Community Loving: Linden Care Foundation
by Achal Prabhala
March 16, 2003
Across from Mackenzie, in a nondescript wooden building by the river in Wismar, a community revolution is slowly taking place in the most loving way possible. Hazel Benn, the originator of Linden Care Foundation (LCF), used to work for the Guyanese government, as part of the Regional AIDS committee for the area. Soon, driven by a lack of funds, she left to form a Non-Govern-mental Organization (NGO) in 2001, which grew rapidly to become the dynamic institution we see here today. Benn, an unassuming presence, has been quietly driving the HIV/AIDS agenda in Linden remarkably well. You will not hear her say it: but it is evident from even a casual interaction with the steady stream of visitors who pour through the doors of her office. It is as evident from the voices and visions of articulate and committed LCF workers, a cross-section of young people from the area, most of whom are donating their time voluntarily.
In a community that began life as an offshoot of Lin-mine, the giant bauxite mining entity in the region, Linden has seen its share of ups and downs. Once, in the 1980's, according to Pauline Melville, a nutritionist at LCF and a long time resident, there used to be a time when Linden paid for the entire country, when its vibrant economy kept up even when everything else was down. Today, and for many of the last few years, Linden is in an economic slump. Linmine is gone and the new owner, Omai, yet to finalize its presence. The socio-economic background that LCF operates in is this: a poor economy, no new jobs, a surprisingly good educational system and comparatively little crime or racial tension (its population is mainly Afro-Guyanese).
Today, Linden's economy rests on the mining and lumber operations that lie beyond it: not only do these occupations provide employment for the majority of Linden's youth, they also bring in a steady stream of migrant labour, who usually pass through the town and sometimes even use it as a base. While the major focus of LCF is Linden, it extends itself to neighboring communities, serving Coomaka, Malali, Mabura, Ituni and Kwakwani. Their main activity in any of these locations is identifying and training young people to serve as peer educators.
At their base in Linden, LCF offers a range of services. Chief among them is a counselling network, for both HIV infected and 'affected' people (meaning, the partners, families and those connected to HIV+ people, including those orphaned by the virus). They have the services of a reputed nutritionist, Pauline Melville, who advises on a range of dietary issues, and Dr. Dickinson, a medical officer with the government (one of only 2 for the entire region) who - despite a punishingly busy schedule - puts in regular hours. Additionally, they have an ongoing programme with young children who again fall into the affected and infected categories - they would rightly, rather not segregate or specify who is what - but they will say that the group includes HIV+ children, orphans of the virus, and those otherwise affected.
Their network of full-time, paid staff is minimal. To a large extent, they rely on the services of professionally trained volunteers, who work for LCF as peer educators, community facilitators and part-time counsellors. "Support from the United Nations Children's Fund (UNICEF) has enabled us to reach out into more areas than we used to," says Benn, "For instance, we are now running regular programmes in schools, and also educating young people directly at their workplace." This is enabled by a thirty three member strong peer educator network, which regularly goes out into the field, working - for instance - with minibus drivers one day, and schoolchildren, the next. Included in the peer education is condom distribution: Keeran, one of the key peer educators, jokes that he became known for a while as 'Safe Sex Keeran' from his habit of carrying a haversack filled with condoms. People from Linden had to only stop him and help themselves to access protection.
In conversation with peer educators and counsellors at LCF, some interesting community feedback came up. For instance, most agreed that the female was generally more serious about issues of sex, and therefore more likely to use protection, or delay sex until after marriage. Many young girls felt resentful that their parents gave male children a lot more freedom. Girls seemed to have a harder time talking about their sexuality, while boys seemed to be discussing it all the time. Not many young children of either gender was willing to discuss issues connected to alternative sexuality at all: thus, when LCF peer educators went to schools, they would simply spell out what was high-risk sexual behaviour in clear, unambiguous terms.
Recently, LCF was able to consolidate its programmes with People Living With HIV/AIDS (PLWHA) and offer them comprehensive treatment and service under one roof. This too, was partially enabled by UNICEF funding. Patty and Estelle (names changed) have been coming in to LCF for the past year. Estelle comes in to receive 'builders' (vitamin and mineral supplements) and to see the doctor. She is currently out of a job, but it is not due to her HIV status. Patty, on the other hand, who has a very visible HIV caused skin infection, is currently working. Her job, which she had before she developed outward signs of infection, was in jeopardy, until LCF intervened, spoke to her employers, and reasoned with them to keep her employed. Neither is open about their HIV status in their community. That would, as Estelle says, "cause too much discrimination."
LCF sends on patients to the GUM clinic in Georgetown (that can dispense anti-retroviral medicine) if Dr. Dickinson feels they are at a stage when they need the treatment. Both Estelle and Patty complain of their lack of privacy. Both at the government health system and places like LCF, as also in their community. Linden, like so many other places, is a small place: and in a small place, there are usually no secrets. The only solution LCF can see is to encourage people of all kinds to attend their programmes - thereby dismissing the stigma that only HIV+ people go into their office. Otherwise, there is little that can be done around this crucial issue.
On a related point, Benn admits that many of the PLWHAs who come in to LCF are doing so out of compulsion: they are too poor to afford private healthcare. People who can, will go to Georgetown and be tested and treated there. Thus, even for those who come in, it is a compromise that they simply cannot afford to avoid.
Keeran, Rondel, Latoya and Kelly are peer educators. Each one is individually exceptional, outgoing and committed to LCF and the HIV/AIDS awareness campaign. In a small community with so much stigma attached, it takes some courage to perform their functions. Three of them have finished up school; Latoya is currently enrolled as a law student at the University of Guyana (UG). All of them have performed extensive service within schools, churches and other community centres in Linden. Keeran and Rondel speak of how their association with LCF has translated into a meaningful vocation, in a place of limited opportunity such as Linden. Many of their classmates from school are now teachers, mainly due to a lack of other job opportunities.
Their feedback however, raises some serious questions. For instance, they report that other than the work they do, there is no established sex education programme in most schools in Linden. At the same time, schools do not object to them going in, so long as the language they use is tempered and the message they send is inclusive of all views and options related to safe sexual practices (for instance, all their communication includes abstinence as one of the options). Kelly feels that a lot of young women come to her because they feel comfortable speaking to another woman. They girls she meets ask questions like - what will it be like the first time? Or sometimes they tell her they just had sex, and want to discuss it to know whether they did anything wrong or dangerous.
Sadly, all four of them agree that if there is one thing that is really disturbing, it is that pregnancy in Linden "is a style." It seems as though to be young, in school and pregnant is a very fashionable thing. Having babies too - as most of them choose - is an extension of the same fashion, thus often sending a bad situation spiraling out of control.
They do not usually encounter any hostility. Indeed, when they presented their message of awareness of HIV/AIDS to a key youth-influencing target segment - minibus drivers and conductors - all they were met with was an attitude of cooperation. In one morning, as we moved between the busy intersections of the main market, where conductors and their affiliates 'hustle' passengers (and it really is a hustle indeed), even these extremely busy workers took the time off to tell us how they could be involved. One important point they raised was that while they may influence youth culture, they are seldom given respect by society at large, which views them mainly as a necessary menace.
Thus, they seemed to suggest, a programme such as the one LCF was proposing - to involve them as peer educators and communicators of HIV/AIDS awareness - would give them a sense of place in a society that has rejected them. They came up with some excellent methods of how they could be involved. They were happy to carry posters inside the bus, stickers outside, or even play tapes and CDs of music interspersed with HIV/AIDS awareness messages. In a sense they were only confirming what the peer educators had already said, that slowly, their profession, and association with LCF was becoming a badge of respect in Linden. Partly, this is because they have aggressively pushed their message through effective communication. Using a part-time media consultant, they have established a weekly television show on the local network that includes footage of LCF staff in action.
On the counselling front, Alphonso, a volunteer counsellor from Linden, feels that there is a long way to go in terms of erasing stigma. "People come here on a very secretive basis," he says. Further, there is a much higher percentage of women who come in, indicating that the stigma runs deeper with men. Yet, he is quick to point out - thanks, in no small part to the efforts of LCF - that there are some stories that cheer the spirit. A teacher from Linden recently told him that once she disclosed her HIV status to her colleagues, she was given even more support and warmth at her workplace.
Margaret Benn, a community facilitator, has the somewhat difficult job of confidentially assisting people from her community to deal with being HIV+. It is made so much more difficult by the fact that it takes her a long time to get them to admit to her that they are.
Usually, it is only after she has been able to build up a strong connection with each of them individually, a connection based on trust and sensitivity. Often, she begins by taking them nutritional supplements from LCF, directly to their homes. Slowly, she tries to convince them to come in for counselling and care.
That Linden is a small town is evident in the question of sex workers - an almost natural corollary to migrant labour. LCF peer educators have a hard time identifying such women. Naturally then, it makes any helpful communicative effort with this high-risk segment much more difficult. Margaret Benn also works in the day as a community health worker at the Christianburg Medical Centre. She says that she has to pay close attention to what is going in the community to figure out when someone displays the signs of possible HIV infection. Even so, she estimates that only about 35% of all HIV+ people in Linden are being reached through the offices of LCF. But she too, has her stories of success: for instance, she can remember a young boy who was wasted away with opportunistic infections, who then began a course of antiretroviral medicines. Today, he is fit, strong, up and running.
Benn is enthusiastic about the future, and glad for the progress LCF has made thus far. UNICEF's support, she says has enabled them to embark on a project where they will use PLWHA as ambassadors in education and awareness. It has also enabled LCF to provide a wide range of services (counselling, nutrition, medicine, and even legal help - with the services of a consultant lawyer) under one roof, which means that people do not have to be sent out as they used to before. It has facilitated the setting up of a core set of counsellors and community facilitators, and has also resulted in the establishment of a mini-pharmacy on premises, which dispenses food supplements and vitamins.
With very young children, UNICEF support enables LCF to run a twice-weekly workshop and feeding programme for about eighty deprived children from the area. A workshop was in progress when we visited. Keeran, Kelly, Latoya and Rondell, along with the nutritionist, Melville, ran an interactive session that was based around when people thought they were ready to have sex. Members of the youth group overwhelmingly supported sex after marriage: the peer educators tried to explain what the merits and demerits of some of the other positions were. The whole exercise was stimulating and there was plenty of pure, old-fashioned fun - always a sure sign that things are working and people listening.
Plans for the future include the setting up of HIV testing facilities in order to begin a full-fledged Volunteer Testing and Counselling (VCT) service. Other key plans include setting up a network of caregivers - in the case of orphaned children, the family at large. LCF plans to counsel and educate these 'support' partners on an ongoing basis, and even organize an annual 'Guardian Day' to recognize their services to community.
In the end, the effort, as Benn concludes, is "to form a safe environment for those affected by and infected with HIV." To involve the community of Linden in their efforts, they have begun an 'adoption' drive, where individual members of society will sponsor the care and upbringing of one of the many children under their wings. Slowly, LCF hopes to expand this campaign. With the kind of track record they have established, there is little doubt it will work.