Uitgelicht

Aids programmes should be sensitive to culture

Lianne Buitendijk on her work in South Soudan

In 2007, Lianne Buitendijk was sent to Sudan by GZB, a Reformed Dutch mission. Lianne works as a nurse in the Aids-programme of Christian aid organisation Across in the region of Adol, South Sudan. She specialises in community health.

“Poor women are more vulnerable than any other group.”
“Faithfulness within a polygamous family is a provisional, halfway solution.”
“Aids programmes must have a long breath. Real solutions will only occur when habits change radically, by following Jesus.”
“The story of the Good Samaritan is a very important story to us.”
Care and awareness

My work is twofold: the HIV/Aids project and the natural medicine project. In the HIV/Aids project we mainly try to inform people about the dangers of the disease. It appears that there are not that many Aids-patients in the Dinka area where I work. But there is a taboo surrounding Aids, so perhaps numbers are higher than is now estimated. That is why we focus on awareness. We try to reach people through churches, schools and by establishing home care.

To start with the latter, this home care is primarily intended for Aids-patients, but since the problem is still rather hidden in our area, we have set up a system of general home care. You could compare it to the Dutch home care: we simply bring medical care to people’s homes. Patients suffer mostly from diarrhoea, malaria or pneumonia. Aids-patients deal with the same ailments, and that is why a well-running system of home care is of life-importance to them.

Schools and cattle camps

In churches and schools we work on “Aids awareness”, a preventive programme. We help young people from school classes think about life skills: how to reflect on their behaviour, how to make their own choices, be firm and communicate those choices. This way they will be less prone to give way to peer pressure. We do this programme mostly with teenagers (12-18 years old).

Cows are essential assets in Dinka culture. In the villages there is no space to keep cows, so the people jointly herd them in the cattle camps outside the villages. This task rests on the shoulders of the younger people; many of them are between 18 and 30 years of age. We try to raise awareness among this group as well, and we always end up having really interesting discussions with them.

Natural medicine

From plants and the bark of trees we extract natural medicine. We are developing an exemplary garden with medicinal herbs. We encourage people to look to their natural environment for solutions. This is of course the way medical care was done traditionally. What we have been preparing so far are remedies against diarrhoea, coughing syrups and medicine to strengthen immunity. These are all very important to people who suffer from Aids. But for the time being we are laying the infrastructure by providing general health care that can easily be modified to focus on Aids-patients. Antiretroviral drugs are not yet available in our region.

In our project we integrate fighting Aids and fighting other diseases. I suppose any organisation working in this field needs to ask itself this question from time to time: is our focus right and does it meet the needs of the people? A one-sided focus on Aids may come at the expense of other urgent needs, like care for patients with malaria. In Across we try to be comprehensive. That is why we chose to set up a general home care and that is why we are working on developing natural medicines.

Insecurity

The infection rate of our area is as yet uncertain. There are very few places where people can have themselves tested. UNAIDS estimates that 3-4 % of the population carries the virus, but this estimate is based on insufficient data. We fear that the real rate is much higher. But it is not yet visible, because few people are actually ill. We are still at the beginning.

The instable political situation in Sudan brings a lot of insecurity. Officially, this year elections were supposed to be organised, but they have been postponed to April 2010. In the year 2011 an official decision has to be made about the independence of South Sudan. It is hard to predict how things will develop in the near future.

Cultural sensitivity

Across tries to connect as much as possible to the prevailing culture and experience of people. Many other organisations have their programme and impose it on a group of people. But Across starts with the experience of people, in the natural medicine project, but also in raising awareness. An NGO could aim to distribute as many condoms as possible. But condoms are not accepted at all in traditional Dinka culture. Across tries to take that into account. We do not distribute condoms, but we carefully bring up the subject, especially among young people. We have no problem providing information, but we prefer to highlight faithfulness and abstinence outside marital life.

It is a tricky issue, in which we try to move forward cautiously. There are many different positions among Christians when it comes to contraceptives. Some are categorically against; others feel that under certain conditions there is no problem using them. An organisation like Across needs to take a stand and communicate it with sensitivity to the culture.

Vulnerable women

There is no doubt that women are generally more vulnerable than men: they acquire the virus more easily. Polygamy is the main cause. In general, women do not have a say in matters of sexuality. Men can easily force women into a sexual relation, even when they are not married. They may threaten women by saying they will make it impossible for her to get married or by saying they will not pay a dower (which is in this part of Sudan a number of cows). It is very clear that males dominate in sexual matters. They have the power to isolate women socially.

Add to the subordinate position of women the element of poverty and the result is a lethal combination. It may happen that young women are sent to the market with a litre of milk and a long shopping list. The litre of milk can never pay for all those items on the list, so she has to resort to other means to come up with the money to pay for her groceries. Sometimes prostitution is option open to her. So indirectly her family forces her into prostitution. “Go and sell your body; we need more groceries than this milk can buy.”

We try to make young women aware of their position, but in such a way that they do not immediately revolt against their husbands. It is difficult to get private talks with these girls, because their only language is Dinka. We need an interpreter and often this will be a man. That immediately creates an obstacle for open communication. In general, women enjoy fewer years of schooling than men do. Many of the older women in the community have never been to school. Thankfully things are improving and today it is quite normal for girls to go to school, but the drop-out rates are very high. Many of the girls are married off at a young age.

Stigma and acceptance

Missionary organisations must accept and embrace people suffering from Aids. Society often stigmatises them and excludes them. Among the Dinka people the belief that Aids-patients should be excommunicated is not uncommon. Some people even believe that those who are infected ought to be burnt! This is where there is much work to be done for missions. Basing themselves on biblical values they should emphasise care for one another. Love your neighbour, even your enemy!

I think stigmatisation is largely due to ignorance concerning the disease. There are all kinds of fairy tales in circulation, exactly because Aids is a disease that has to do with sexuality, and sexuality is taboo subject. When people get sick, others soon suspect them of promiscuity.

The dilemma of polygamy

In a situation of polygamy, soon an entire family may be infected. On top of that, a stigma may easily be placed on husband and wives, even if all of them are faithful within their given situation. Condemning polygamy categorically is obviously not the right way to deal with this problem.

Based on our Christian faith, we do bring up the subject of monogamy, but polygamy is very deeply rooted in Dinka culture. It is inconceivable that an outsider would come in and change this overnight. It will take years for such cultural patterns to wear off. That is why I plead for cultural sensitivity, which in this case means raising awareness within the context of polygamy.

Of course it is important to clarify the biblical message concerning marriage, but that does not mean that, within the given situation, we should not look for ways to prevent further spreading of the virus. So the message is: be faithful to your wives. Even when you have four or five of them, you can still be faithful. This approach fits in the policy of Across. Faithfulness in a polygamous situation is a kind of provisional, halfway solution. If four out of five wives are expelled, more harm is caused!

The Gospel and Aids

The way we bring up the Gospel varies according to the different programmes. In my work, I read and talk about the Bible in devotions, especially in our church-based programmes with pastors. Prayer is also an important part of those contacts. This may strengthen the message we try to convey considerably. In South Sudan this is a very natural approach as the majority of the population is Christian.

Churches in Adol and surroundings are sometimes exclusively focused on ethics. It is all about what is allowed and what is not. But people also need to know what Aids is and how to prevent and fight it. Growing knowledge leads to growing awareness. In addition we want attitudes to change by the biblical message of acceptance and inclusion, rather than stigma and exclusion.

The story of the Good Samaritan is a very important story to us. It helps us to show that the way of Christ is not to stigmatise people, but to love them. In South Sudan loving your enemy is a sensitive point, not in the least because of the Civil War that raged for 21 years here.

Long breath

Sometimes I sense that in Dutch churches there is not enough interest in the problem of HIV/Aids. I even feel that people are sometimes quick to pass judgment. Too quickly and too easily we associate Aids and promiscuity. So in the Netherlands, among Christians, we are also guilty of stigmatising Aids-patients. Churches hardly pay any attention to World Aids Day. I have learned that there is no easy solution to the problem of Aids. That is why I grew milder, less judgmental.

Missions should be aware of the complexity and the tenacity of the problem. Aids programmes must have a long breath. Real solutions will only occur when habits change radically, by following Jesus. It is a matter of conversion. This can only be a process that stretches over a long period of time. In policy and budget churches and missionary organisations must take this into account.