‘Normal death’

‘€œI think we’€™ve reached a stage where we think it’€™s normal. I’€™m burying people all the time and we are starting to think it’€™s normal,’€ says Bishop Hugh Slattery flashing a wry smile, almost as if he’€™s trying to soften the blow of his comment.

A short, earnest man with piercing blue eyes and grey hair, Slattery left his native Ireland for South Africa 49 years ago and settled in the Tzaneen area in 1984.

‘€œNow, when I ask girls who are 12 or 13 what their biggest fears are, they say their fear is getting sick. That’€™s surely abnormal,’€ says Slattery, who urged his diocese as far back as 1990 to prepare for the impact of AIDS.

Attending a Catholic AIDS conference in London in 1990, Slattery heard about the ‘€œdecimation’€ of Uganda.

‘€œI said to myself that it’€™s got to hit South Africa too and we tried to run awareness programmes, but people laughed at us. We got nowhere. Nobody was interested at the time,’€ recalls Slattery, who is adamant that the solution lies in promoting behaviour change and giving people hope.

‘€œThe solution ultimately lies in building family life and a sense of respect. We need to see AIDS in the context of making us a stronger nation. Maybe we need to say that what doesn’€™t kill us will make us stronger,’€ says Slattery.

Today, Slattery’€™s diocese serves a huge chunk of Limpopo province, from Musina on the Zimbabwe border, to Giyani bordering the Kruger National Park in the East, Dwars River in the west and Olifants River in the south. The 13 parishes include much of the former homelands of Venda, Gazankulu and Lebowa.

The church’€™s programme, Kurisanani (We help each other grow) is a faith-based response to HIV/AIDS using local people. Ironically, only two percent of residents in this area belong to the Catholic Church, but all people are assisted.

Focus programmes include Education for Life, a programme aimed at young people which teaches life-skills and abstinence-based prevention programmes, homebased care, the care of orphans and vulnerable children and an antiretroviral (ARV) treatment programme.

Before government started introducing ARVs for the sick, the church, spurred on by the spiraling death rate, initiated an ARV based response and today has more than 3 000 registered, around 2 000 on its programe and 600 on ARV treatment. This service is mostly concentrated in rural areas where health services are few and far between. The number of people able to access treatment is limited by fund restrictions.

But despite several interventions, the death rate is high and skewed towards younger people.

Danie Hartzenberg, Funeral Arrangements Manager at National Legal Aid, the biggest undertaker in the province, revealed that up to 450 funerals take place in Tzaneen on one weekend alone. Around 30 undertakers vie for the lucrative business around the small, bustling town which serves a large rural area.

Around Tzaneen, National Legal Aids buries anything between 50 and 90 people on a weekend and has more than 10 000 people as members of its various funeral plans.

‘€œWe can definitely see that the people who are dying are younger. We bury very few old people, most of the deceased are between nine months and 45 years old,’€ said Hartzenberg.

Mauritz de Bruin, who has been running the mortuary for the past 11 years, concurs: ‘€œIn the past we had mostly old people. Now it’€™s mostly young people in there,’€ he says, motioning to the four   white fridge doors behind him.

‘€œWhen winter starts, we bury a lot of babies,’€ says De Bruin, before scurrying off to help workers stack the almost 50 coffins needed for the coming weekend.

Duigan, who headed the church’€™s AIDS response from the start, believes that there is human suffering on a massive scale. ‘€œBut you have to focus on the positive. The negative side can really paralyse you and take your energy away leaving you feeling hopeless,’€ says Duigan, a plucky Australian nun with short cropped grey hair.

Dressed in a light blue blouse, navy skirt and sensible black shoes, Duigan is a down-to-earth and laughs easily, showing incredible rapport with the community members she interacts with. But her soft spot is clearly children. ‘€œI don’€™t think we’€™re providing enough for the children. We need more safe havens for the children. I’€™m afraid it’€™s going to be too late for some children.’€

Clutching the steering wheel of her Isuzu bakkie as she steers it into a glorious orange-hued bushveld sunset, Duigan lowers her voice, barely audible above the drone of the diesel engine: ‘€œIt really worries me. I am really worried about the girl children. We have a humanitarian crisis in our own backyard and we’€™re trying to respond as fully as we can. This is where we need to be.’€

Figures compiled from the 13 parishes reveal that caregivers visited almost 13 000 homes in 2006. Around 9 000 food parcels were distributed and 10 000 sick people visited.

Over 35 000 children in families received some form of support while almost 3 000 orphans were identified last year alone.

‘€œThe situation is abnormal and completely overwhelming,’€ agrees Sister Christine Martin, who heads up the diocese’€™s programme for orphans and vulnerable children.

‘€œThese children have had such trauma and they live with such a struggle to survive,’€ says Martin, a fellow Aussie who grew up with adoptive parents.

‘€œI can’€™t see child-headed households being the answer. Like children the world over these youngsters need adult mentors.

‘€œThese are children who are at home looking after terminally ill parents who are in terrible pain and for whom there is no relief in the form of morphine. You can find a person lying on a mat and a child trying to mop up the parent’€™s vomit and diarrhoea and soothe the high fever. Such children are witnessing the death of their parent. Their homes become child-headed households long before the parents finally die,’€ sighs Martin, tears streaming down her face.

‘€œSeeing a two, three-year-old sitting with the corpse of a parent’€¦,’€ she says, lowering her eyes to the floor.

Martin reveals that she can no longer do the daily ‘€œcoal face’€.

‘€œI fall apart emotionally at the coal face. I can’€™t, I just come home and cry. I just feel so distressed and powerless,’€ she says.

Martin is responsible for training caregivers who are every day faced with the scenarios she finds so tough to deal with. ‘€œI have realised I have to step back and support the caregivers. For them the pain is there every day and I can never reason out why or how they are able to keep going except that they are courageous and people of deep prayer.

‘€œThe most effective support I can be to them is to be there to listen, debrief and encourage.

‘€œIt’€™s all completely overwhelming. In any other kind of life you could just give up, but we can’€™t run away from it.’€

* Duigan can be contacted on 015-3074233 ‘€“ Health-e News Service.

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    Health-e News is South Africa's dedicated health news service and home to OurHealth citizen journalism. Follow us on Twitter @HealtheNews

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