HIV Caregiver in Chad: Counselor, Healer, Hero

By Lane Hartill

See that woman there, the one in the red shirt with her back to you? She just sold all of her plates and glasses and most of what she owns. That girl in the background? That's her 10-year-old daughter. She does the cooking now. And most everything else because her mom is sick: That's what she tells her, anyway.

The woman watches the neighborhood kids stare at her. She ignores them, looking off in the distance. They know what she has. Let them stare; she has other things on her mind. Like how in the world she's going to come up with $4. She could always sell her last big basin. Once that's gone, she'll own nothing of value.

For the price of a large designer coffee or two cans of soup, Mary could pay for her hospital tests. Once she gets those, she'll be eligible for HIV medicine. Until then, the HIV will eat away at her. Sitting there, her cracked feet tucked under her, she thinks about $4.

Now take your eyes off of her. Look at the woman next to her. She just rode up on a bike, pedaling at a stately pace. She has a serious face and warm brown eyes. See how calmly she looks at Mary? See how she leans into her? She doesn't take her eyes off her. That's Monique, a 56-year-old mother of nine, and a woman whose kindness hits you before she even opens her mouth.

At this point, she's all Mary has left.

Caregiver's Hospitality

People like Monique. They open up to her. It's the way she looks at them, the way she listens to them. Her voice is tender and soothing, her reactions genuine.

Don't tell anyone, but she's breaking all the caregiver/patient rules: She lets people with HIV stay with her when they come to Kélo, this town in southern Chad. They sleep in her mud-brick house, which has become a hostel for those in need.

Monique's hospitality is well-known among HIV-positive Chadians. One woman wore out her welcome by staying more than two weeks. "She was in paradise," Monique says, laughing. She ate meals with her every day, chatted with her, all while slowly draining Monique's savings. Monique never said anything, of course. She couldn't bear to kick her out. Food is hard enough to afford in the village where she lives. A hotel is out of the question.

For the longest time, Mary wanted nothing to do with Monique. She knew that Monique helped people with HIV. If her friends saw them together, they'd suspect she had the virus. But when her friends started abandoning her, when her husband died, she had nobody to turn to.

"When I was passing by on the street, she called me and called me and called me," says Monique.

That's when Mary, which is not her real name, told Monique her story through a cascade of tears.

She told her about her mother who lives in Nigeria, her trip there, the man she married. He died and left her with five kids to take care of. Her father, who remarried, has a wife who beat Mary; she didn't want her around. Mary's life is a shifting mess.

" 'The sickness of my husband has attacked me,' she told me through tears," Monique says. " 'I think about dying. I've sold my things to pay for the tests. I've even run to my uncle to ask for money, and he said, "Where am I going to get the money? All you have to do is go see Monique." ' "

But Monique's tapped out. She has scores of patients she helps. While she gives them what money she can spare, it's herself that she doles out without hesitation. That may be the most important thing Monique does: to be there for Kélo's HIV-positive residents. As a home-based care worker with Catholic Relief Services' partner, the Diocese of Laï, Monique is often the only person the sick can rely on.

Healing Friendships

Evidence is emerging that shows a link between friendship—like that of Monique and Mary—and improved health. While no studies have been done regarding friendship in HIV patients in southern Chad, the data from the United States is startling. A recent New York Times article quoted a psychology professor, Bella DePaulo, who works at the University of California, Santa Barbara. Her research has found that friendship influences health more than family members or spouses.

"Home care is viewed by people living with HIV as the only thing keeping them alive," says Sende Djangrang Epainete, CRS' HIV and AIDS program manager in Chad. He says HIV-positive Chadians have said, "Although we have been abandoned, the caregivers have become our fathers, wives, brothers and sisters."

Those living with the virus say the caregivers help. But food is essential.

"If you don't eat all day, you are going to fall sick," says Etienne Abadoussou, who works as an HIV counselor in Kélo.

Hunger is one of the biggest issues with HIV-positive Africans. More calories and certain vitamins are needed in order for the HIV drugs to be effective. That's why, twice a month, CRS is providing millet, beans, sugar and vegetable oil. This also represents a huge savings for those who are sick and can't work.

Without it, Etienne says, many would go hungry. And hunger, when you have HIV, is torture.

"You get the shakes," he says. "You shiver and have a headache." Etienne says trying to ignore the hunger pangs and scrape together money for food isn't easy.

Stigma and Poverty

Etienne is somewhat of a celebrity around here. He's HIV-positive and isn't afraid to show it. His work and public education about AIDS here since the early 1980s have made a difference. Three HIV associations are active in Kélo and the members enjoy strong support from one another. While the stigma still exists here, it's not as strong as in other countries, say those who work with the sick.

Poverty, however, isn't as easily overcome.

Poverty is the devil on the shoulder of those with HIV here. Chad has some of the worst water and sanitation infrastructure in the region, according to a 2004 demographic and health survey. Only 23 percent of young women are literate and unemployment is high. This forces many women into prostitution.

Kélo is a crossroads. Truckers from the north pass through here on their way to Moundou, the largest town in the south. The increase in oil workers in southern Chad, and the breakdown in traditional values during the civil war (1979 to 1982) and the chaotic years that followed, have given rise to a growing prostitution problem.

With no other work, young women lurk in Kélo's bars at night offering their bodies to pay the bills. This contributes to the HIV prevalence rate. Nobody is sure of the exact rate in Kélo. In a February 2000 study by Chad's National Program to Fight AIDS, the prevalence rate, taken from specific testing sites in Kélo, was 15.4 percent. In 2005, another national survey of three zones, including Kélo, found an HIV prevalence rate of around 6.4 percent. The rate for the country is about 3.5 percent.

Home-Based Care

Back at Mary's compound, Monique is helping however she can. She gets right to work stoking the fire and tidying up. She talks with three of Mary's children. Sometimes she bathes the patients. She reminds them to take their medicine, which CRS pays for. CRS also supports counselors like Monique, who has been working as a home-based care worker for the last five years.

"When you see someone suffering, it's like you are suffering," she says. "If I see someone like that who I help, I give them something. They say it themselves: [Monique] did this for me, [Monique] did that. That touches me."

Take Céline. "She couldn't even stand up," says Monique, squatting next to Céline, a round-cheeked woman who is rolling tourto, peanut paste that she shapes into long, elegant cigars. She sells each for a few cents in the market. It's not much, but Céline has her life back on track now, thanks to Monique's constant help and the HIV medicine. "You can't even tell she was sick," Monique says.

She walks over to a mud shed with a tin roof. This is where Céline was left to die, abandoned by everyone but Monique. Her life mirrored that of Mary's. Monique knows that if all goes well, in a few months, Mary will be smiling like Céline.

Lane Hartill is the West Africa regional information officer for Catholic Relief Services. He is based in Dakar, Senegal.