Fighting AIDS by bolstering African families

Strengthening the family is the answer to many of Africa's ailments, says Kenyan paediatrician, mother and award-winning novelist Margaret Ogola.
Margaret Ogola | Aug 26 2005 | comment  

The West is obsessed with saving Africa. From street protests to political summits, from condoms to rock concerts, everything has been tried, or so it seems. But one thing always seems to be overlooked – how the family, the basic social unit, is faring. Now there is a movement from within the region to put the family at the centre of all efforts to promote development and eradicate the scourges of poverty, disease and war.

Last weekend people from ten African nations, together with supporters from the Americas and Europe, met in Nairobi, Kenya, for a congress geared to strengthening family life in the continent. At the conclusion they launched a new umbrella group, Voice of the Family, to coordinate further initiatives. This will be a group to watch.

Dr Margaret OgolaOne of the keynote speakers at the congress was Dr Margaret Ogola of Kenya, a paediatrician and mother, with four children of her own and a growing number of adopted children. Dr Ogola, founder and medical director of the Cottolengo Hospice in Nairobi for HIV-positive orphans, heads the Commission for Health and Family Life of the Catholic Church in Kenya. In her spare time she writes books: her 1999 novel, The River and the Source, which tells the story of four generations of African women, won the 1995 Jomo Kenyatta Prize for Literature and the 1995 Commonwealth Writers’ Prize for Best First Book. A sequel, I Swear by Apollo, was published in 2003.

As the congress got under way, Carolyn Moynihan asked Dr Ogola what has been happening to the African family and what it needs for the future. She responded with a combination of gravity and optimism that inspires confidence in her belief that “good things are going to happen in Africa”.

MercatorNet: What is Western consumer society doing to the African family?
Dr Ogola: The problem is quite deeply rooted and has many decades of history behind it, probably since the arrival of the colonial powers in Africa when the traditional family values were so deeply shaken and weakened and even removed. Even though Christian values have been brought in to strengthen the African family, they have been very much confused with the Western world view. So that instead of the strong Christian values that were very similar to the traditional African family values, what we have is Western values that are very consumeristic and that interfere very heavily with African family values, where the family is the basic unit and a person is valued within the context of the family.

We do not have this individualistic approach where a person stands alone and self-gratification is the greatest value. The greatest value is the contribution of the individual to the greater good -- that is, the family and clan. We have lost that, because to support the family and the clan you have to be less selfish, whereas to get all the consumer goods that the West offers, people have tended to sacrifice their family values. It’s called “standard of living”, but quite often a person’s internal standard of living is very low. Even though they may appear quite well-endowed materially, they have lost values and strength and social capital that only a strong extended family system can give a person in Africa.

MercatorNet: How bad is the epidemic of HIV/AIDS in Kenya right now?

HIV-infected childrenDr Ogola: It is probably not as bad as it was a couple of years ago, but we still have a large number of very sick people. Two million people are infected, and about 200,000 need medication, but only about 40,000 have access to medicines that prolong life – the anti-retroviral (ARV) group of drugs. Even this much improvement has only happened in the last three years with the intervention of such programs as the American Presidential Emergency Fund and the Global Fund for Aids and Malaria.

Prior to this the devastation was extremely severe. We have lost two million Kenyans and behind them they have left 1.2 million orphans, who constitute a second epidemic because nobody has planned for them. Therefore we are faced with a situation where about 20 per cent of our children have absolutely nowhere to turn.

You must remember that social security for Africans is the extended family. What HIV has done is destroyed a generation of brothers and sisters, so that you find that homes have been laid waste with only grandparents and little children left. Therefore we have orphans in the absolute sense of the word where a child does not have anybody. Previously this was not possible because if your father died your uncle took over – a child had many fathers in his uncles and many mothers in his aunts. This was our social security network and so the epidemic has hit us very, very hard. In the whole of Africa south of the Sahara there are 13 million orphans.

MercatorNet: What does Cottolengo Hospice offer these children?

Dr Ogola: There are 50 children, all of them living with AIDS and all of them abandoned or orphaned, with absolutely no one to look after them – this is the criterion for residence. Initially we took them in so they could have a safe place to die, but with the discovery of ARVs we have children who are thriving and the oldest is now 18 and is in high school. So these drugs, even in the lives of children, have changed the picture dramatically. But of course the Cottolengo children are the lucky ones; there are 200,000 children living with AIDS who have no access to care at all. Because they are children they are unlikely to be helped because for many planners it is not as worthwhile to keep a child alive as to keep an adult alive.

MercatorNet: Cottolengo, I believe, is sponsored by the Catholic Church. What else is the Church doing to address the AIDS crisis?

Dr Ogola: Yes, it’s one of the many organisations set up by the Catholic Church, which provides about 40 per cent of health care in Kenya. Every year we see about 10 million cases – 50 per cent of these are from complications of HIV – which is a lot considering that this is a country with 30 million people. And the Church does this with very little funding. You must remember there is a lot of hostility to the Church because of certain stands that have been taken, so we get no funding from the Kenyan government and very little from the donors who may think that our stand on the condom, for example, is arbitrary and that we use words that are just plucked from the air.

We have free anti-retrovirals in 15 of our hospitals. We have programs for prevention of mother-to-child transmission of HIV. We also have programs to strengthen education for life for young people, to teach them skills that help them reject unwanted sexual advances. We have abstinence programs being developed for our schools, because the Catholic Church also happens to be a major provider of education, with over 5000 schools sponsored by the Church. We train a large number of health workers to support all the work that we do for families, as well as teachers, and we have programs for peer support of youth so that they help each other develop positive values.

There is one area we not yet very strong in, and that is improving the situation of women. AIDS began as a male epidemic but now 53 per cent of those infected are women, and young women between 15 and 25 are three times more likely to be infected than their male counterparts. Remember that these are women of child-bearing age, so their children are also more likely to be infected.

The main reason for this is poverty and the disadvantaged place of women. Therefore prevention programs should have women at the core, not only to help them say "no", but also to have alternatives when they say "no". This means attention to the poverty prevailing in our country which is extremely severe, with about 57 per cent of Kenyans living on less than one dollar a day. Most of the poor are women, and particularly young women, because socially they are not considered equal to men and so have less access to education and resources at every level. Their situation has to be addressed in a holistic and integral manner, so that you not only foster family values but also give them opportunities to make a living other than by transactional sex, which young girls get into out of sheer poverty.

MercatorNet: How is the family the answer to AIDS in Africa?

Dr Ogola: The family is the answer to everything in Africa! All our strategic interventions to bring this epidemic under control require that we build family values, and family fortunes – the capacity of the family to make a living, so they can live together in a civilised way and no family member is tempted to bring the virus into the family fold.

It’s a very, very strong challenge, because nobody expected that in 20 short years we would have lost two million young men and women who were supposed to have been the ones doing the work We will not defeat HIV without convincing young people that the most beautiful thing they have is their family. It used to be the duty of a young African man to go out and start a family and defend it. We must discover that value again.

Also the idea of divorce or separation was foreign to us, because once a marriage was consummated there was no way anyone understood you could undo it. Even though there was polygamy, family break-up in the way we see it now, the lightness with which the marriage vow is treated, is totally un-African. Marriage was the highest good for the family and the clan. It was families that brought a couple together and therefore they had an interest in helping them stay together. This value we must also recover.

MercatorNet: What does the African family need from the rest of the world today? We know what it’s had during the past 20 years or so, which is lots of condoms …

Dr Ogola: We don’t want any more of those! What we need is stated in the Millennium Goals adopted by the United Nations and highest on that list is the eradication of extreme poverty. If you reduce poverty you reduce AIDS in an exponential manner, because AIDS is a disease that is driven by poverty. Poverty does not cause AIDS but it worsens it and provides the conditions for its spread. The poor are prone to everything more than everybody else, so we must target poverty – especially poverty among women – and introduce laws that make it possible to make an honest and reasonable living. For me it is very clear that the fight against poverty is very high on the list.

That is a very complex economic issue, of course, because there are all sorts of things going on that impoverish the African farmer. They cannot compete with farmers in the West who are heavily subsidised. We have a saying that it is better to be a cow in Europe than a farmer in Africa.

On a very serious note, I think the West has to look at the millennium development goals and help Africa achieve them. They include health goals as well, for example the reduction of maternal mortality, diseases such as malaria, child mortality – all these have been laid out, and it is a matter of people looking into which of these goals they want to get engaged in. Whether they are health professionals or teachers or engineers, they all have a role to play in realising these goals. For me they capture in a beautiful way what needs to be done.

MercatorNet: Your life must be very busy with your very responsible job, your involvement with Cottolengo Hospice and your speaking engagements as well as a husband and four children. How on earth do you find time to write books?

Dr Ogola: Actually we have five children. My husband I adopted a girl, and now we are about to acquire two orphans from my extended family because I have lost three first cousins and their wives so we have 10 orphans to look after in the extended family. So we will soon have six children in the house – the seventh is my daughter who is at university in South Africa. So though I am past the age of child-bearing my family continues to grow! And that is the story of everyone in Kenya today – you have orphans that you are taking care of because they have nowhere else to turn.

Cottolengo Hospice is something I do very much part-time to keep the clinical side of me alive. But being in charge of Catholic health services in Kenya is a very tough job because, as I said, we reach 10 million patients a year in 410 health units.

As for the books, for me writing is a form of relaxation, and since I sleep very poorly I tend to write at night, when the world is asleep, although when I wrote The River and the Source, it was when my children were younger and I had more time.

I am not trained as a writer. I did literature only up to fourth form, but I have a great family tradition of story-telling. I think it rubbed off on me from my mother. So this book is the distillation of some of the stories my mother told me about her own life as a child, which is at the same time the common history of the African woman, and this I think is why so many people identified with the book and made it such a runaway success. The publisher and myself have never quite recovered from the shock of it. I have written a couple of other books but they have not done as well.

MercatorNet: Are you hopeful that Africa and its families can overcome the great problems they face?

Dr Ogola: Yes I am very hopeful. Perhaps there is some problem with my brain! Someone once attacked me because my book was so full of hope, and I hadn’t realised that. Considering everything that has happened in the last 10 years, and the awareness that exists in the world now about the plight of Africa and the impact of HIV/AIDS, and the good will and the funds that are beginning to come in to do the right things, not just dish out condoms, but to provide care and support, to provide care for hungry children, to provide clothing so that they can at least go to school decent and look like other children – all these things are beginning to happen. And when everybody is concerned, surely human ingenuity can defeat any virus. We will defeat this one just as we defeated smallpox and polio and all the others.

So I repeat, I’m full of hope. Good things are going to happen in the African continent. We have beautiful people and we have a lovely and very wealthy continent which is completely untouched.

Carolyn Moynihan is deputy editor of MercatorNet

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