International Federation of Red Cross and Red Cresent Societies - 10 July 2003
Varaidzo Dongozi of the Zimbabwe Red Cross

His body grows weaker, largely due to a continuous loss of fluids, caused by the diarrhoea he has had for the past three months.

The main challenge the 23-year-old encounters every day is summoning the strength to go into the bush to relieve himself, as there is no latrine in his village, in Matobo district in southern Zimbabwe.

The only other alternative left to him is for his mother, Judith Moyo, to assist him with using a bedpan in his hut. But Jabulani cannot bear the thought of his mother seeing him naked and unable to care for himself - yet.

"Because I have HIV, I know that one day it may come to that. But as long as I still can, I want to go to the toilet on my own," he says.

It takes Jabulani at least 15 minutes to walk the 500 metres to the nearest bush. "By the time I come back, I feel so tired. But there is nothing else I can do. I frequently need to go, especially now because of the diarrhoea", he says.

Access to adequate sanitation facilities is not the only problem Jabulani and his family face. They also struggle to get safe water. The nearest water source is the Hovi river, three kilometres away. Jabulani's mother, who is her son's sole carer, is forced to leave him unattended when she goes off to collect water.

"I worry about leaving him alone, because he has been unwell for so long. I want to be near him all the time, so that I am there for him if his condition deteriorates," she says. Jabulani's diarrhoea was probably caused by consuming untreated water from the Hovi river. This water is a threat not only to Jabulani, but to his whole village.

The lack of access to proper water and sanitation facilities is posing an increasing threat to communities not only in Matabeleland, but throughout Southern Africa, a situation exacerbated by the HIV/AIDS pandemic.

The Red Cross is all too aware of the danger of communicable diseases spreading due to the consumption of polluted water and shortage of latrines. To fight this growing threat and to deal with it in a holistic way, the Red Cross is striving to fully integrate its regional programmes in water and sanitation and HIV/AIDS.

The Zimbabwe Red Cross (ZRCS) Provincial Programmes officer for Matebeleland South, Siphiwethina Tshuma, says the danger of communicable diseases spreading from one person to another in homes where at least one person lives with HIV has become more and more evident to Red Cross volunteers.

"We have come across two deaths and small outbreaks of waterborne diseases in our home based care project, where diarrhoea was established as the cause," she says. "This prompted us to realise that within the HIV/AIDS home-based care project, there is an urgent need to provide safe water and sanitation facilities for the clients and their families, to keep them safe."

As a consequence, the Zimbabwe Red Cross is now striving to integrate the two components as a way of caring for people affected by HIV/AIDS in a more holistic manner.

"With the home-based care project, our focus has been on the care of the client. By adding water and sanitation and the promotion of health education, we will ensure that the environment of the client and their families is also safe," says Catherine Marenga, the ZRCS Health and Social Services Officer.

She adds that the Red Cross care facilitators can easily play the dual role of attending to the clients as well as promoting a cleaner home environment for the whole family. "When a care facilitator visits a home, he or she will attend to the client, as well as ensuring that the environment has safe water and sanitation facilities, and that other health hazards such as dumpsites, which breed mosquitoes, the cause of malaria, are properly take care of," Marenga says.

"Malaria, which is a constant hazard to the already ailing health of the client, can easily be minimised through promoting health education, which is a key feature of the water and sanitation project," she adds.

Matobo district has been selected to host the pilot project integrating the two programmes. Already, 38 HIV/AIDS home-based care facilitators there have been trained in health education.

The water and sanitation project, which has been running as a separate programme from the home-based care project, started in 1999 with technical assistance from the International Federation, in response to several cholera outbreaks.

To date, a total of 7,779 toilets have been constructed in eight provinces, reaching 180 000 beneficiaries. During the same period, the Zimbabwe Red Cross has built 154 new bore holes, while rehabilitating 84 existing ones. In addition 57 wells and 12 springs have been rehabilitated.

In the same provinces, 22 home based care projects have to date been established, since 1992.
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