Release date
March 03, 2008

Window to A Life

March 03, 2008, Obuasi, GHANA —

By Lane Hartill

Obuasi, GHANA — Asha* lies on a crumbling mattress on the floor in a sour-smelling room. She's waiting for Alice. She's waiting for her bath.

Asha is sick. She has HIV. Nobody wants to touch her or get near her. Except Alice.

Alice and Lydia, home-based-care volunteers

Alice and Lydia each care for two HIV-positive Ghanaians. They often use their own money to buy them breakfast or lunch. Photo by Lane Hartill/CRS

Alice has been coming for months, bathing her, counseling her. She even gets down on all fours and scrubs the peeling linoleum in the single room Asha shares with her mother and siblings.

Few people know she has HIV. If word got out, Asha's reputation in the community would be shot. That's why when I go to visit Asha with Alice, we speak softly in her apartment. The neighbors are sitting outside, eavesdropping. They are looking for clues about Asha's ill health. We whisper. They grow quiet. Soon all we hear is the rooster in the courtyard and a lady swishing clothes in a bucket.

On the mirror propped up beside Asha's bed, pictures show her pre-HIV in tight braids and black shades. Her husband is there, too, holding a bouquet of fake flowers. And so is her son, wearing rainbow-colored overalls.

Alice lies flat on her stomach on the sweaty sheets and dusts the mirror. Asha looks at the pictures that remind her of her former life, a life that she wonders if she'll find again. With Alice's help, she just may be able to.

Collaboration, Care and Support

Alice volunteers for the Community Collaborative Care and Support project, which was started — and is funded — by Catholic Relief Services. CRS partners with five Catholic dioceses in Ghana that have high HIV prevalence rates in their areas. The Church works closely with project volunteers.

Community Collaborative Care and Support project has one of the most comprehensive HIV programs in Ghana. Its volunteers counsel everyone from junior and senior high school students to waiters and hotel workers. The project pays exam fees and provides schoolbooks, schoolbags, stationery and uniforms to children orphaned by AIDS. It also works with HIV patients in 12 support groups — an increasingly effective way to teach them about the virus and help them keep up their morale. But most of all, the project's outreach workers respect and care about those whom the rest of society rejects.

Part of the problem, says Mary Akorli, CRS' HIV and AIDS point person, is that parents don't talk to their children about sex and abstinence. They are left to pick it up at school, from friends or on the street; they often get the wrong message.

"Parents' inability to talk to their children about sex is more cultural," says Mary. "Even where parents want to, most of them use concealing words."

The drumbeat of HIV statistics from Africa is overwhelming: More than 24.7 million people live with HIV in sub-Saharan Africa; one in four people in Lesotho are infected; 2.1 million Africans died of AIDS in 2006 (that's akin to the entire population of New Mexico dying off). Many Americans have become numb to the numbers. They can't wrap their mind around the scale or the depth of HIV's reach in Africa.

But when you meet Alice, you begin to understand.

She wakes up every morning at 4 and prepares banku for breakfast. The fermented corn paste is a staple here, and it's what she feeds the 12 children who live with her. Only three of them are really hers. Five belong to her brother-in-law who died of AIDS. The other four are from her husband's second wife, who fled when she learned he was infected with HIV.

When her husband fell sick, Alice didn't run. She stayed with him day and night. She changed his clothes, washed his sheet, and fed him.

'I Enjoy Helping Others Get Well'

"When my husband got sick, if I hadn't been around him he'd be dead," she says. "I enjoy helping others get well."

Alice scrubs the floor for Asha.

Alice scrubs the floor for Asha. Asha's mother used to take care of her, but now works in the market to be able to purchase medication for Asha. Photo by Lane Hartill/CRS

Back at Asha's room, Alice jokes with her about men in Twi, the local language. Asha doesn't talk much now, but it doesn't faze Alice, who just keeps prattling away.

Then she tenderly slips Asha out of her red nightgown and gives her a sponge bath. She brushes her teeth with Mega Fresh toothpaste and holds a cup to her lips. Asha spits.

Alice rummages through a pile of clothes at the end of the bed. With no closet, most of Asha's shirts, dresses and underwear hang from a beam overhead. Asha throws the outfit Alice chooses back in the pile, preferring to go with a striped shirt under a denim jumper. She doesn't go out anymore, but she still likes to look nice.

Then comes the best part: the warm shea butter. Alice lifts Asha's arms and kneads it in. Asha looks forward to it every visit — someone pampering her. It feels good on her sore muscles and joints, she says. It feels good to be touched.

Asha has been sick for a few months, and it's gotten to the point where she can't walk. Now it's up to Alice to encourage her to get up and try. Asha's mother used to take care of her, carrying her to the toilet, bathing her. Now she sells pito, an alcohol made from corn, in the market, hoping to make enough money to buy food and Asha's antiretroviral drugs.

But today, Asha's mother left no money for her and nothing to eat. It's one of the biggest problems for HIV patients: affording antiretroviral therapy — and the right kinds of food to eat with it. Without enough protein and the right micronutrients, infections are much more likely. HIV increases the body's demand for vitamins E and C, beta carotene, and zinc.

If HIV-positive Ghanaians continue to eat pounded yam with weak sauce — a staple for many here — the lack of antioxidants in the body may speed up immune cell death and increase HIV replication, leading to higher viral loads. HIV will spread through the body faster.

Her Sisters' Keeper

Alice knows this after caring for her HIV-positive husband. That's why she buys Asha a little something to eat — hot chocolate and bread — with her own money. It's a simple breakfast that doesn't cost much more than a quarter. But there's no loose change in this house.

Alice isn't paid to bathe Asha or the other HIV-positive women she cares for. She didn't have to go to the hospital when Asha was sick. Or be the one to break it to Asha's mom that she was infected. She did it on her own. She's so committed to her "sisters" that the customers at her hair salon have been grumbling that she's not around enough. Let them gripe, she says — she has her priorities.

"When I think of losing customers and appointments, I'm sad," she says. "But when I see the people, I can't help it. I can't leave them."

Alice snaps on yellow rubber gloves and pours disinfectant on the floor. Then she gets down on her knees and starts scrubbing. As she scrubs, she tells me why she does it.

"I feel satisfaction when they say God bless you," she says, "when they say thank you."

Her generosity is in her genes. She learned it from her mother, Alice says. Growing up in Wa, a city in northwestern Ghana, Alice would see her mom leave a bowl of food outside the house for strangers. She trusted them so much that she would leave the house with her guests still eating inside.

As Alice finishes washing the floor, the stale fug of the room is replaced by the sharp smell of a clean locker room. When she's done, she's pouring with sweat.

"People get tired," says Kate Boakye, the Community Collaborative Care and Support project assistant. "She doesn't get tired."

On her way out, when nobody is looking, Alice fishes around in a Calvin Klein pocketbook and then shakes hands with Asha. The exchange is subtle and smooth. They've done it before.

*All names have been changed.

Lane Hartill is the West Africa regional information officer for Catholic Relief Services. He has visited CRS programs in Burkina Faso, Ghana, Liberia, Nigeria and Sierra Leone. Lane is based in Dakar, Senegal.