Catholic
Pastoral care as a response to the HIV/AIDS pandemic in Southern Africa
(Journal of Pastoral
Care & Counseling 57,2
(2003) 197-210.)
Stuart
C. Bate, D. Th.
Professor
of Religious Education and Pastoral Ministry
St
Augustine College (Catholic University of South Africa)
Johannesburg
PO Box 44782
Linden
2104
South
Africa
Recent
estimates suggest that more than 10% of Southern Africa is HIV+. This article
is based on a research study of sixty four pastoral care projects focussing on
the HIV/AIDS pandemic in Southern Africa. The projects, which fall under the
auspices of the Southern African Catholic Bishops’ Conference AIDS office,
focus on both education for HIV prevention and the pastoral care of people
living with HIV/AIDS (PLWHA). The article recounts the results achieved by
these projects over the last two years discussing
their strengths and weaknesses and proposes some recommendations for
further action. Finally the author discusses the pastoral and theological
dimensions of these pastoral services indicating the importance of
socio-cultural mediation in pastoral responses.
Thembelihle
Dlamini has just died of AIDS. Her first name means ‘beautiful hope’ but
now she is one more victim of this major pandemic in Southern Africa.
South African government figures recently reported that approximately
4,2 million South Africans are already infected1. This is more than ten percent of the population. The situation in the
surrounding countries is somewhat similar.
Thembelihle was a Catholic. However the Catholic Church was initially
quite slow in its response to the crisis “influenced by socio-political
realities, by ethical dilemmas, and by an inability on the part of church and
community leadership to recognize signs of impending calamity”2.
But now things are improving and in 2000, the Southern African Catholic
Bishops’ Conference (SACBC) established an AIDS office to coordinate and
oversee the various pastoral projects set up to respond to the pandemic.
In
2002 I was asked to provide a report on the impact of the Catholic Church’s
response to HIV/AIDS in Southern Africa3. In collaboration with the SACBC AIDS
office, a questionnaire was developed for use by a team of independent
evaluators who were to visit the various projects. The questionnaire was
designed to access both quantitative data on the various types of activity as
well as qualitative responses to issues emerging. Many questions were kept
open ended to achieve the latter. In this way the research tool had both
positivist and phenomenological aspects4.
The questionnaires were completed by the evaluator during an interview
session with the project leader. For this reason evaluators had to be
experienced in the work themselves and this was achieved by choosing them from
amongst experienced staff members of the larger and more established projects.
Results
Penetration
By
2002 there were eighty different HIV/AIDS pastoral care projects operating
under the auspices of the SACBC AIDS office or receiving funding through it.
These cover three Episcopal Conferences: The Namibian Catholic Bishops’
Conference, the Lesotho Catholic Bishops’ Conference and the Southern
African Catholic Bishops’ Conference (South Africa, Botswana and Swaziland).
For various reasons only sixty four projects participated in the study. They
are operating in South Africa, Lesotho, Swaziland and Botswana. South Africa
has 91% of the total population of these four countries. The projects are
relatively evenly spread throughout the region. Almost every diocese has at
least one HIV/AIDS project. Thembelihle was a beneficiary of one of these
projects before she died as we shall see later.
Capacity
The
vast majority of the projects are new. More than two thirds were established
since 1998 and 15 since 2001. There
are 475 full time workers. Five large projects employ more than twenty five
workers each. Together they account for 236 of the full time staff. They are
institutions providing hospice, orphanage and clinic facilities or a
combination of these. Thirty nine medium level projects work with a small
number of full time staff and volunteers providing a variety of community
services. Twenty small scale projects are run by volunteers only.
Activities
and services
The
evaluators were asked to determine the programmes and activities of each
project. They found a great diversity of activities but four very common ones:
Home based care, Orphan care, Counselling and Youth education. Two principal
goals of these activities were identified: pastoral care of victims and the
promotion of awareness and education about HIV/AIDS within the larger
community especially youth. Projects render a large variety of services but
there are six big ones. In
numerical order these are: home based care services, counselling and guidance,
work with orphans and abandoned children, hospice or clinic services,
education and training, and,
finally, projects which provide some material help for people. Other services
include paralegal guidance to help people access benefits and state services,
children’s art projects, abuse prevention, and advocacy and lobbying for
people living with HIV/AIDS (PLWHA) to government and society.
Forty
four of the sixty seven projects have a component concerned with home based
care (HBC). A very large number of people suffer from numerous AIDS
related sicknesses yet institutionalization of the sick is only possible for a
few. Home based care projects focus on training families to look after the
sick person at home. Volunteers are also taught how to visit the families on
an ongoing basis in order to provide assistance and training in primary health
care and nutrition, as well as to help with more serious health issues.
Thirty one projects provided quantitative data giving a total of
7559 families reported as being visited on a regular, usually weekly,
basis in home based care activities. Thembelihle was one of these. When she
lost her source of income in the city she came back home to her ancestral
village. As she began to get very
sick, the family didn’t know what to do. Luckily they had heard about the
group of people who did home visiting of sick people and contacted them. Home
based care workers visited her, showed her family what to do to help her, and
came periodically to check up on her during the last few months of her life.
When
she died, Thembelihle left two small children behind: Musa, a five year old
boy and his sister Lindiwe. These are just two more in the upsurge of orphans
and other vulnerable children resulting from the continually increasing number
of deaths from AIDS. Faced with this reality a number of the projects have
tried to introduce some form of orphan care and by 2002 twenty six of the
projects had set up some response to this need. Some have been able to develop
institutions such as orphanages and care centres. But the principal thrust is
in promoting the placement of children within a family environment. In some
cases the extended family is happy to take the children as has happened with
Musa and Lindiwe. If this is not possible they search for a foster family
within the clan or, if necessary, look for foster care elsewhere. Only eight
of the twenty six projects provided figures giving a total of 620 orphans or
other vulnerable children being placed with families or in other forms of
care.
A
third major area of pastoral care of PLWHA is in the provision of counselling
services. Twenty four of the projects are active in this area. Post test
counselling is essential for those who receive confirmation of HIV positive
status and ongoing counselling of both PLWHA and their families helps people
to cope with their situation. A few projects, especially in schools,
have begun training young people as peer counsellors. Youth discuss
sexual matters with their peers and the presence of some young people with
training helps in awareness of the relationship between HIV and AIDS as well
as in providing some input about alternatives lifestyles to avoid the dangers
of promiscuity. Only three of the projects provided figures giving a total of
415 people having received some form of counselling.
In
most Southern African cultures, issues of sex are taboo and not discussed in
normal company. Thembelihle never heard about HIV and AIDS and its link to
sexual practice until after she was HIV positive. Preventative care demands
the education of youth around sexuality and sexual behaviour as well as
promoting awareness regarding the HIV/AIDS pandemic. Thirty four of the
projects are responding to this need in youth education or awareness
programmes. Many focus on education and training for lifestyle change,
promoting behaviour which is compatible with Catholic teaching and which will
avoid infection. These programmes do not promote condom usage and stand in
contradistinction to the government and a number of other religious
organisations which support the “ABC” campaign which promotes Abstinence,
Being faithful to one
partner and the use of Condoms.
The Catholic Church is promoting an “ABCD” campaign where A stands for Abstinence
outside of marriage and B for Being faithful within it. C, however,
stands for Change your lifestyle through correct moral choices which
people should make in life and D for Danger of contracting HIV/AIDS.
The campaign has reached most tertiary institutions of South Africa, all
Catholic parishes and all Catholic schools. Many have criticised the
anti-condom stance of the Catholic Bishops as being too idealistic5. But the
message of condoms in a society of high sexual promiscuity may give a false
sense of security to people and “permissive
and irresponsible behaviour has to be addressed if any impact is to be made on
the spread of HIV infection”6. Other initiatives in education and training
include the provision of AIDS
awareness programmes and skills training, especially of volunteers, in areas
like home based cared, primary health care, income generating projects and
counselling skills. Not all, the projects quantified their results. From the
majority that did we know that 450 different courses were held during a twelve
month period. 313 were skills training courses of which ten were ongoing and
114 AIDS workshops were held.
The
fourth main area of activity was in the provision of socio-economic services.
Seven projects provide access to poverty relief through food distribution.
Many families are provided with regular food parcels. Another popular approach
to this problem was the establishment of
income generating projects. These included initiatives such as
community gardens, and small scale production of various artifacts like
candles, textiles, and even coffins for low cost funerals. The project in
Thembelihle’s area has set up a small scale community based farming
operation.
Strategies
and approaches
There
are a number of different pastoral strategies adopted by the projects.
Institutional
Some
have opted for the more traditional institutional approach. This involves
setting up a resource within the community which provides medical expertise
and caring skills for those who can make use of the service at the site of the
institution. These hospices, orphanages, clinics and caring centres do vital
work in a society where the State is not yet able to provide these services to
all people. In some cases
existing institutions have set up an HIV/AIDS caring component.
Community
based
The
large numbers of people infected and affected by the pandemic means that there
will never be enough resources to provide institutional services to all people
especially those in the more disadvantaged regions of Southern Africa.
A community based pastoral response offers access to greater numbers
especially in the more disadvantaged areas. It focusses on bringing the
community on board in the planning and execution of the pastoral services.
Twenty eight of the projects have gone this way. Some, including the one near
Thembelihle’s village, praise the enthusiasm of those communities which
provided volunteers to help
achieve the project’s goals. Others established support groups for the
project within the local community. Some have described how effective
education of people in the community has helped reduce the stigma of HIV
amongst people. This allows patients to be more open about their HIV status.
Greater awareness helps to break the powerful silence and shame which
surrounds HIV/AIDS in most Southern African communities. A community based
approach to pastoral care also builds good relationships with local health
authorities and clinics. But there are sometimes difficulties. The Sisters who
set up the AIDS project near Thembelihle’s village went there because it was
in an area of high HIV prevalence according to figures supplied by the local
clinic. When they first arrived they contacted the local leaders to explain
what they wanted to do. They were surprised by the response of the elders of
the area that HIV/AIDS was not a big problem there. The real concern was
poverty and the provision of jobs. Initial community support for the project
was only obtained when a poverty
relief component was introduced into the services provided.
Goal
changes
A
question was asked about how goals had changed since the project began. Just
under half the projects indicated that they are still working to achieve the
goals they set themselves initially. However,
slightly more than half declared that they had modified their original goals
as a response to pressing needs emerging in the course of their work. Two
principal changes were reported. The
first was the introduction of new goals responding to the reality of AIDS
orphans and other vulnerable children. Fourteen projects had incorporated this
kind of work as they found this need to be much greater than was initially
envisaged even though it was one of the four principal services provided by
the 65 projects in the original goals.
The
second goal change was in response to the situation of abject poverty on the
ground. A few projects initially envisaged a poverty relief component as an
essential aspect of their work but the majority preferred to focus their
efforts on providing care which directly responded to the HIV/AIDS crisis. But
most, especially those working in rural areas, eventually found that there
work was impossible without a poverty relief component. A common problem of
AIDS patients, is the lack of adequate nutrition which rendered both
medication and other aspects of care almost ineffective. The socio-economic
level of the people being served by the projects was almost without exception
low. Adjectives such as “poor”,
“very poor”, of the “lowest level” and “very disadvantaged” were common. This level of poverty required strategies to change in order
to incorporate a poverty relief component in the pastoral care services.
Clearly these two goal shifts have meant additional work for the
projects and will result in the need for additional resources.
Use
of volunteer help
The
projects would not succeed without the large numbers of volunteers who work
for little or no recompense in day to day care of people. They have succeeded
in animating around 2500 volunteer workers and this can be seen as a major
success in the work that they do. All of them have enlisted some volunteer
work.
Strengths
of the projects
Those
involved recognize many strengths in what they do and perceive their projects
as fundamentally strong. There is a large amount of positive energy amongst
those involved and a deep belief in what they are doing.
The major strengths indicated were “people related strengths”,
“organisational support”, “care based outcomes through education” and
“management”.
125
responses point to the quality of “people support” for the projects
expressed in high quality staff, committed volunteers and support from the
local community. The largest number (45) saw the support of the local
community as their greatest strength, a sign that people around them recognise
the value of their work. This was closely followed by the “quality of the
staff” involved in the projects (43). Almost as many responses (37) pointed
to the volunteers involved in the project as a major strength. The quality of
human resources involved in these services is also a tribute to the ability of
project leaders to access dedicated, effective
and committed people.
Sixty
four responses point to a high level of organisational support from other
institutions or stakeholders. Twenty two referred to the support from the
Church whether through the Bishop or the local parish. Sixteen referred to the
support of professional health care services such as hospitals, clinics and
professional health workers. Twelve spoke of the support received through
government institutions like health, welfare and other departments. Eleven
responses indicated that networking with other groups and organisations was a
strength for their project. Some mentioned the essential support of funders.
Training
for effective pastoral care was recognized as another strong area. Thirty five
responses recognised how training and education had improved the quality of
care given especially home based care. Twenty three responses indicated that
training local people had empowered them to respond to the pandemic rather
than be victims of it. Training had also been valuable in the setting up of
income gathering projects and providing poverty relief. Twenty three responses
referred to the location of the project as a major strength. For some this
meant that the project was situated amongst the people giving them easy access
to it. For others, especially hospices and caring institutes, the issue was
about the tranquil surroundings in which one could recuperate or die with
dignity. Finally, eighteen
responses mentioned the quality of management
which has allowed some projects to become sustainable if present
resources are maintained. Others noted that a model has been developed which
can be effectively replicated elsewhere.
Weaknesses
When
asked what were the weaknesses of the projects, project leaders referred
either to failures experienced in trying to make the project effective or to
difficulties being encountered. Failures are clearly more serious since they
point to areas of difficulty that those involved feel they cannot overcome.
Happily there were many more reports of difficulties (265) than failures (36).
Failures
The
greatest areas of failure were the lack of funds (7) and transport problems
(6). Funding failures were often linked to the highly prescriptive approaches
of some donor organisations which are only prepared to make funds available
for certain tasks. Once in the situation, project managers find that the
reality is somewhat different and priorities have to be rearranged to meet the
needs discovered. When funds are not made available for these needs the whole
project suffers. Transport failures occur when infrastructure is poor and
vehicles are unavailable. Other failures resulted from the social context of
people since local communities generate their own issues which can inhibit the
work of a project. Village divisions and rivalry often exacerbated problems of
caring for all people. Such rivalry has even led to the withdrawal of
community support for the project. Another problem was the lack of male
involvement. Males occupy leadership roles in rural culture and their support
is often critical for effectiveness. Culture can also militate against the
ability of young people to care
for the elderly. It is culturally unacceptable for young people to have the
kind of intimate contact required to care for terminally ill patients when the
person is elderly. This problem is easily overcome in a caring institution
like a clinic, hospital or hospice where the cultural environment is very
different and where the sick person is cared for by strangers. But in rural
areas where the people are known to one another, the taboo may become an
insurmountable obstacle to the work.
Difficulties
The
265 difficulties fell into twenty two different categories mainly influenced
by the different kinds of contexts within which the projects operate. However
half the responses (52%) were in five principal categories. These were
“transport difficulties” (32), “volunteer difficulties” (27),
“obstacles generated by government structures” (25), “obstacles
generated by HIV/AIDS stigma” (23) and “obstacles generated by lack of
support of local communities” (21).
Transport
The
most serious weakness seems to be
the lack of transport whether to reach patients, take patients to clinics or
hospitals or get people to training events. Bad roads in some rural areas
exacerbate this problem. Transport is a major obstacle holding back a lot of
the work. Workshopping the problem among stakeholders might lead to some
creative solutions.
Volunteers
The
second most commonly reported difficulty results from problems generated by
the attempt to work with volunteers. Whilst volunteer commitment was one of
the greatest strengths of the programmes it is clear that the system also
generates some problems. The work can be dangerous and is often stressful.
After an initial enthusiasm volunteers may tire. Often they volunteer with the
hope of possible future employment. Sometimes they suffer the taunts of their
peers who ridicule them for working for nothing.
The government does provide cash incentives for registered volunteers
but there are many problems involved in registering people and often
government bureaucracy makes any formalizing of projects difficult.
Government
Obstacles
generated by government structures is the third most important weakness
reported by the projects. Twenty five (almost half) report some difficulty
here. These problems were only reported with regard to the South African
government and not the other countries in the region. This matter is most
discouraging when one reads about this government’s stated commitment to the
struggle against HIV/AIDS. The most serious problem seems to be bureaucratic
obstacles. These prevent the
registration of projects so that they can receive State incentives. Another
obstacle created is in preventing victims from registering for welfare grants.
Thembelihle was never able to get a welfare grant for her children because the
official required the father’s birth certificate. Now the father of Musa and
Lindiwe was a miner who used to visit Thembelihle when she was staying in a
squatter camp in Johannesburg. He made empty promises about marriage but
nothing happened and when he found out about her condition he disappeared so
she cannot get this certificate and cannot get the grant. Problems like this
are the norm rather than the exception in many areas so most people who
qualify don’t get the grant.
Another
problem is that some government welfare bodies such as clinics and social
welfare offices are not supportive of collaboration with the Church and renege
on promises made. Some of the projects staffed by white people spoke of an
anti-white ethos in some government structures. Clearly there is a need for
the SACBC AIDS office to liaise with relevant government structures to attempt
to deal with these problems on a more formal level.
Stigma
A
fourth area of weakness is that generated by the stigma of HIV in communities
and the attitudes of denial, disbelief, and fear, which surround it. This is
an ongoing cultural problem, which must be tackled by continuing education and
HIV awareness campaigns. People like the elders in Thembelihle’s village
when the Sisters first arrived prefer to pretend that the problem doesn’t
exist and the lack of community support for the projects in some areas may
well be tied up with the question of HIV stigma. Sometimes a sense of
demotivation may pervade impoverished communities which makes people unable to
help themselves and leads them to wait in misery for someone to solve their
problems.
The
Church’s response to HIV/AIDS
Project
staff were asked to evaluate how their programme has “enhanced the response
of the Church in Southern Africa to the HIV/AIDS pandemic”. The responses to
this question were very varied and so two different hermeneutic lenses were
applied to interpret them. The first approach was to look at the responses
from the perspective of “agency” whereas the second was in the nature of a
“values analysis” of the response statements.
A
Church agency
This
is a praxis based analysis which looks at what kind of activity is perceived
as “Church activity”. We might expect that an analysis of the responses
made would reveal a number of different “visions” or “models”
of what the Church is and
what the Church does. And this turned out to be the case.
Obviously these models could be reflective of the views of either the
evaluator or those involved in the project or both. Nevertheless, it is useful
to examine them as they reveal the kind of theologies which are operating at
project level. We can then compare them to the Gospel and the teaching of the
Catholic Church to discover what kind of evangelisation or catechesis may be
needed in Catholic HIV/AIDS
projects.
The
most popular understanding was to see the Church as the agent of the
project’s response to HIV/AIDS. In other words the project represented the
Church in action. There were forty such responses which reflect many verses of
scripture as well as Vatican documents like Gaudium et Spes and Apostolicam
Actuositatem7. They highlighted the compassion and care of the Church in
the community through its service to people at grass roots level. A number of
responses noted that the Church was the only body responding to this problem
in their area whilst others said that the Church had initiated a greater
community response to HIV/AIDS. The next highest group of responses concerned
the role of the Church in promoting sexual morality amongst people and in
responding to the simplistic “condomising” message of others through its
ABCD programme. This is clearly in line with the Church’s moral teaching and
the 2001 SACBC statement on HIV/AIDS8. There were 22 responses highlighting
this area of Church agency. Fourteen responses emphasised that the Church was
not an NGO9 providing a service for people but rather, that the Church was the
people: those Christians involved in the project and ready to respond to the
needs of those suffering in that place.
However,
another view saw the Church as an institution concerned just with spiritual
things. Fourteen responses presented a view in which the Church and the
project were two separate things. The project was providing a service in which
either “the Church was involved” or “the Church was being helped” in
some way. Here the Church appears to be equated to a purely “religious”
entity: the priests and sisters at the mission where we go on Sunday. The
Church in this model is seen as “them” as opposed to the “we” of the
project. This view is also present in the eleven responses to the question
about the role of the Church which focussed exclusively on the commitment, or
lack of it, by priests, bishops and nuns. Such a view could perhaps be
summarized as “the Church is
the bishops, priests and nuns”. This
view is clearly not that of Vatican II and suggests that some work needs to be
done to promote a more Gaudium et Spes vision of the Church and its
praxis amongst certain stakeholders.
Catholic
agency and Ecumenical
agency
Ten
comments referred to the specific Catholic nature of the projects indicating
how the Church is seen as supportive and caring amongst some communities they
serve. However, more comments (13) focussed on the ecumenical dimension of the
work and in particular how the projects have promoted interdenominational
cooperation. This is a pleasing trend as merely sectarian approaches will be
less effective than those emphasising collaboration.
Prayer
and worship
Finally
a very disappointing number of comments focus on the importance of prayer and
worship. It is difficult to detect from many of these projects whether this
specifically Christian contribution is being pursued at all by these
Christians. It appears to be a disappointing lacuna in this work of the
Church. Recent scientific studies
have shown that religious factors have a positive effect on healing.
In the USA, the National Institute for Healthcare Research published a
series of three volumes between 1993 and 1995 collecting together medical
research on spiritual subjects10. It was shown that
“most of these studies indicate a positive benefit for religious
commitment”11 including improved general health, reduced blood pressure,
improved quality of life in cancer and heart disease patients, and most
importantly, increased survival. Harvard Medical School’s conference on
“Spirituality in Healing” provided studies showing the clinical benefit of
religious practices like prayer and worship12. These studies, and others like
them, allow us to venture that medical science is also now beginning to
recognize the operation of clinical factors in religious healing. It is thus
disappointing to see an absence of such an approach to healing in Church based
organisations which appear to run the risk of becoming too secular in their
approach. In a deeply religious society like Southern Africa, people may come
to Catholic pastoral services just for their material well-being and go to the
“healing churches” such as African Indigenous Churches and Pentecostals
for their spiritual needs.
Education
is needed on the effectiveness of faith, worship and prayer on physiological
curing and psychological well-being. Education is also required on the
difference between curing and healing13 so that programmes can be developed to
enhance the promotion of effective Christian healing services and rituals for
those who are chronically and terminally ill. Pastoral care programmes for
those infected and affected by HIV/AIDS are required.
B
Values analysis
The
values analysis of the Church’s response to HIV/AIDS showed a similar
picture with regard to worship and prayer. It is in ninth place out of the
twelve values identified with only four responses. The greatest number of
responses focus on the value of “involvement in the struggle against
HIV/AIDS”. Twenty five responses note that the Church is committed, in a
“practical” and “vital” way, to respond to the suffering caused by
HIV/AIDS. In this way, the Church is perceived as being an active participant
in the transformation of society through involvement with people in especially
difficult situations.
Twenty
five responses support the value of “promoting sexual morality” and were
actively affirming Church teaching in this regard. Their support was manifest
in promoting the ABCD programme of the SACBC and in educating people in the
values of abstinence and chastity. They noted the importance of countering the
facile solution of condomising proposed by other players. Some noted that the
Bishops’ stand on some of these matters had been challenging for them in
their work with others who could not accept this position.
Fourteen
responses refer to the value of “service” that the projects provide for
the community. This is well in line with the pastoral plan of the SACBC which
sees the Church in Southern Africa as a “community serving humanity”14. A
similar number of responses affirmed the value of the “hierarchical
structure” in the Church, noting in particular how the commitment of
sisters, priests, bishops and diocesan structures manifests the presence of
the Church in the world. Twelve responses substantiate the values of “care
and compassion” in the work of the projects as key values the Church was
manifesting. Ten referred to the value of “cooperation” and in particular
to ecumenical cooperation in the work the projects carried out. The other
values affirmed had fewer responses. Five noted the value of “support”
saying that the Church was supportive of their endeavours. However, the same
number of responses suggested that the Church still needs educating about the
challenge posed by HIV/AIDS.
Discussion
Elsewhere
I have defined ministry and Christian pastoral action as “culturally
mediated Christian praxis responding to culturally mediated human needs”15.
The socio-cultural component of HIV/AIDS ministry is particularly
important. This is because of the many ways in which social matters impinge on
the etiology of the syndrome. HIV is more easily contracted in contexts of
poverty, ignorance and social disorganisation. This is one of the reasons why
it is so prevalent on the African continent. Cultural factors also compound
the suffering of those living with AIDS. It is highly stigmatised both in the
Christian context where it is identified with sinful behaviour and in the
African traditional context where it is linked to witchcraft16.
Those working to respond to the pandemic have discovered how important
it is to listen to the people they work with and those in their local social
network. Listening helps the pastoral worker to understand, together with the
people of the place, exactly how it is that needs are culturally crystallized.
In the same way it is important to allow the Holy Spirit to come upon (cf Lk
1:35) each human context in order that Jesus may pastor to his people.
Christian pastoral praxis defines the body of Christ in which the ministering
Jesus lives. If pastoral praxis is to be God’s work it must be perceived as
being of service to the people. Those who come from outside the culture have
to be very careful not merely to impose the solutions that seem sensible to
them. The diverse mix of projects that have emerged in the Catholic AIDS
effort seems to reflect some cooperation with local views. Western
institutional approaches can be very powerful in dealing with urgent medical,
material and some psychological needs. But the community based projects, which
may respond more directly to the cultural concerns of the people on the
ground, are essential to respond to a situation as prevalent as HIV/AIDS is in
Southern Africa.
This
study has shown that the vast majority of the projects funded through the
SACBC AIDS office are doing wonderful work throughout Southern Africa. They
are established in contexts of great need and are doing their best to respond
to the need as they find it. Taken together the projects demonstrate a
multi-pronged response to the various challenges posed by HIV/AIDS. Sterling
work is being done in the area of HIV awareness
and disease prevention. There is a good focus on youth and on promoting
behaviour change amongst the youth within a coherent and practical lifestyle
vision. Many projects are providing various levels of care for the infected
and the affected with a pleasing emphasis on the development of home based
care programmes which involve family and the local community in effective care
of the sick and dying. Some resources are also employed in more traditional
caring institutions so that those who have no one to look after them can find
somewhere to be cared for or to die in dignity. There is also an increasing
response to providing services for the increasing number of AIDS orphans and
other vulnerable children. In undertaking this processes of evaluation, I have
been most impressed by the commitment, ability and dedication of those
involved in these projects.
Of
course there are still weaknesses. Revealing them does not ground criticism,
but rather challenges further development to make the projects stronger and
more effective. Many are already doing a lot to deal with their own weaknesses
and to improve the quantity and quality of their services. Many
recommendations were made in the formal report. Just a few are given here. It
seems that the greatest need is in the rural areas and more projects are
needed here. Given the socio-economic situation of rural areas, it is clear
that projects without a poverty relief component will not be as effective.
Transport is a major obstacle holding back a lot of the work and there
is need for some creative reflection probably on the Southern African regional
level to try to workshop some solutions for this problem. Some obstacles to
the work of the projects seem to be generated by government structures.
Liaison with the State is important here so that these problems can be
resolved on a more formal level. Donor organisations are also a source
of some difficulty. They need to be helped to see the importance of openness
to the methods and strategies adopted on the ground in order to provide a more
effective service. Some funders are highly prescriptive on how they wish their
money to be spent. Whilst this may help them in being more accountable to
their donors, it is not sufficiently accountable to the context of those
attempting to solve the problem on the ground. A number of projects have
complained about this problem.
The
two principal personnel matters concern the care of those involved in the
caring ministry and the question of volunteers. It is clear that some form of
“care for carers” is needed. Caring work in this field is extremely
stressful and draining. Programmes are needed to meet this need. Issues
surrounding the recruitment, use, training and recompense of volunteers in the
projects must be discussed by all stakeholders. Guidelines and resources must
be set up to prevent this promising system collapsing through a failure to
respond to the difficulties it generates.
On
the level of spiritual healing, more education is needed on the effectiveness
of faith, worship and prayer in physiological curing and psychological
well-being. Whilst the disease is not curable, pastoral care can mediate
various forms of healing to these patients on the emotional, spiritual and
psychological levels17. Programmes should be developed to show how to conduct
effective Christian healing services and rituals for those who are chronically
and terminally ill.
Conclusion
After
a slow start the Catholic Church is now making a powerful response to the
prevention of HIV infection and the care of PLWHA throughout the Southern
African region. Commitment is found on all levels, from bishops, many of whom
have a hands on approach to ordinary Christians in rural areas who volunteer
their services for the care of their neighbour. Eighty projects in a few short
years is a good start but it merely scratches the surface of this enormous
plague which infects so many and affects all of us. Thembelihle has died of
AIDS and her children are orphans. The body of Christ is HIV positive. Jesus
is with his people but more helpers are needed for the vineyard so that the
beautiful hope may be realized.
(Footnotes)
1
South African Minister of Health, Dr Manto Tshabalala-Msimang, 18 April 2000.
A figure closer to 5 million is given in “The Barcelona Report: The Report
on the Global HIV/AIDS Epidemic” (Geneva: UNAIDS, July 2002).
2
Alison Munro, “Belated, but powerful: The response of the Catholic Church to
HIV/AIDS in five southern African countries”. Proceedings
of the XIV International AIDS Conference,
(Barcelona, Spain, July 7-12, 2002. Monduzzi
Editore, MEDIMOND Inc), p. 399.
3
Stuart C. Bate. “Independent Evaluation of HIV/AIDS projects funded through
SACBC”. (Johannesburg, St Augustine College of South Africa 2002).
4
G. K. Huysamen, Methodology
for the Social and Behavioural sciences. (Johannesburg: International
Thomson Publishing, 1994).
5
A Message of Hope from the Catholic Bishops to the People of God in South
Africa, Botswana and Swaziland (Pretoria, Southern African Catholic
Bishops’ Conference, 2001)
6
Munro, ibid.
7
Gaudium et Spes is the Vatican II document on the Church in the modern
world. In §43 it stresses the role of all Christians in Church activity. Apostolicam
Actuositatem is the Vatican II document on the role of lay people in the
Church and in § 10 it makes a similar point.
8
See note 4.
9
Non-Governmental Organization.
10
Dale Matthews, David B. Larson, and Constance Barry,
The Faith Factor: An Annotated Bibliography of Clinical Research on
Spiritual Subjects Vols 1, 2, 3. (Rockville, MD: National Institute for
Healthcare Research 1998). The idea was to provide a collection of clinical
abstracts of research carried out using the medical model and the scientific
method showing the influence of religion on medicine and psychology.
11
Dale Matthews, The Faith Factor ( NY: Viking 1998).
12
The conference “Spirituality and Healing in medicine” was held in Denver,
Colorado from March 19-21 2000. Details of the effect of prayer on healing are
available at the templeton.org website.