In the developing world, the battle against HIV/AIDS is rarely waged with the latest medications or hi-tech equipment. Instead, the most common tools are care, compassion and patience, as in the case of a community based AIDS program in eastern South Africa.
Philanjalo. It’s a Zulu word that means, ”May you live longer.” It’s a saying – which in this time of AIDS – may also be a prayer.
The village of Tugela Ferry – about 110-kilometers from Pietermartizberg – is the home of the Philanjalo Home Based Care Program. It’s run by the Church of Scotland Hospital, a small government facility.
According to the principle medical officer, it is located in a place with “a harsh climate and harsh geography – a forgotten part of South Africa.”
Dr. Tony Moll says HIV/AIDS is a constant presence in the two thousand square kilometer region surrounding the village.
He says, "In reality, it’s touching every family, every school, every institution, whether it’s a hospital, police station or post office. Somebody is surely to be touched somehow with a relative dying or a brother or a sister – mother and father – dying. And this is just what we’re seeing on a daily basis."
Rural Kwazulu-Natal Province is ill equipped to deal with the modern plague of AIDS.
Dr. Moll says, "Most of our patients live in mud huts with grass roofs, without electricity, without water and without communication. So, you know, looking after a specifically terminally ill patient under such conditions is really, really difficult."
Dr. Moll says in the mid 1990’s it became clear that AIDS would soon overwhelm the Church of Scotland Hospital in Tugela Ferry. So the Philanjalo program was born.
"You know, our hospital is a 300-bed hospital. And that, in itself, is not sufficient. So, we’ve looked at, for instance, terminally ill patients with AIDS – there are hundreds and hundreds of them. And so we’ve developed a home-based care program, where we’ve brought the community on as partners to help us with the burden. And we’ve trained a whole network of more than 200 community home-based carers who are looking after terminally ill patients in their own home."
While the death rate from HIV/AIDS is high, it is difficult to say just how high.
If you can just imagine in our community having little clusters of huts and homes, spread out in mountainous valleys over an area of two thousand square kilometers. This happens silently," he says. "You have a death here a death there, a death in this community, a death in that community. But certainly in our hospital, itself, we are having about one AIDS-related death every single day, sometimes two. And that certainly is a reflection of the magnitude of what’s happening."
Drive in any direction on any given weekend, he says, and you’ll see two or three funerals within a few kilometers. Dr. Moll says he cannot understand politicians and scientists who question the existence of AIDS. He says if they spend a few weeks in rural Kwazulu-Natal, they’ll go home thinking differently.
While residents have heard of AIDS medications, they know that none are available at the hospital in Tugela Ferry. That’s why Philanjalo hopes to broaden its operations to include a hospice, orphanage and better treatment of opportunistic infections. The program also needs better nutrition programs.
Despite the odds, Dr. Tony Moll says he’s gratified for small victories.
"I think that one could despair and really just be completely overwhelmed by something that is out of one’s power to manage or to do anything. What keeps one going is making a little difference for patients and for the community. And just knowing that we’ve helped that patient. We’ve helped this family secure food. We’ve helped that little orphan find a family and that is rewarding."
He says when you’re dealing with AIDS, it’s best “to just look close by and see what you can do.”