The Lost Children of
Author: Helen Epstein
Publisher: The New York Review of Books
In January 2003, President George W. Bush asked Congress for $15 billion
to fund international AIDS programs in developing countries under the
President's Emergency Plan for AIDS Relief, or PEPFAR. One tenth of the
money was to be spent on children whose parents were victims of AIDS.
Most of this money would go to Africa, home to some 12 million such
children who for nearly two decades had been all but forgotten by their
own governments, as well as by foreign donors such as the US.
The new money is part of a welcome trend. Rich governments and private
donors now spend some $6 billion a year on international AIDS programs,
twenty times more than they did a decade ago. Funding is also increasing
for programs to help what are known in aid circles as "orphans and
vulnerable children," or OVCs. These are children who lack parental care
because their parents have died of AIDS or are too sick to look after
them. The OVCs category also includes the relatively small number of
such children who are HIV-positive themselves. Roughly $600 million
will be spent on aid programs for OVCs in 2005, and this is predicted to
triple by 2007.
While this is good news in many respects, it may also be cause for
concern. As foreign aid budgets rise, they tend to become more political
and sometimes less effective. I worked in Uganda during the early 1990s
when the country's HIV infection rate was at its peak, with some two
million people infected. In response, foreign donors were pouring money
into the country, but it wasn't always clear whether it was going to the
right places. European and American consultants came and went from the
airport and their brand-new sport utility vehicles churned up the narrow
lanes of slums and villages across the country. They hired servants and
guards and drivers and translators and set up offices in newly renovated
buildings in Kampala's genteel suburbs. Ugandans tended to greet them
with outward courtesy and inward skepticism. In private discussions they
wondered why the aid workers were spending so much money on offices and
vehicles and staff residences that were palatial by local standards,
when so many Ugandans were sick and poor and hungry.
The Ugandans were right to wonder. At least 60 percent of US foreign aid
funding never leaves the US, but is instead spent on office overhead,
travel, procurement of American-made cars, computers, and other
equipment, as well as salary and benefit packages so generous that just
one of them would be enough to feed, clothe, and educate hundreds of
African children for years. Some of the money that arrives in Africa
is well spent, but much of it is wasted on ill-conceived projects
designed by foreign technocrats with little sense of African realities.
In the high-stakes scramble for funding, the best projects-those that
truly meet the needs of local people so that they can eventually support
themselves-are often overlooked. People used to joke that there were two
kinds of AIDS in Uganda: "slim AIDS" and "fat AIDS." Those with "slim
AIDS" grow thinner and thinner and thinner until they finally disappear.
"Fat AIDS" afflicts development agency bureaucrats, foreign consultants,
and medical experts who attend lavish conferences and workshops in
exotic places, earn large salaries, and get fatter and fatter.
In June 2005, I accompanied Jonathan Cohen of Human Rights Watch on a
mission to South Africa to report on discrimination against AIDS orphans
in the education system. Among the many organizations we visited were
two programs funded by President Bush's PEPFAR that made me wonder
whether history might be repeating itself. Between them, these programs
had received roughly $10 million from the US government to help AIDS
orphans but, like some of the programs I had seen in Uganda, very little
of it seemed to be reaching the people who need it most.
It is far too early to pass judgment on the entire five-year PEPFAR
program, slated to run until at least 2008. Most PEPFAR funding is being
used to support medical treatment for AIDS patients and HIV prevention
programs. Early assessments have been mixed. PEPFAR is supporting some
exemplary AIDS treatment programs such as the AIDS Support Organization
(TASO) in Uganda and the South African Catholic Bishops Conference, but
much of the money for HIV prevention is going to evangelical Christian
groups that disparage condoms. In addition, treatment programs are
reaching fewer people than was originally hoped. The dire state of
African clinics and hospitals is part of the problem, but the greed of
US-based contractors is also a factor.
For example, the Maryland-based Institute of Human Virology proposed to
spend $600,000 to hire three consultants to "mentor" South African
health workers-an amount that could have been spent on antiretroviral
drug treatment for some five hundred poor South Africans. In another
example, the North Carolina-based Family Health International proposed
to hand over $1 million of a $3 million PEPFAR grant to Northrop
Grumman, a military contractor, which would conduct "monitoring and
evaluation" of Family Health's orphan programs. Under the terms of the
original contract, which was fortunately changed, Family Health
International and Northrop Grumman would each receive more than twice as
much money as all the orphans combined.
The US government makes it nearly impossible to obtain detailed
financial information about its foreign aid programs, and federal
agencies have thus far failed to give me information about the programs
described here; a Freedom of Information Act request has been pending
for two months. USAID officials need to tell us more about where
taxpayers' dollars go after they leave their offices, if sending money
to Africa is to do more than merely make Americans feel good about
In December 2002, the American talk-show host Oprah Winfrey rented a
sports complex near Soweto, the vast black township on the outskirts of
Johannesburg, South Africa, and gave a party for 124 AIDS orphans. There
are around one million such children in South Africa. Most live in
extreme poverty and many suffer from abuse, discrimination, and neglect.
At the party there was food, dancing and singing, and a gift for each
child-for some, it was the first they had ever received. "One little
girl was so excited that she could not open her present, and instead was
kissing the plastic," Oprah told South Africa's Star newspaper after the
When we were in South Africa, Jonathan and I met some of the orphans who
had attended Oprah's Christmas party. We were introduced to them by
Elizabeth Rapuleng, a stout, elderly African woman who lives in
Meadowlands, a bleak neighborhood of tiny concrete houses on a flat
dusty plain on the edge of Soweto. At the time of Oprah's party,
Elizabeth was working for Hope Worldwide, a US-based Christian charity
that runs medical relief programs in seventy-five countries. Hope is
linked to the International Church of Christ, a fundamentalist
evangelical Christian group, and receives funding from the church
itself, the US government, and various private donors.
In 2002, Hope was one of the largest US nongovernmental organizations
working on AIDS in South Africa, and had been providing counseling,
medical care, and HIV prevention advice to patients for some ten years.
So when Oprah wanted to give a party for orphans in Soweto, she
naturally contacted Mark Ottenweller, the director of Hope's South
African office. At the time, Hope had just begun to work with orphans,
but Ottenweller knew that his colleague Elizabeth ran an organization in
Meadowlands called Sizanani Home Based Caregivers that provided food,
counseling, and other services to many such children, and he asked
Elizabeth to invite them to the party.
As publicity for Hope, Oprah's party was a great success. Oprah's Angel
Network charity produced a film in which Ottenweller introduces Oprah to
some of the orphans. Hope's press release about the party is still on
its Web site three years later. Around the time of the party, Hope began
negotiations with PEPFAR officials and in 2004 it received an $8 million
US government contract to provide services to 165,000 AIDS-affected
children in South Africa and five other African countries. We can
imagine that its chances were not hurt by the publicity from the party
and the link with Oprah.
Meanwhile Sizanani-Elizabeth's organization-was struggling for funds. In
2001, Elizabeth, along with her two grown daughters, Florence and
Dorothy, had established Sizanani with a small grant from the South
African government's Department of Social Development. The
administration of President Thabo Mbeki has been rightly criticized for
downplaying the impact of AIDS in South Africa. However, for the past
four years it has been funding a small number of "Drop-In Centres" like
Sizanani that provide services to OVC children. Africa has few formal
orphanages. It is the policy of African governments and international
agencies to keep as many children as possible out of institutions, and
to encourage extended families to take in orphans. However, as Jonathan
and I found, and as other studies have shown, many families are too poor
to care for extra children and even in relatively well-to-do families,
AIDS orphans are sometimes abused and neglected. They are less likely to
attend school than the biological children of their guardians, they are
more likely to be forced to perform arduous labor, and they are more
likely to be physically abused and raped by guardians and others.
In the late 1990s, the South African government began to recognize that
its own child welfare officers and social workers-of which there are now
only three for all of Soweto, with a population of well over a million-
could not meet the needs of the nation's rapidly growing orphan
population. Experience from other African countries has shown that
small, locally run and managed organizations can provide a crucial
safety net for OVCs. So the Department of Social Development began
funding a small number of organizations throughout the country -Sizanani
among them-to provide AIDS-affected children with food and clothing and
other basic needs and to identify cases of abuse or neglect.
Elizabeth had been born and raised in Meadowlands and during the
preceding decade she had seen how the AIDS epidemic was wrecking her
community. The willingness of African families to take in so many
orphans has been seen as an expression of the spirit of "Ubuntu"-the
ancient African concept of shared humanity captured in the traditional
Zulu saying "A person is a person through other people." However,
Elizabeth knew that Ubuntu had its limits. As she witnessed the
unfolding horror of the AIDS crisis, she wanted to create a
community-based center that would be open all the time where orphans and
children with sick parents could receive free food and other
necessities, and where they could play safely and find adults who could
help them if they were in distress. She wanted, as far as possible, to
give these children the care they lacked. When she heard about the new
government funding, she jumped at the chance.
Today Sizanani has headquarters in a shipping container behind a church
in Meadowlands. It employs twenty-eight staff who work as counselors,
cooks, drivers, and drama and sports coaches. After school hours and on
weekends, the yard outside the shipping container is alive with
children's shouts and games until the church gates close at dusk. The
children receive three meals a day and snacks, as well as clothes,
toothpaste, and other necessities. When the principal of a local
state-run school tried to expel some Sizanani children because they
could not afford tuition, Elizabeth badgered him into letting them
attend for free. In South Africa, even state-run schools charge fees,
but by law, principals must admit all children, even if they are too
poor to pay. In practice, many schools refuse to waive the fees and many
poor children-especially orphans- drop out, unless an adult is willing
to advocate for their rights. When Elizabeth finds a child being beaten
or otherwise abused, she calls the police. When the abuse doesn't stop,
she moves the children into her own tiny house.
So far she has rescued seven children from particularly abusive homes,
including a teenage girl whose uncle used to drag her from her bed night
after night and send her out in the dark to buy beer for him at a local
pub. Even now, the uncle sometimes comes around to Elizabeth's place and
calls for his niece in a drunken rage. Another fifteen-year-old orphan
decided she could stand her aunt's beatings no longer, and fled to
Johannesburg where, she said later, she planned to kill herself.
Elizabeth frantically looked for her everywhere. The aunt seemed
unconcerned. Elizabeth contacted local government social workers, who
got in touch with their colleagues in Johannesburg. They discovered the
girl three days later wandering the streets of the city, and brought her
back to Meadowlands. She now lives with Elizabeth too.
Elizabeth pays for the care of all these children out of her own
Sizanani salary of $400 per month. The government offers a foster-care
grant to guardians like her, but the application process is so
bureaucratic and laborious that only some 2 percent of eligible children
benefit from it.
In her small office inside the shipping container, Elizabeth spends most
of her time writing letters and making phone calls, trying to raise
money. She worries about whether there will be enough food for the
children, whether they all have toothpaste and shoes, and whether they
are all going to school. The South African government provides Sizanani
$60,000 a year, an amount that Elizabeth reckons permits the group to
help about half the orphans in Meadowlands who need it. Moreover, the
payments from the government sometimes arrive months late. She receives
occasional donations of food and clothing, but it is never enough. So,
shortly after Oprah's party, Elizabeth asked Hope's directors whether
they would be willing to help support Sizanani.
Elizabeth reasoned that Hope's existing programs, though valuable, could
not reach most of the children who needed help. Hope runs group
counseling services in health clinics for AIDS patients and their
children, but the counseling sessions take place only once a week, and
are not open to children whose parents have already died of AIDS or are
in a state of denial and refuse to be tested for HIV or to enroll in
antiretroviral drug programs. Hope also places social workers in a small
number of schools around the country who train teachers to run group
therapy sessions for troubled children and to conduct a fifteen-step
"bereavement curriculum." But Elizabeth knew that traumatized children
need more than occasional support groups and short-term counseling
services; they need stable, daily human contact-a group of people to
rely on and trust, to make them feel less abandoned-something a weekly
support group can't provide.
Hope officials in South Africa declined to support Sizanani, saying that
Hope did not support "feeding programs"-an odd claim in view of all the
help Sizanani gives aside from meals. Eventually, Elizabeth quit her
job at Hope to run Sizanani full time. She received occasional donations
of food or other items from Hope, but otherwise did not hear from them.
Then in 2004 officials from Hope contacted her again. They wished to
offer Sizanani a "Memorandum of Understanding," or MOU. According to
this document, Hope would promise to help Sizanani by "reviewing its
current HIV/AIDS-related needs and responses"; by
"developing/strengthening a local working group on HIV/ AIDS"; by
"developing HIV/OVC strategies"; by "developing community competency";
and by performing other, similarly vague activities. Meanwhile, Sizanani
would continue to pay its own staff, purchase all supplies of food and
other commodities for the children, and provide "space and resources"
for its own programs. In addition, Sizanani would be required to fill
out three sets of forms each month listing the number of children
helped, the "kids clubs" set up, and other data, and send these forms to
Hope. Hope would provide no money.
Elizabeth declined the offer. "I'd been running this program for three
years," she said. "Why do I need advice from them?" The offer did seem
odd. Hope's South African budget is several million dollars a year;
Sizanani's is $60,000. Sizanani has offices in a shipping container;
Hope has offices in one of the most exclusive neighborhoods in South
What was Hope up to? Hope officials did not return my phone calls, but
it is possible to imagine their concerns. In 2004, Hope Worldwide
received an $8 million grant from PEPFAR to "support the care" of
165,000 orphans. Hope officials probably knew this was an overly
ambitious target. However, like other organizations that receive PEPFAR
funding, Hope is now under enormous pressure to produce statistics on
the numbers of children it has helped in some way. This may explain the
mysterious Memorandum of Understanding, which was presented to Sizanani
in late 2004, around the time Hope received its PEPFAR grant. Had
Sizanani signed the MOU, Hope would have been able to claim right away
that it was "supporting care" for all three hundred of the children
registered with the organization, even though it was doing virtually
nothing for them.
Every month, PEPFAR officials report to Congress how many people have
been helped by its programs overseas. This is important to the Bush
administration because PEPFAR has political as well as humanitarian
goals. President Bush announced the $15 billion PEPFAR program on
national television one week before the declaration of war against Iraq,
and it was meant to send a clear signal that his foreign policy was
compassionate as well as tough. Bush pledged that by the end of 2008,
PEPFAR-funded programs will have supported antiretroviral drug treatment
for two million people living with HIV/AIDS; will have prevented seven
million new HIV infections; and will have supported care for ten million
people infected with and affected by the disease, including orphans and
US government-funded programs routinely set such targets because they
make it easier to evaluate the success or failure of particular
projects; and in attempting to meet the targets, PEPFAR has put
thousands of people on antiretroviral drug treatment. However,
measuring the care of children affected by AIDS is much more difficult
than measuring the number of patients being treated, because there is no
pill that can be given to an abused or neglected child. Thus "supporting
care" can mean many things, including "mentoring" organizations like
Sizanani that do not need it.
The emphasis on "meeting targets" rather than on actually helping people
may well be having a detrimental effect on US-funded AIDS programs. A
number of Hope's counselors have quit in recent years, because, as one
former Hope counselor told Jonathan Cohen and me, the pressure from
PEPFAR to produce numbers made their work all but impossible. She had
worked for Hope for years, and had been devoted to it, but then
something changed when organization officials started angling for
"You cannot give quality counseling anymore because PEPFAR has
counseling quotas. If you have to do one thousand people by the end of
the month, you end up not doing good counseling. It compromises people's
dignity. And the stress on people from the paperwork! All the time we
were thinking, 'I have to fill this form because PEPFAR is coming!'
They're not asking 'Are we really meeting the needs of these people?'"
In order to receive ongoing funding from PEPFAR, organizations like Hope
must meet their targets-however empty. Their predicament reminded me of
Nikolai Gogol's novel Dead Souls, in which the main character, a minor
nobleman named Chichikov, travels through the countryside, trying to
purchase the names of dead serfs from local landowners, reasoning that
landowners would be only too happy to hand over the names of serfs who
had died between one census and another, because then they wouldn't have
to pay taxes on them. Chichikov planned to mortgage the dead serfs to an
unsuspecting bank, which-thinking the serfs were alive-would give
Chichikov a loan with which he could build a real fortune of his own.
Hope's strategy of leveraging the names of children for future gain
seemed to me similar.
What is Hope doing
with the $8 million PEPFAR grant if it is not giving it to organizations
like Sizanani? From Hope's Web site, I learned that shortly after Hope
received its grant it established the ANCHOR program-which stands for
African Network for Children Orphaned and at Risk. According to its Web
site, ANCHOR will do the following things: "promote effective OVC
policies"; "provide training and support for scaling up HIV/AIDS
treatment, care and prevention"; "coordinate and facilitate capacity
building in communities using tested community support and mobilization
strategies and technical assistance"; and carry out "monitoring and
evaluation to assess program impact."
I was curious to know what these goals meant in practice. Activities
such as "technical assistance" and "capacity building"-which means
helping organizations to improve management-can help fledgling
community-based groups manage their funding and work more efficiently.
But the same terms can also serve as jargon behind which public health
contractors can hide when donors make impossible demands on them for
political purposes. Such activities can also allow these organizations
to appear to be helping far more people than they actually are.
The ANCHOR program is run by a consortium of organizations, including
Hope and the Rotarian Fellowship for Fighting AIDS (RFFA), a subsidiary
of Rotary International-a private membership organization that raises
money for humanitarian relief projects around the world. When Hope
officials did not reply to my requests for an interview I contacted
Marion Bunch, the Atlanta-based director of RFFA-and one of the authors
of the grant proposal that funded ANCHOR -about Rotary's role in the
program. She said that Rotary was encouraging South African Rotary Club
members to raise funds and solicit donations locally and abroad.
"Sometimes someone will donate one thousand blankets," she said. "We'll
give those directly to people in the communities. We also fund-raise
from local businesses in South Africa, like a supermarket will give us a
food donation, something like that."
"So," I asked, "if Rotary is soliciting donations for food, clothing,
and so on, what is the $8 million PEPFAR grant for?"
"That's in the grant proposal," she said, referring to Hope and Rotary's
application to PEPFAR. "It has direct costs and indirect costs," and
then she suggested I contact USAID if I wanted more information.
But USAID will not discuss the ANCHOR program. A Freedom of Information
Act request I submitted to USAID in early August 2005 is still pending.
"We wanted to do something on a huge scale," explained Greg Ash, the
white South African plastic surgeon who founded NOAH-or Nurturing
Orphans of AIDS for Humanity-another South African orphan program that
has received approximately $1.5 million from PEPFAR. "We acted as though
the responsibility for every orphan in the country were ours." I had
been referred to Ash's organization by a press officer at the US embassy
in Pretoria. He said it was a PEPFAR success story-a truly indigenous
South African organization that was helping thousands of children.
Ash hadn't thought much about AIDS before he started NOAH. Like many
white South Africans, he considered leaving the country after the ANC
came to power in 1994. But then he was offered a job at a private
hospital in Umhlanga Rocks, an exclusive beach community of swaying
palms, oceanfront high-rises, and luxurious shopping malls, and he
decided to stay. Having made a commitment to raise his own children in
South Africa, he began to think more seriously about the country's
future, and that's when he began to worry about AIDS orphans.
"Apartheid," he said, "gave us this feeling about ourselves, like we're
bad people. Maybe that's why an amazing number of people want to do
something for the first time. It's relatively easy to get money for
kids. People are just waiting for someone to tell them what to do." In
2001, he approached officials at the US embassy with a scheme that he
said would help a million AIDS orphans in South Africa by 2008, and in
2003 NOAH began receiving US government funding.
NOAH is a franchise organization. It funds the construction of "resource
centers" in schools-separate buildings that, according to the plan,
house a small library and five or ten computers, where orphans can stay
after school and receive a free meal, read books, and learn how to use
computers. NOAH is currently building twenty-two such centers-at a cost
of roughly $1 million-and the plan is to build many more.
I asked Ash why it was necessary to build new buildings and buy
computers when so many of the orphans I had met in South Africa seemed
to have much simpler needs. "We need to break the cycle of AIDS and
poverty," he said.
Many of the schools in South Africa are, frankly, not very good, but in
the future South African kids will have to compete for jobs with kids
from Korea, from Shanghai.... They need that competitive advantage. And
setting up some computers is easy, it doesn't cost anything, and the
kids teach themselves how to use them. The resource centers have a staff
of six people, and local volunteers are also recruited from the
community to work with especially needy children.
One drizzly Wednesday morning in June 2005, I went to visit a NOAH
center in a poor black township known as Nkobongo some thirty miles and
a world away from Umhlanga Rocks. Nkobongo sprawls over the veldt behind
the town of Shaka's Kraal, named for the powerful Zulu king who
conquered much of southern Africa in the early nineteenth century. By
the early twentieth century, white settlers had forced the Zulus off the
best grazing land into tsetse- and malaria-infested valleys and
lowlands. Young men were recruited to work in the distant gold and
diamond mines of the Transvaal, and the rural economy of small-scale
farming and cattle raising that had sustained the Zulus for centuries
was gradually destroyed. Today, most Zulus live in desolate rural
homelands or impoverished townships like Nkobongo. Staggering levels of
unemployment and poverty have further hardened these tough people. In
village bars, drunk and rowdy men listen to booming rap music, fight
about women, and sometimes kill each other. Even small children greet
each other with gangster hand signals. A study conducted in a nearby
area found that among adults in their twenties, around a third of all
men and half of all women are HIV-positive.
The manager of the local NOAH program was not around when I arrived in
Nkobongo, so I waited for him at the Nkobongo community center. The
community center is on a hill with a view of the whole region: the neat
rows of tiny box-shaped houses spread across barren hillsides, a latrine
in each front yard. Right below the community center, I noticed that a
large crowd had gathered. About two hundred people, young and old, men
and women, were sitting around the periphery of a rain-soaked tarmac
lot. "Those people really appreciate the bones," said a woman I had met
at the community center. "What bones?" I asked. Just then, a pickup
truck arrived and parked in the middle of the lot. Two men got out and
began off-loading stripped pork bones -refuse from a local
abattoir-which they piled up in a heap on the tarmac. The crowd looked
on keenly as the men began to distribute the bones-five or six to each
person-until the heap disappeared.
Overseeing this extraordinary event was Charles Southwood, a retired
white South African businessman who volunteers to help numerous
charities in the area, including NOAH. He'd been distributing bones for
a local Catholic charity for years, he said. When he started there would
be such a mob when the bones arrived that they knocked Charles over
several times, and almost overturned the vehicle once or twice. "I told
them they had to sit down and form an orderly queue; otherwise there
would be no more bones."
According to the Ministry of Agriculture, roughly one third of all South
Africans experience "food insecurity," meaning that they live in fear of
hunger. At a high school in Soweto, a teacher described to Jonathan and
me how many of the students, especially those who were orphans,
complained that they did not get enough food at home. Sometimes they
would stare through the windows of the faculty room at the teachers
eating lunch. "How do you teach a hungry child?" she asked us.
South Africa is the richest country in sub-Saharan Africa. There are no
wars here, no refugee camps; the country has a social welfare system, a
free press, and regular peaceful elections. But the agrarian traditions
that once sustained people here-the techniques they had developed over
centuries of survival on the sandy marginal soils of Africa, and that
one nineteenth-century European visitor said showed such a profound
understanding of nature that they closely resembled a science-have been
all but lost. Meanwhile, the industrial future has yet to arrive,
and some three quarters of all adults in places like Nkobongo are
unemployed. Although South Africa's powerhouse economy, based on
gold, diamonds, commercial farming, and services, is growing rapidly, it
produces very small numbers of highly skilled jobs.
Charles Southwood introduced me to some of the people who worked at the
Nkobongo NOAH resource center. The new building was still under
construction, and the resource center was temporarily housed in a
church. There was no library, although there was a kitchen where a daily
meal was prepared. I was also shown a room with nine computers. The 150
children registered with NOAH love them, but because demand is so high,
each child is allowed only one hour of computer time every two weeks. It
seemed unlikely that this would break the cycle of AIDS and poverty that
seemed to be churning so rapidly here.
Back in Soweto, Jonathan and I asked Elizabeth what she knew about NOAH.
She said that one of their representatives-a tall white South African
woman-had visited Sizanani some months before. After a series of
meetings the visitor announced that NOAH would begin funding Sizanani,
but in order to obtain the funding Sizanani would have to fire its
entire paid staff and all of them, including Elizabeth, would have to
reapply for their jobs. NOAH would rehire only six of the twenty-eight
staff who worked there. "This is my dream!" she said. "I wasn't going to
let them kick me out!"
Unlike Sizanani, NOAH relies heavily on unpaid volunteers to provide
care for needy children. Ash had hoped that these volunteers-"who are
unemployed anyway," he told me-would serve out of a sense of altruism,
or "Ubuntu" in African terms. But as Elizabeth and Charles Southwood
discovered, this isn't so easy. Few people in this troubled place want
to help AIDS-affected families for free. "They come for a few days,"
Charles said of the volunteers. "Maybe a month. Then they realize
there's no salary and then you never see them again. Sometimes you go to
visit a sick person and the volunteer will just stand at the door and
not go in," he said.
There's an old black man who lives on his own. He's blind and can't
walk. Someone stole his wallet and pension book. Some volunteers were
supposed to go and feed him, but then I found last week that no one had
been there for three days. Sometimes I think the Zulus think I'm mad.
When I blow my top, as I did last week about the old man, they fail to
understand what I'm angry about. They just don't seem to care. They
aren't kind to each other. I don't know why. I guess poverty disempowers
people, makes them mean.
"Some families don't want my help," a NOAH outreach worker told me.
"Some of them swear at me, chase me away. Sometimes they tell the
children to tell me they aren't there. They embarrass me in front of the
neighbors, say I am some kind of prostitute."
When Charles finds committed volunteers, he tries to raise money to pay
them from local churches or businesses or simply from people he knows.
According to Ash this should have been easy, but Charles hasn't had much
luck. South African businesses may occasionally contribute food or toys
that they can't sell, and they are often keen to donate funds for
buildings and computers and other infrastructure projects they can put
their names or business logos on, but few will support the salary of a
sympathetic human being even if that is what orphans need most of all.
"Most of the white people in our country are totally unaware of the
situation of poor blacks," Charles said. "The whites around here avoid
me; no one wants to know what I am doing."
Before I left South Africa, I tried to visit two other NOAH sites in
KwaZulu-Natal. According to the list I had been given by NOAH officials
in Johannesburg, there should have been two NOAH community groups in a
town called Mtubatuba that I happened to be visiting the following week.
But when I arrived, I was told by a NOAH coordinator that they were not
yet set up. There was not a single volunteer or community worker I could
In October 2005, UNICEF will launch a campaign to raise millions of
dollars for AIDS-affected children. UNICEF, the US government, the World
Bank, and many AIDS experts officially recognize the importance of
supporting community-based groups like Sizanani. At present, there are
far too few of these groups, and most of their funding comes from local
sources, often from the poor themselves. The South African
government supports only four such groups in all of Johannesburg, and
there are none at all in many regions of the country. When Jonathan and
I visited the UNICEF officer in charge of OVC issues in Pretoria, she
said she had not had time to visit Sizanani or any of the other
community-based organizations supported by the South African government.
In her view, NOAH provided a better model for orphan services, although
she showed no close acquaintance with its programs.
She repeated a common criticism of community-based organizations-that
they were "unsustainable"-meaning they start with good intentions and
then collapse after a while. Maybe she had a point, but it seemed hollow
to us. Of course these organizations collapse if no one supports them,
or if they are uprooted by larger organizations with millions of dollars
at their disposal. As Elizabeth said, referring to NOAH's takeover bid.
When the Americans come, we sing, we dance, they take our picture, and
they go back and show everyone how they are helping the poor black
people. But then all they do is hijack our projects and count our
 About one third of children born to HIV-positive women inherit the
virus during childbirth or breastfeeding. Most of these children die of
AIDS by age five; a very small number are being kept alive for longer
periods with antiretroviral drugs.
 Curt Tarnoff and Larry Nowels, "Foreign Aid: An Introductory
Overview of US Programs and Policy," Congressional Research Service,
Library of Congress, updated January 19, 2005.
 See Human Rights Watch, "Letting Them Fail: Barriers to Education
for Children Affected by AIDS," October 2005.
 See Helen Epstein, "God and the Fight Against AIDS," The New York
Review, April 28, 2005.
 See UNICEF, "Africa's Orphaned Generations," 2003; Human Rights
Watch, "Letting Them Fail"; Takashi Yamano and T.S. Jayne, "Working-Age
Adult Mortality and Primary School Attendance in Rural Kenya," Economic
Development and Cultural Change, Vol. 53, No. 3 (2005), pp. 619-654;
Anne Case and Cally Ardington, "The Impact of Parental Death on School
Enrollment and Achievement: Longitudinal Evidence from South Africa,"
unpublished manuscript, February 7, 2005; David Evans and Edward A.
Miguel, "Orphans and Schooling in Africa: A Longitudinal Analysis,"
unpublished manuscript, March 1, 2005; and Martha Ainsworth, Kathleen
Beegle, and Godlike Koda, "The Impact of Adult Mortality and Parental
Deaths on Primary Schooling in North-Western Tanzania," Journal of
Development Studies, Vol. 41, No. 3 (April 2005), pp. 413-415.
 See Geoff Foster, "Supporting Community Efforts to Assist Orphans in
Africa," The New England Journal of Medicine, Vol. 346, No. 24 (June 13,
2002), pp. 1907-1910.
 See Case and Ardington, "The Impact of Parental Death on School
Enrollment and Achievement."
 Or so said Elizabeth. Hope officials did not return phone calls or
reply to e-mails.
 Although perhaps not as many as the US claims. See Craig Timberg,
"Botswana's Gains Against AIDS Put US Claims to Test," Washington Post
Foreign Service, July 1, 2005.
 My thanks to Allison Prete for drawing my attention to this.
 Mark Ottenweller, "ANCHOR Program in Africa," Hope Worldwide
newsletter 2004, issue 2.
 Colin Bundy, The Rise and Fall of the South African Peasantry
(University of California Press, 1979).
 See the Department of Agriculture and Environmental Affairs:
 See Geoff Foster, Bottlenecks and Drip-feeds: Channeling Resources
to Communities Responding to Orphans and Vulnerable Children in Southern
Africa (Save the Children, June 2005).