The issue of Iraq grabbing the headlines shouldn’t make us forget there are plenty of other issues that deserve equal (if not more) of our attention, thoughts, and help. When it comes to Iraq, i tend to ignore everything else; then along comes something like this to shake my ignorance.
Grace Matnanga, shoe seller, Sarah Boseley
The Guardian, 18 February 2003
Grace has a little place in the suburbs. It’s not much, perhaps - the whitewash is coming off the walls, the red-baked ground is stoney and the persistently cheerful rhythms thumping from the bar round the corner look set to go on all night - but it’s impossible to be lonely in her one-room house in a block of four, surrounded by friends and their children, and it’s a short walk to work across the fields.
She says she’s happy. She’s just 30, she’s single and she has a good job selling luxury shoes from a shuttered wooden kiosk in the Central Market, the exuberant commercial hub of Lilongwe. All her life should be spreading out before her, but a glance into the future shows death staring back, just a few years on.
Like every fourth young man or woman in Malawi’s towns and every sixth in the villages, Grace Matnanga has the HIV virus running like a slow and silent poison in her veins. You can’t tell who most of them are. They teach children, they police the streets, they work in hotel receptions and bring up children. They laugh and smile like every other Malawian. For months or years, they appear well. Then the downward spiral begins. Maybe next year, maybe in five years time, depending on how well she eats and how healthy she keeps herself, Grace will begin to lose weight. She will get an infection - it might be just a minor one - but after that she will get another, more serious. It could be pneumonia, it could be TB or it could be meningitis. There are drugs in Malawi’s hospitals to treat all three successfully, but each time she recovers, her immune system will be that little bit more battered, her weight lower and her chances of surviving diminished. The curves of healthy flesh will disappear. She will begin to look wasted and everybody she knows will understand why. Eventually her body will give up the fight, the pain and fever will engulf her and Grace will become just another Aids statistic.
She doesn’t think about it, she says, with a smile and a slight shrug, as she looks out of her kiosk at the vitality and the colour of the market, where brightly dressed women sit among their sacks of mint leaves, tomatoes and red aduki beans, tailors peddle sewing machines and heat flat irons on open fires to repair old clothes and everything from door handles to dried fish to pineapples is for sale. But she knows too well what is in store. Her freedom and independence were wished on her like a curse. Once she had a husband. Once she had a child. Both are dead.
“I was married for eight years,” she says. “My husband passed away in 1998. He collapsed and was taken to the Central Hospital and put on oxygen.” Like most of the young people who die, he had not been tested for HIV, but there’s little doubt that Aids killed him.
He survived longer than their little daughter. Tiyajane was born in 1993, the longed-for fulfilment of marrriage in Malawian society, where almost every young woman has a baby strapped to her back. Tiyajane appeared to be healthy at first, but then the weight gain slowed. She stopped thriving. She began to get sick. She picked up infections. When she died, aged three, she was a pitiful, wasted scrap, the ulcers in her throat and mouth making the pain of swallowing more vicious than the pangs of hunger.
Grace will never marry again, she says. “I have got HIV so I will not get married or have any more children. I would adopt some, but I will never have any of my own.”
So she lives alone, with a small radio and her friends, and says she is content. She eats as well as she can afford to, which is not as well as she should, but better than many Malawians in the year after massive crop failure, exacerbated by the permanent absence of so many young women and men who should be working in the fields. Grace knows that nutrition is important to staving off illness. She buys vegetables, eggs, soya beans and milk to supplement the inevitable Nsima, a meal of maize flour which is the nation’s staple diet. As long as she keeps her job she can afford the 650 kwacha ($7.38 or £4.67) rent each month on her house and her food because - unusually in Malawi, where extended families are the norm - she has nobody else to support. If she becomes sick, she will lose her job and her home, her diet will deteriorate and so will her health.
If she were living in a bedsit in Clapham on the fringes of central London instead of a bedsit in Mwenyekondo, just outside the old town of Malawi’s capital, Grace would not have to face this imminent downhill dance to death. She would see her GP, who would send her to a consultant, who would put her on antiretroviral drugs (ARVs). Three drugs in combination, taken every day for the rest of her life or until such time as the scientists find a cure for Aids, would keep her alive, active, healthy and working. There are lots of people in the UK with HIV. They teach children, they police the streets, they work in hotel receptions, they bring up children. You wouldn’t know who they were, and you won’t, because they are on ARVs.
Grace knows about ARVs. She knows that they could save her. And she knows that they cost 2,500 kwacha a month - around $28 or £18. That’s almost twice the $170 per capita income in Malawi for a year’s supply. It’s an unimaginable sum of money, even for a single, working girl with no dependents.
…] This is not only the story of Grace and Dessa but the story of every Malawian. Everybody knows someone who has lost several members of their family. Everybody wonders who in their own family will be next. Aids has brought average life expectancy down from 53 to just 39. The whole of sub-Saharan Africa shares Malawi’s tragedy. There are 29.4 million infected with HIV, 60% of whom are women. Last year alone 2.4 million died. Four million are in urgent need of drugs, but less than 50,000 are getting them.
The most thriving businesses in Lilongwe are those of the coffin makers - you see them everywhere, the bright metal handles and plaques on the boxes catching the sunlight to call out of the workshop gloom.
…] Malawi is running with children - ragged, dusty-footed children with large inquiring eyes and shy smiles. More and more of them are orphan children who have lost either both parents to Aids or just one - usually their mother, leaving a father who is unable to cope. There’s never been any question over the future of a motherless child in Malawi. Grandmothers, aunts and uncles take him in, share the maize porridge and the rice, clothe him and send him to school. Until now. Aids is taking not only the mothers and fathers, but the aunts and uncles as well. It is striking down those who should be working the fields. Aids has played a dire part in the food shortages caused by crop failure last year, so that no family has enough to eat. The villages do their best to absorb the bereaved children but they are at saturation. There are officially 475,000 orphans among Malawi’s 11 million population, but it’s hardly an offficial census figure, and many believe there could be as many as one million. The dangers should be obvious. Those who guide children - the parents and the teachers - are dying. Those who feed these children are hungry themselves. Even the CIA has acknowledged Aids could breed a new generation of terrorists.
In Tilerane, still in the district of Lilongwe but part of the countryside, is a school set up for some of these orphans by local people. It’s midday. Children of all ages are spilling out of the door of the schoolhouse, tumbling down the few steps like a waterfall. A small child in a dirty pink T-shirt is trying to pick up a toddler in an identical dirty pink T-shirt who is stuck halfway down, like the wrong shaped stick in a bend of a stream. The wave of Lilliputian humanity parts around them and forms again on the other side, until a teacher picks up the tiny one by the arms and swings him easily to the ground.
The orphan centre does what it can. There are 500 children registered at Tilerane, although not all of them come to the school. Volunteers visit the surrounding villages to help and support others. The school gives them love, care, very basic education and - fundamentally important - some food. When they arrive at around 7.30am, they get tea and rice or maize porridge which allows them to learn their ABC and do a few sums without the familiar, distracting cramps of hunger. But the children have to be sent home at midday because there is nothing more for them to eat.
…] Prevention efforts, such as HIV education and the use of condoms may help slow the infection rate, but only treatment with unaffordable drugs that a Londoner, Mancunian or Glaswegian would pick up for free on the NHS can check the tidal wave of death that is set to overtake so many like Grace.
As she sits among her smart sandals and a tiny mock-leopard skin handbag, doing very little business because it is the quietest time of year, when families have just scraped together every last kwacha to pay for school fees, Grace’s cheerful serenity slips just for a moment. “If ARVs were available and they were here, I would take them,” she says. She is no more indifferent to her life than her contemporary in an up-market shoe shop in Durham or Leeds. She’s just living on the wrong side of the global divide.