Millions of AIDS Orphans Strain Southern Africa
By SHARON LaFRANIERE
http://www.nytimes.com/2003/12/24/international/africa/24ORPH.html

CEMENTO, Mozambique - On the day last July that he and his wife died of
AIDS, 36-year-old Samossoni Nhambo leaned up from a hospital bed a few miles
from this dirt-road village of thatched huts and asked his preacher a
despairing question: who would take care of his children?

Five months later the answer is glaringly obvious: no one.

Three-year-old Fátima died in early December, perhaps from AIDS, perhaps
from malnutrition. Five-year-old João, infested with worms that have reduced
his toes to red stumps, can walk only on his heels. His 7- and 9-year-old
brothers, Ricardo and Samsoan, are covered with dime-size sores from scabies
mites, which infect the entire family.

Sixteen-year-old Maria, who dropped out of school to care for her sick
parents, was pregnant by a man whom she refuses to identify, and in early
December she gave birth to a boy.

That leaves the eldest, José, a slim, short 17-year-old who just finished
seventh grade, as the surrogate father. In their half-built shelter of
stones and sticks on the bad side of a poor village, with no walls and a
single cane chair for furniture, the Nhambo children reel from crisis to
crisis.

"Life is very difficult," José said. "No food, no clothing, no bed covers.
We have to struggle."

So do millions of others like them. Southern Africa is increasingly home to
children like the Nhambos, robbed of their childhood by AIDS and staggering
under adult-size hardships.

The United Nations Children's Fund estimates in a new report that 11 million
children under 15 in sub-Saharan Africa have lost at least one parent to
AIDS. About a third of them have lost both parents. By 2010, Unicef
predicts, AIDS will have claimed at least one of the parents of 15 percent
of the region's children - 20 million in all.

The social implications are enormous, Unicef and other relief organizations
say. Orphans are more likely to drop out of school, to suffer from chronic
malnutrition, to live on the street, to be exploited by adults, to turn to
prostitution or other forms of crime and to themselves become infected with
H.I.V., the virus that causes AIDS.

African social traditions dictate that relatives should take them in. But
AIDS has pushed so many families to the brink that the surviving adults are
beginning to turn away their young relatives. An aunt and a grandfather live
down a dirt path from the Nhambos, but the grandfather says neither can help
them.

So far, governments have done little either: of 40 sub-Saharan countries hit
by the AIDS epidemic, only six have plans in place to deal with orphans,
Unicef says. Their sheer numbers, plus the state of African bureaucracies,
make even the simple act of registering orphans so that they can be exempted
from school fees an enormous task. In countries like Zambia only 1 in 10
births is even documented.

For Mozambique, a nation nearly twice the size of California that stretches
along the Indian Ocean coast, orphans are not a new phenomenon. When 17
years of civil war finally ended in 1992, hundreds of thousands of children
were left without one or both parents.

But AIDS has sharply multiplied their ranks. Now, in a nation of 18 million,
16 percent of the children - more than 1.2 million - are already missing at
least one parent. AIDS is responsible for the plight of a third of these
children, according to Unicef.

Maria Cemedo, an official of an agency that serves women and children in
Sofala, the region where the Nhambo children live, said an entire generation
was being lost. "We may become a society of old people and children," she
said.

Sofala, in Mozambique's narrow center, has been particularly hard hit
because it has both a port and a major highway running to Zimbabwe. The
combination of poverty-stricken women and lonely truckers spreads the AIDS
virus all along the corridor. Now 1 in 4 adults in the province is infected.

Of the 46,000 registered orphans in the province, said Antônia Charre, the
agency's director, few receive any government help. Fewer than 5 percent
obtain food through the World Food Program, she said.

"It's a shocking situation," she said. "It is not clear how some of these
children survive from one day to the next."

Group homes are one possible solution. But as yet, few exist here. The
government's only orphanage - by far the largest in this region - houses
just 78 boys and girls. Paula Salgado, its energetic coordinator, said 16
H.I.V.-infected children were housed this year at the airy two-story center
by the ocean at Beira, the nation's second-biggest city. Only four survive
today.

One of them, Mavis, 5, was taken to the center by government workers in late
October, weighing just 24 pounds and suffering from tuberculosis. Her
parents were dead, apparently from AIDS, and her 15-year-old brother was
reduced to begging for food from neighbors, Ms. Salgado said.

Although the institution lacks the money to buy the antiretroviral drugs
needed to prolong Mavis's life, her health has improved in her six weeks at
the orphanage. But she has yet to smile, Ms. Salgado said. During a visit,
she refused to accept a cloth doll or to acknowledge a guest who stopped to
button her dress.

Such stories of separation and suffering seem as common as mango trees here.
Sixty miles away, in the village of Nhamatanda, Jorge Danielle, 15, said he
had cared for his two younger sisters for four years after his mother had
died of AIDS.

Then, quite recently, a couple who claimed to be friends of his dead parents
took the 9- and 12-year-old girls away, he said. He now lives alone in an
8-by-9-foot hut and survives on handouts of rice and the pennies he earns by
carrying parcels at the local market.

"They told me, `We cannot feed you too, so you must fend for yourself,' " he
said. "I am very sad because they are far away from me. Now I am always
alone."

Amador Ernesto Luís, a volunteer with a Unicef-financed relief group called
Asvimo, said he feared that the two girls had been taken away for labor or
prostitution. But without relatives to care for the children, and in the
absence of government help, he said he was powerless to stop the couple.

The Nhambo children remain together. But there are few other blessings in
their lives.

Their hut was always on the bad side of Cemento, far from the highway and
the single hand-pumped well that serves 600 people. The Nhambos fed their
children rice and sweet potatoes they grew in a tiny kitchen garden.

Mr. Nhambo never held a steady job. His wife, Caterina Tole, held the family
together with her industry and love for her children, said José Missasse, a
Christian Evangelical pastor who knew the family well. "She had great love
for her children," he said. "She was very conscientious. The house was
clean, clean, clean - right up until the day she could no longer move."

Their family life began to fall apart five years ago, when Samossoni Nhambo
left to live with the wife of a deceased uncle. When he returned, in 1999,
José said, he and Maria, the eldest children, were not happy to see him.

Nor was his mother, he said. "They very seldom spoke," he said. "My mother
would cook for herself and the kids, and my father would cook his own meal."

In African culture, women are obliged to meet their husband's sexual needs,
and so Fátima was born within a year. Later, Mr. Missasse said, he
recognized the symptoms of AIDS in both parents and the baby.

He said he had seen Caterina Tole a month before her death. "She never
forgave her husband," he said. "She said, `I am going to die because of him
and leave my children alone.' She was very angry. I would tell her, `God may
send someone to care for your children.' But it would end with her crying."

Ms. Tole died on a mid-July morning, stretched out on the dirt floor of her
neighbor's mud hut. Mr. Missasse told her husband of her death as he lay on
a cot in a clinic with broken windows and dark halls that serves as the area
hospital. Stricken with remorse, Mr. Nhambo told Mr. Missasse: "It would
have been better if I died first." Six hours later he stopped breathing.

With heavy sticks, rocks and corrugated iron donated by Asvimo, neighbors
built the children a basic open-walled shelter to replace their tiny reed
hut, which had collapsed. But no one offered to feed the children - not
their mother's sister, who lives with her own seven children about 50 paces
away, nor their widowed grandfather, a frail 70-year-old in ragtag clothes.

The children eat one meal a day of corn porridge, along with 70 other needy
children at Mr. Missasse's church, a half-hour's walk away. They also get a
110-pound bag of rice monthly from the World Food Program, and in the summer
they pluck mangoes from the tree that shades their hut.

The younger boys share one toy - a metal car they built out of bits of wire
and beer cans. Their few clothes are filthy. Mr. Missasse said there was no
hope for João's fly-covered feet because the children could afford neither
medicine nor cleaner living conditions.

José said he had planned to carry Fátima two miles on foot to the nearest
doctor when he woke up on Dec. 10, surprised she had not aroused him as
usual with her crying. Neighbors buried her in an unmarked grave between her
parents.

Exactly a week later, Maria delivered a baby boy, and the scramble to feed
another mouth began.

=====
Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique
Health Alliance International, Seattle, WA, USA
http://depts.washington.edu/haiuw/
Coordinator South Asian Public Health Forum http://www.saphf.org
jawad@alumni.washington.edu      http://www.DrJawad.com