Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Cresent Societies - 2 September 2003
John Sparrow and Selma Bernardi in Chitungwiza, Zimbabwe
Tuesday
10.05 am
Alice is eight months pregnant. She is also HIV-positive. What does the future hold for her baby? What will happen when Alice inevitably dies in the not so distant future? What will happen to millions of other children destined to be orphans from the moment of their conception?
The answer is that no one knows, except that the prospects are horrific. Southern Africa already counts 3.2 million children orphaned and made vulnerable by AIDS, and society cannot cope. Extended families are overwhelmed. The capacity to care is saturated.
Children have become unwanted. They roam the streets. They are abandoned, abused and prostituted. The scenario can only get worse, and is doing so rapidly. Zimbabwe alone had 782,000 orphans from AIDS in 2001, a figure expected to rise to 1.14 million by 2005.
Spiwa is eight, an orphan and HIV positive through mother-to-child transmission. She weighs just 14 kilos. What is happening to her is a gross denial of children's rights and she is not even on Chitungwiza's streets.
Her plight is the concern of Ruth Mutukwa, another Red Cross home-care volunteer in Unit D. She's a frequent caller on Spiwa and her three elder sisters and has brought them food, clothing, blankets and an auntie-like eye.
She would be there round-the-clock if she could. She's furious to hear that half the Red Cross food she brought them on her last visit has again been taken from them by their grandfather.
"It's terrible," she says. "What can these children do against a full-grown man?" She'll intervene but carefully. She doesn't want him harming the children as a consequence.
Spiwa shares one small room with Florence, 18, Jane, 17, Ottile 16, and the oldest girl's own toddler in what used to be the family home.
Their father died in 1996, their mother four years later. Since then, the rest of the place has been rented out by their grandfather. He lives elsewhere in the neighbourhood and the rent he collects pays for the costs of the place, which is considerably less than the amount he collects from the tenants.
The money, though, is not shared with the children, so Florence works on a food stall to earn a little cash. She is hoping to make the equivalent of US$ 3 or 4 a month.
The room is two metres by one and a half. Newspaper pages are taped to the wall as decoration. There's one small plant in a corner. The girls haven't much but they are trying to make a home of it.
Jane looks after Spiwa. When their mother died they all moved up one in the family structure. Florence became the breadwinner and Jane took her place caring for the youngest children.
Yesterday she took Spiwa to hospital after the Red Cross suspected she had tuberculosis. She had a sputum test. There'll be another test tomorrow, and a third the day after that. If she has TB, treatment will be free. The system will take care of that.
What it will not take care of is the severe skin infection over much of her body. She is in pain and has been for the past month. The sores on her face and head are awful. The hospital has prescribed treatment but someone has to pay for the ointment and medication before it can be dispensed. A social welfare letter could exempt her from payment but she needs a birth certificate for that. Through no fault of her own she hasn't got one.
Couldn't her grandfather pay? Jane did ask and reluctantly he said he would, when he felt like it. The child sits on the floor of her concrete room and waits. The Red Cross workers are appalled. They give Jane the money from their own pockets but they know they haven't solved the problem. There are far too many similar cases.
Child negligence is a criminal act. Except, it seems, in southern Africa where health care is falling apart and access for the poor gets ever worse.
A recent World Health Organization assessment of Zimbabwe's health sector reported rising mortality rates while 24 per cent of all medical posts were unfilled. Since January 2000, it said, 12 per cent of doctors, 13 per cent of clinical officers, 18 per cent of pharmacists and eight per cent of nurses had left the employ of the Ministry of Health and Child Welfare.
The quality and quantity of services had been compromised and the amount of women and children who have access to them has been reduced by charges levied.
Countrywide, the WHO warned, a million people were vulnerable due to a lack of basic health services.
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