photo by Shamus Finnigan
I spent my summer living in Nyumbani Village, which is located outside of Kitui, Kenya. Nyumbani is Swahili for ‘home,’ and a haven for children affected by HIV and AIDS. Arranged around a football pitch the village contains a primary school, secondary school, polytechnic institute, agro-processing center, clinic, social hall, and administration building. The outskirts of the village have twenty clusters of houses, each cluster containing four families. A family consists of a “shos shos,” (grandmother or grandfather) and ten children, each of whom may be related to the shos shos or may have been taken in from distant relatives and neighbors. All of the children have lost parents to AIDS and some of the children are HIV positive.
The HIV/AIDS epidemic rarely makes the headlines in the States. We know that it exists; we recognize that it is terrible; the gravity of the situation is not fully comprehensible. The burden of the disease, like so many other diseases, falls disproportionally on the African continent. While there are many debates about prevention and treatment, the debate that seems to have fallen aside is the vulnerable populations that are left behind in the wake of the pandemic.
The total number of children globally who have been orphaned due to HIV/AIDS is around 20 million, nearly double what it was a decade ago. 90% of these children live in sub-Saharan Africa. More than 9 million HIV/AIDS orphans reside in 6 countries – Kenya, Nigeria, South Africa, Uganda, United Republic of Tanzania, and Zimbabwae.
As the HIV/AIDS pandemic steals a generation from Africa, those who are left behind create makeshift families with children or aging grandparents serving as the head of the household. They are often the sole breadwinners and are caring for others who are disabled and ill. With a loss of parents there is a loss of values, cultural knowledge, and most of all, love. They depended on those who are now gone, and in the absence of parents and caregivers they are left in a situation that leaves them vulnerable to poverty, disease, and a loss of dignity.
Nyumbani Village is an attempt to answer one of the most important and overlooked questions in the HIV/AIDS epidemic: What about those who are left behind? In its simplest form the village is an orphanage and retirement community that sits on an organic farm. The idea is anything but simple, and is rooted in the concept of social justice and the protection of vulnerable populations. In recent years global public health has come to envelop not just disease control, but also a crucial roll in international development. Development is a broad term that not only encompasses the development of a nation, but also that of the children who are its future.
In the debate as to when individual rights become more important than those of the collective group, the line must be drawn at vulnerable populations. By the nature of its name public health is concerned with the greatest amount of good. It is in constant conflict with the balance of individual rights, with that of the collective good. The protection of the dignity of those who are most vulnerable is an essential principal in the doctrine of public health ethics.
It is easy to think of orphans as vulnerable populations, but the grandparents who have assumed the responsibility of raising these orphans are perhaps even more vulnerable. These grandparents are raising children for the second time, many of them serving as the sole income. In places where no social security exists for the aging population, they rely heavily on their children.
HIV/AIDS challenges the darkest and most fundamental morality of human nature. It shows us the stark contrasts in wealth, living conditions, education, and gender. The fate of those left behind from the pandemic exposes that public health should not seek just to promote the greatest amount of good, but to protect vulnerable populations.
Places like Nyumbani offer a chance to tackle the problem of those left behind, but it is not enough. Kenya has an estimated 1.2 million orphans due to HIV/ AIDS.
Nyumbani village has a capacity of around 1,000. If we are to tackle HIV/AIDS we must not forget about those are left behind.
Andrea Fletcher was in Kenya as a Global Health Institute Field Scholar researching the intersections between health, faith, and development. She is a Master of Public Health candidate at the Rollins School of Public Health at Emory University in Atlanta, GA. As part of the Hubert Department of Global Health she focuses primarily on evidence based strategic planning, health policy, and human rights. As a research assistant for the Emory Preparedness and Emergency Response Research Center she has gained insight into decision-making processes, resource allocation, and disaster preparedness and response. Her interests in ethics began as an undergraduate at Washington & Jefferson College in Washington, PA, where she created her own major in bioethics combining courses in biology and philosophy and completing an internship at Bioethics International in New York, NY.
[1]
UNAIDS Global Report 2010
[2]
UNAIDS Global Report 2010
