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 A Crushing Choice for Ethiopian Mothers With HIV
 
 By Emily Wax
 
   ADDIS ABABA, Ethiopia -- The young mother sat in the orphanage waiting room, a baby playing in her lap. At 22, Adelaw Astake had become so gaunt from illness that her dirty skirt was wrapped twice around her narrow frame and held up at the waist with rags.
 
 She was there to ask a dreadful favor.
 
 "I am dying," she told Addis Tamrat, the manager at Hope for Children International. "I want my child here at your place. He is too sick and no relatives will take him in."
 
 The baby, 15-month-old Sintayenu, had a purple lesion on his forehead. He had recently come down with pneumonia, and weight had been pouring off his body. He had not been tested for HIV, but Astake knew, and so did her older son, who is 6.
 
 "He's been kicking the baby, saying he doesn't want to catch the virus from him and get sick and die like me," Astake said.
 
 The fate of Astake and her infant son are part of a quiet calamity affecting hundreds of thousands of Ethiopian mothers and children. Although the country's overall infection rate of 4.4 percent for HIV/AIDS is far lower than those in countries such as South Africa and Zimbabwe, it has the highest rate of HIV-infected children in the world, according to a United Nations report issued in December. More than 200,000 Ethiopian children are living with HIV/AIDS, the U.N. report said. Every day, 70 babies are born from HIV infected mothers, and the Ministry of Health estimates that 750,000 children are without parents because of AIDS.
 
 Poverty and cultural taboos are largely to blame, health workers and government officials said. The society deeply shuns those living with HIV, and several landlords are in court in the capital for evicting HIV-positive tenants.
 
 Poor mothers often breast-feed their children, thus transmitting the disease, because they can't afford bottled milk or are ashamed to acknowledge their illness. When Tamrat gently prodded Astake about how her baby had become sick, the young woman said she had not realized she had the virus until she was diagnosed with tuberculosis several weeks before.
 
 "When I was pregnant, I didn't know I had HIV," Astake said. Tamrat asked whether, once Astake had been told, the nurse had explained that she should stop breast-feeding to protect her baby.
 
  "She did," the mother mumbled as she rocked Sintayenu, who was crying.
 
 "Were you able to stop?" Tamrat asked. "Be honest with me."
 
 "I kept going," Astake said, folding a hand over her eyes. "I thought my lady neighbors would know. They would say, 'Why aren't you feeding? What is wrong with you? Are you HIV-positive?' Also, I can't afford the cans of milk. It's too much."
 
 UNICEF and Ethiopian donors pay for milk for 35 HIV-positive mothers. For Astake, Tamrat took change from her own purse and sent the mother to the shop next door, telling her to be sure and spend it on milk.
 
 "Society is slow to change," she said. "Meanwhile, it's our children that are suffering."
 Prevention Campaign 
 As Ethiopia grapples with HIV/AIDS, it has received relatively little foreign aid. Lifesaving anti-retroviral drugs, widely available in the West, are just an expensive rumor here. 
 
 In December, the U.S. government started paying for treatment of 14,000 HIV-infected Ethiopians. The Bush administration wants to expand the program to reach 210,000 people in the next five years.
 
  But since 1998 the Ethiopian government has also launched a campaign to prevent AIDS, calling it "a calamity unforeseen even during the Great Famine of 1984," according to government handbooks on the disease.
 
 Every high school has an HIV-prevention club, run by HIV-positive youth. Buses and billboards have life-size posters of masculine-looking music stars holding condoms. The posters also show a group of Ethiopians sitting around a basket for serving the country's staple food, a napkin-like bread called injera, which people eat with their hands. "It's okay to share food," the poster reads. "No matter what your HIV status."
 
 So many mothers are passing AIDS to their children that the country has started another program to provide pregnant women with free HIV testing. They will also be providing nevirapine, a drug that in most cases prevents mother-to-child transmission during pregnancy and birth. Still, in rural Ethiopia, two-thirds of mothers don't have access to a health clinic and sometimes only suspect they are sick.
 
 "The impact on our country's children is immense," said Birru Birenji, policy and advocacy team leader for the Ethiopia HIV/AIDS Prevention and Control Office, a government-run group. "This means the most productive members of our future are parentless, sick and in serious trouble. A big change must happen here."
 'When Will It End?' 
 As Adelaw Astake was waiting her turn, another young mother, Etenesh Geremew, was pleading with Tamrat for help. Her voice was hoarse, the edges of her mouth were white and her face was swollen with bumpy sores from HIV-related sicknesses.
 
 Death would come soon, perhaps in the next few weeks. Already she was vomiting blood, and a thick chest cough made her wheeze.
 
 "I will leave them quietly," whispered Geremew, her eyes on the floor. "They won't know their mother is going."
 
  Geremew explained that as she had grown increasingly ill, her husband told her to leave their home. After that, she survived by begging in the dusty alleys and intersections of the capital with her two children. As she worked, Yibeltal Ademe, a chubby-faced 4-year-old, waddled by her side. Workone Ademe, 2, with a head full of curly hair, bounced along on his mother's back.
 
 "My husband, he gets so drunk. He makes the house crazy. He hurt me so much," she said, weeping. "Now that we are homeless, we don't have access to food. I don't want them to remember me like this."
 
 Tamrat also started crying, slow tears rolling down her face as she told Geremew there were no spaces for her children. In fact, there was a waiting list of 150.
 
  "Day to day, the number increases. I ask myself, when will it end?" said Tamrat, who helped start the center in a one-room apartment with two chairs several years ago. "You know, I haven't cried in a long time. Because you can't let them see. You have to stay strong, maybe just for the children. They fear when you cry."
 Lonely for Their Parents 
 Six-year-old Radeat Behonegn used to spend hours at the window of the Hope for Children orphanage, waiting for her parents to return. 
 
 They left her here two years ago, and soon afterward died of AIDS-related illnesses.
 
 The small girl with wavy brown hair is friendly and smart. She plants little white flowers outside the cement buildings of her group home. Eight children -- four in each room -- live with the group's resident "mother."
 
 One afternoon, Radeat sang a song about a girl who wakes up one morning to find she has only arms and legs. A bird has flown away with her heart. The girl in the song says her body is healthy, but she misses her heart and asks the bird to return it.
 
 The words and sad melody have made the song one of Radeat's favorites. She is healthy but, like the others in her group, she misses her parents' love.
 
 Wosene Maru, 35, is the only adult some of the children have known. She cares for them, reminding them to brush their teeth and clean their clothes. She reads to them at night.
 
 She used to work as a nanny for American diplomats. This job pays far less, but she feels she's needed far more.
 
 "They are still just kids," Maru said, hugging one. "I know they don't have anybody."
 
 One child tugged on her skirt and asked, "Please make us nice food," then smiled as the others joined in. "You are so nice to us."
 
 All over the capital, women like Maru are helping children orphaned by AIDS. And unlike in many countries in Africa, orphanages here don't carry a stigma. Wealthy Ethiopians raise funds or open homes for the children, giving them hope when relatives don't want to care for them.
 
 Tamrat started as a volunteer after she finished college. She had a neighbor who died alone of HIV, her twin babies left outside in the cold evening air.
 
 "I started collecting one birr [about 11 cents] from everyone I knew," she said, referring to the country's currency. Tamrat said she kept at it because she felt proud to help her country. She recently named a 14-month-old child who was left at the doorstep "God's Work," or Yeabsira in Amharic, the Ethiopian language.
 
 But sometimes her work makes her question her judgment. Children dropped off at the orphanage can grow hysterical, sending others into a panic. Recently, Tamrat had to start a new policy, telling parents they should bring their children in to play a few times and then, on the last day, just leave quietly. Later, the children are told that their parents are dying.
 
 "I don't know which way is better," she said. "It's too hard, either way."
 
  
 
   

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