Zambia is one of nine countries hard hit by the AIDS pandemic in sub-Saharan Africa. Dr. Michael Bush is a senior medical advisor at a hospice for Zambia's terminally ill patients. The 120-bed hospice is located about 15 kilometers from Lusaka in Chilanga Township. It sits in a small, clean block of green lawns, hostels and a church. It's more often called Mother of Mercy hospice because of the care it's currently giving to 350 poor, outcast, and terminally ill patients with HIV/AIDS. The hospice was established in 1989 with donations from well-wishers and Christian organizations.
Dr. Bush says the patients are near the end of their lives and need home care. But many have been rejected by their families and live alone in their huts. He says the hospice gives the type of care the government and even families are not providing.
"Part of our aim is to build hospices in Africa for people who are severely ill, terminally ill, but have nowhere to go. Rather than die in the corner of the hut, in really atrocious circumstances, it was better to bring them into the hospice where they could have care that they needed (so) that they could die with dignity, they could be cleaned, they could be specially taken care of…their physical needs taken care of and their psychological needs taken care of. People who are close to death often have a lot of psychological and spiritual problems as well, and these are taken care of at the hospice," he says.
Although officially a Catholic institution, Mother of Mercy provides medical, emotional and physical care to many religious and ethnic groupings, including Moslems, Christians and Jews.
The government and international donors are working to contain the epidemic. For example, the government provides free antiretroviral drugs to over 150,000 people living with HIV.
Dr. Bush says, "The majority of the [HIV-positive] people that come into the hospice are [also] infected with tuberculosis. We can treat TB, and we have at our fingertips antiretroviral drugs given out free via the international community. You know American money is channeled through various NGOs and they supply drugs for free."
As a result, the HIV prevalence rate among Zambia's 12 million people has dropped from 16 to 14 per cent.
The hospice is planning to open a school for AIDS orphans – children whose parents died from the illness. Most of the children have no one to take care of them, so they will live at the school and will be taken care of by the hospice volunteers.
There are several hospices in different parts of Zambia. They supplement government programs by working in communities that are challenged economically as well as by hunger and disease. Most of the other hospices also provide care for HIV/AIDS although they are not linked to the Catholic Church. Some are set up by families or individuals with friends or family infected with HIV.
The Treatment Advocacy and Literacy Campaign, TALC, is a leading Zambian advocacy group that lobbies for fair access to AIDS treatment.
Clementine Mumba is the group's chairperson. She says the government should consider supporting hospices and donors and others will help build more.
She says the hospices do as well or better than government institutions that treat HIV patients, like the country's largest government-run treatment center, University Teaching Hospital (UTH).
Mumba says "(The hospices are doing a commendable job in that) When you look at the situation at UTH and then compare them to some of these hospices, you will agree with that they are far much better looked after and cared for (patients) in terms of nutrition...The food they give the patients…in terms of the cleanliness and also in the administration of the staff. I think they are doing a very commendable job. [However], they are catering to a small number of people in the nation [because they are] depending on well-wishers for the resources they use at their institutions."
The Zambian authorities say they cannot spend more than what is annually allocated to the Ministry of Health. The government says it can only provide services according to the availability of financial and material support.
Zambia is one of the countries most affected by HIV in the world. About one million of an estimated 12 million people are HIV positive.
Health advocates estimate that nearly 500 Zambians die of AIDS-related illnesses each day and people continue to get infected daily.
HIV/AIDS has weakened the extended family system in Zambia. Also, widespread poverty, unemployment and the burden of orphans makes it almost impossible for the Zambian government to look after terminally ill people.
The staff at Mother of Mercy Hospice says they recognize and support people living with AIDS in what is still a stigmatizing environment.
Dr. Bush says although the demand is high and resources limited, the hospice tries to respond to every call it receives. He believes that most hospice patients die without pain.