ideas?

We would welcome opportunities to exchange ideas with groups elsewhere. We are new. Obviously we would also welcome any opportunities for financial support for our activities.

Readers who would like to contact Doris and Josephine should contact the editor:

editor@healthmatters.org.uk