Fighting AIDS by bolstering African families

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

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
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

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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  • Margaret Ogola